[3] Musically, the song features art rock riffs and the extensive addition of guitar reverb.
[4][1] The verse riff in the first half of the song revolves around an arpeggiated diminished seventh chord, and has been compared to that of "Eton Rifles" by The Jam.
[6][7][8][9] Lyrically, the song describes advanced-stage anorexia;[10][11][12][13] it is about a teenage girl who wants "to be so skinny, that she rots from view".
[6] Stephen Thomas Erlewine of AllMusic wrote: "the diary of anorexia '4st 7lb' is one of the most chilling songs in rock & roll".
[10] Tim O'Neil of PopMatters described the song as "the most specifically evocative track on the album".