When fat things happen to good people. On being thin, fat, and your false assumptions.

"Such crazy thoughts in that Aussie article!"

Do you think that if only you do the right thing—eat a healthy diet, exercise, get enough sleep—then you will achieve your dreamed of weight, live free of disease and live happily ever after? This, dear readers, is a fairy tale. 

If you believe that eating nutrient packed, low calorie foods is solely responsible for whether or not you get cancer, or arthritis or MS, think again. And don’t be fooled by the preaching of Dr. Fuhrman in his book, Eat for Health, that health equals nutrition divided by calories, period. Health is not such a simple equation. And no, eating whole grain, veggie packed meals won’t protect you from an eating disorder either. 

If you think that eating 'right' ensures thinness, as was recently emphatically suggested in a popular newspaper article in Australia, it is yet another fantasy.

And if you torture your overweight self with the belief that you must lose weight--at all costs, and that your inability to reach target goals based on BMI charts is your personal failure, you’re wrong again.

“What is she thinking?” you’re thinking? Let’s start from the top. 

Eating healthy equals health

Yes, diet can impact many, many health measures. And I certainly encourage a balanced, varied diet filled with a complement of vitamins, minerals, antioxidants, and an appropriate level of fiber, to name a few. Yes, there are correlations in populations that have higher intakes of alcohol and saturated fat, for instance, with increased rates of cancer and high cholesterol, respectively. And a nutrient-rich diet chock full of antioxidants and lycopenes, like those found in tomato-based products, may help stave off such conditions as Alzheimer’s, cancer, and other diseases. But eating a proscribed diet will not guarantee your health. Nor will it ensure happiness, which is not to say I don’t encourage making healthy choices—I surely do. But do not, for a moment, think that if you are fortunate enough to stay healthy (or unfortunate enough to become ill) that it is solely by your hand. Credit your parents for their genes, to start.

Fallacies about thin

And do you know what? Eating well does not ensure thinness either. I see my share of patients who choose the most wholesome foods, but eat in excess—even those nutrient rich, heart healthy foods, like avocado and almonds, lean protein and kale. By excess I mean frequently eating without regard for hunger, and eating past a point of comfortable fullness. And eating well—high quality, nutrient-rich foods—even eaten mindfully and intuitively—may not keep you slim. Yup, it’s a sad truth that many of you don’t want to hear. And in fact, the very act of pushing your body to be a weight it is not meant to be, may put you in worse shape—both physically and psychologically. Just wait until you hear about these studies!

Stay tuned. That’s my next post, based on fascinating research presented at the Renfrew Conference I attended last weekend.

And those who are thin do not necessarily eat well and are often hardly fit by any standard. Do be careful about equating weight with health because they do not always pair up as you’d expect. Individuals may be thin because they are genetically predisposed to be, or they may be thin because, in contrast to what journalist and dietitian Susie Burrell believes—that they “know what to do to control their weight”—they may fall quite short in controlling it appropriately. They may be no better than someone who binge eats for emotional reasons at knowing “how to cope when things are tough”. Don’t be fooled into assuming that thinness is simply a lifestyle choice, a moral higher ground.

And I’d caution her, and you, not to overgeneralize about thin people’s skill at “assuming responsibility for self”. Just spend a few hours in my office; even those without eating disorders may allow anxiety or depression to stand in their way of eating enough. How responsible for self is the person who denies herself nourishment when low energy or headachy—hunger gone too far—or pushes herself to exercise even when she reports constant fatigue, or pain? 

Eat when they are hungry, stop when they are full? Some thin people may. But overgeneralizing about a segment of the population isn’t too intelligent. 

No, I didn't leave the rest over, for the record.

Thin people may self-regulate just fine. Or they may deny their hunger and fluid load or rely on high volume low calorie foods. They may eat nourishing foods, or a diet of junk—just not excessive in calories. Or they may compulsively exercise, hardly resulting in mental health, potentially leading to loss in muscle mass, heart problems and a range of symptoms if accompanied by undernourishment. Really, the only thing you can generalize about thin people is… that they are THIN. You can’t assume they are healthy, or happy, or good at self-care or self-regulation.

