Book Review: Stand Tall Little Girl

Stand Tall Little Girl is a memoir by Hope Virgo that focuses on her experience with anorexia nervosa. If you are active on social media, you may recognize Hope from her Dump the Scales campaign to stop weight being used as a barrier to mental health services for people experiencing eating disorders.

Throughout the book Hope refers to her Anorexia as a person (using the pronouns she/her) to capture the role it played in her life. There are sections written by her mom to capture the family perspective on Hope’s illness, and these add an interesting layer to the story.

The seeds of her illness began early; while growing up, she was skilled at hiding painful emotions and acting as though she was okay. By age 12 she had become weight-conscious food dominated her thinking. She mentions that she got positive feedback after losing weight because of an illness, which is a stark reminder of the potential for harm that can result from messages praising thinness.

She describes how at the time she experienced anorexia as a good thing; it became her best friend, as it helped numb the pain and made her feel valued and worthy. She felt a sense of achievement with each meal she skipped, exercise she did, and calorie information she learned, whereas she felt that she was bad at life in general. The sense of worthiness anorexia provided came at a cost; “I knew I’d need to go on proving my worth if I wanted her to go on believing in me.”

Hope’s family didn’t recognize the problem until her school raised concerns, and a chapter written by Hope’s mom explains how this could have happened. Even after she started seeing the Child and Adolescent Mental Health Service, she continued to try to lose weight. She describes the various tricks she would to deceive others about her weight. She would vomit in the shower so she wouldn’t be heard, and studied the emesis to make sure everything she’d eaten had come back up. She tried to hide this at her weekly appointments by consuming large volumes of water, wearing layers, and putting weights in her pockets to make it look like she was gaining weight.

She became sufficiently ill and at risk of serious medical consequences that she was hospitalized for a year. When she was admitted, she “wondered if the scales would be accurate. Would they show how good at anorexia I was? Did it mean I was a successful anorexic now that I was being told my heart was about to fail?” She describes the experience of being an inpatient, including the strict routines that were imposed to manage the illness. Even in hospital, she would try to find ways to minimize her intake and exercise without the treatment team noticing.

She explains the challenges of managing post-discharge, and anorexia maintained a presence in her life. “The battle with my Anorexia was entering a new phase. I didn’t know if I should listen to her. I knew she’d let me down, but how could I push her out of my life when she had been such a vital part of me — and such a trusted friend for so long?” It was hard for her to imagine “what it would feel like to get up in the morning without feeling fat, and without a compulsion to exercise, or count calories. In a way, these things were all a part of my identity now.”

Despite some significant stressors over the next few years, she continued to work on her recovery, despite anorexia trying to sneak its way back to the forefront. After a death in the family, she “flirted” with the pull of anorexia, exercising more, counting calories, and weighing herself frequently. She was able to find the courage to reach out for help, but discovered that despite her symptoms, not having a significantly low body mass index (BMI) “only made things harder — I wasn’t going to be thin enough for a quick referral and I wouldn’t be eligible for any extra support.” The idea that someone could be not thin enough for help is profoundly disturbing.

She writes about how she’s been able to move forward since that setback, and she’s able to have days when she doesn’t feel her anorexia. She acknowledges, though, that she can never let her guard done, because anorexia will still be there waiting to destroy her and everything around her.

Hope has even been able to identify some positives that have come out of her illness: “The one thing I do know is that my Anorexia has made me who I am today. It has made me determined, and maybe even slightly stubborn. But it has also made me driven and ambitious. It has changed me for the better, and whilst I still ask why it chose me, I don’t think it really matters.”

This book offers a powerful, up-close view of anorexia nervosa. Hope is very open and forthright about her experience. She allows the reader to see the way that anorexia can twist people’s thinking, and how seductive it can be once it has grabbed hold of someone. While she is open about the ongoing challenges, she also offers a very hopeful message that recovery is possible.

Hope has taken a serious illness and used it to become a strong advocate for people with eating disorders. She is a remarkable example of the transformative power that mental health advocates can have.

You can sign Hope’s Dump the Scales petition on

Originally published at on July 3, 2019.