And of course the reverse is also true. The only thing you can tell by looking at a fat person is….? Yup. It’s that they are fat. You cannot predict their lipid levels or their blood pressure. You can’t tell whether they’ve never exercised or they exercise too much. And you can’t determine the quality of their diet.

My own parents are perfect examples of this, as I’ve written about previously. 

The mere suggestion that health is 100% in our hands I take offense to, as would the rest of the population which struggles with MS, and cancer, and ALS, and type 1 diabetes and arthritis and, and and… And I can say the same thing about a target weight or size. I hate to break it to you, but even if you do all the ‘right things’, you may not achieve your desirable, fantasized-about weight. And you know what? It’s not your fault.

Stay tuned for part two, (which I hope to get out within the week), which will address obesity, weight loss, and the risks and benefits of change.

Did this post push your buttons? Did it challenge your thinking? Did it offer some relief? Do let me know what you’re thinking! 

Thanks for reading, and if you liked this post, please share!

Fat enough. Coming to terms with weight when it’s less than ideal.

I don’t know which made me saddest—her sense of vindication when reporting the oncologist’s orders: “I don’t want to see any more weight loss”, or her distress that her weight was up 5 pounds. Or perhaps it was her pride in getting down to the lowest adult weight she has seen in many decades. Ahh, the perks of esophageal cancer!

She’s lived so tormented by her weight, berated by doctors and non-supportive family members to reach for something unattainable, to get thin, from the time she was a pretty, young, school-age girl. “You’re beautiful”, they’d say, “if only you could lose some weight.” Perfect labs and low normal blood pressure were not good enough. No, she didn’t look fat on paper.

And yet her obesity just might have been the source of her potentially fatal illness. There. I’ve said it. Admittedly, GERD, gastroesophageal reflux, is linked with manyfactors, and obesity is just one of them.  But after a decade living on antacids, popping Rolaids like LifeSavers—no pun intended—with a blood sugar approaching diabetic levels, she had gastric bypass. The GERD? Finished! Antacids were no longer a fixture like Kleenex and lipstick in her purse. Yes, she was free of heartburn and indigestion—and her blood sugars dropped to normal. With her 90 pound weight loss came a reversal in symptoms and the promise of a better life.

So it came as a quite a shock last year to learn that she had esophageal cancer. And hers, located at the very bottom of the esophagus near the stomach, was not a result of alcohol or smoking but from many years of damage from acid reflux.

GERD can lead to changes in the cells of the esophagus—between 5 and 10 % with GERD get Barrett’s.  And Barrett’s Esophagus can develop into cancer, with an overall lifetime risk of 5%. 

Could it have been prevented in her case?

Sure, earlier screening by endoscopy to evaluate progression to Barrett’s sooner could’ve helped. And being more proactive with a procedure called ablation to wipe out the changed “Barrett’s” cells would have helped too. 

As for weight loss?

It’s not that she didn’t try. Perhaps she was genetically meant to be a large woman with a high BMI. Still, she could have worked in more activity, walks at least, something, setting realistic, achievable goals. And stress reduction to prevent emotional overeating and anxiety-driven overeating.

Yes, those might have helped her weight and subsequent chronic reflux and possibly prevented her cancer. But in our society it would never have been enough. She would still be viewed as obese, with the stigma we project on that label. Doctors would still say her weight was too high, falsely envisioning the fast food drive-ins she never frequents. (Actually, her meals have been quite healthy and balanced for as long as I could remember.)

In spite of her post cancer, post surgical weight loss of more than 40 or 50 pounds—honestly I don’t know how much exactly—following the doctor’s orders and not striving to lose more weight is quite a challenge. Self-acceptance doesn’t suddenly appear at age 75 when it has been long absent.

So please don’t wait until changing is a matter of life and death. Seek support for working on self-acceptance. And try to see your weight as just a number—not a reflection on your character, nor your motivation, nor your fitness level or your health.

Thanks for reading.

And yes, I've written about this before with a bit of a different focus.

Not thin enough? Not sick enough? YOU—eating disordered?

I’ve done it. In just a few sessions I made my mark on a future generation of nutrition providers—an intern interested in eating disorder treatment, no less. She was, like most, biased by the sensationalized images and the media’s descriptions of emaciated anorexics; of teenage girls who ‘just wanted to be thin’; and of visibly unhealthy looking bulimics. Those were people with eating disorders, she believed.

Yet in the few days she has spent with me, she’s seen anorexic men, normal weight binge eaters, and women in their 40s, 50s and 60s struggling with eating disorders. Some developed their disorder recently, some only recently presented for treatment, having struggled with their relationship with food for decades. All are pained by their condition—no one chose to live with a disorder. Really, there are places they’d much rather be than in a medical office on a nice summer day.

Yet what they all have in common is that their appearance is not a give away. Most look just fine, I must say. (Although I’ll admit that without their layers of clothes some would be viewed as significantly underweight.)

Yet most carry their disorder on the inside.

It’s unfortunate, really, because as a result, they have suffered silently. Their doctors and health care providers never knew to direct them for the necessary expertise and failed to support recovery. And often they put their foot-in-their-mouths with inappropriate comments about weight or “healthy, runners’ blood pressures.” If only they could have seen it. If only it was as clear as the media portrays it. If only they knew that most people living with eating disorders don’t look like they have an eating disorder.

If you didn’t know to ask, you’d have no idea that perhaps 95% of their thoughts are spent perseverating about when they will eat next, and just how much; about whether their stomach is still flat, or whether they will have access to a bathroom after eating to purge; or whether they’ll have an opportunity to binge without anyone to witness it. If only medical providers thought to evaluate food intake and behaviors before the comprehensive, costly GI workups which fail to identify the cause of the chronic distress from hunger or slowed motility, or the reason behind the heartburn—namely, the chronic purging.

How helpful it would be for primary physicians or the referred-to neurologist seeking an answer to the puzzling chronic headaches. No, no one considers inquiring about the time between eating and the food restriction. Yes, migraines and other headaches occur more often with under eating.

Hope comes with new DSM

Fortunately, the new DSM-5 guidelines may help. They’ve changed the criteria for defining anorexia, removing some of the requirements that kept individuals from getting the help they needed. And, from misleading health providers about what eating disorders really look like. Now, rather than defining anorexia by using a specific weight change (such as the previous 85% of normal weight) it appropriately offers a broader definition. A low BMI is not a requirement for diagnosis!

The guideline states “the clinician should consider available numerical guidelines, as well as the individual's body build, weight history, and any physiological disturbances". In other words, an individual who is objectively overweight or high BMI can now, fortunately, be fairly labeled as anorexic if he/she has restricted intake resulting in significant weight loss together with physiological signs of starvation together with meeting all other criteria for the diagnosis. And, missing a period is no longer a requirement for diagnosing anorexia. That certainly may impact the many men out there struggling with feeling like an imposter with a ‘women’s disorder’!

No, you don’t have to fear that your weight isn’t low enough for your disorder to be acknowledged. And you don’t have to look like an adolescent poster child for anorexia.

No longer should you feel you need to lose weight to fit the anorexia definition to enable treatment or, for that matter, to validate your suffering. No longer does EDNOS—that vague ‘not otherwise specified’ diagnosis—need to be used for those restricting, nor for those suffering with Binge Eating Disorder (BED). Yes, you aresick enough.

Anorexics are 60 lbs. And individuals with anorexia are also 200 lbs. Dropping weight with severe food restriction is no less serious if your 30 lb. or 50 lb. weight loss brought you to 130 lbs. or to 90 lbs. Thank you, Deb Burgard, PhD, an AED member and blogger for HAES, for making this point loud and clear.

Having a BMI in the healthyrange is hardly healthy if you are compulsively exercising, purging or restricting to maintain this place.

I’m so glad the intern gets it. It will make her a better provider when the time comes to practice, as she will now know to ask the questions to help identify and ultimately support recovery from an eating disorder.

But have I made my point strongly enough for you to hear? Please pass this along to increase awareness—to your friends and family members who you’d never know might be suffering—and to your medical providers who never thought to ask.