Growing Big: When Health and Self Esteem Collide

When I was growing up, I was big. I'm not sure where exactly I fell in relation to other kids my age, because I rarely went to the doctor. That's what happens when you don't play sports and move every couple years, and thus don't have a good relationship with a doctor. But, I was definitely bigger than most kids. And I got teased for it. Throughout high school, I wore a giant, baggy jacket, because I was so ashamed about my body. As a sophomore in high school, I was asked by another student if I was pregnant. One of my friends desperately wanted me to go to the homecoming dance as a freshman so that I could have a Cinderella moment.

Point being, I know what it's like to have a low self-esteem.

But, as a doctor, I also know the harms of childhood obesity. I've talked about it before. So, I want young girls to get healthy and be at a healthy weight.

Problem is, weight is a very sensitive subject for adolescent girls. I saw a girl in clinic who completely shut down on me, to the point where we got a social worker to come talk to her, because I mentioned she was heavier than was healthy. It's not an easy subject to discuss, and I hate bringing it up, but I do it because it's in their best interest.

Well, a recent study has come out that may affect how I bring up the topic. This study took a group of girls and asked if someone had ever called them 'too fat'. They specifically asked about family members, teachers, and peers. Girls who were labeled as such at age 10 were significantly more likely to be obese at age 19 than those who were not, independent of what weight they started at.

Makes you wonder about all that media that girls consume now, doesn't it? How they are comparing themselves to the size 0 models in magazines, or worse, real women who are photoshopped to be unrealistic in proportions. Or how Ursula and the Queen of Hearts underwent a makeover to make them skinnier.

Yes, obesity is a problem.

But you know what? I was at my healthiest weight when I felt great about myself. It took me a long time to get there--years of affirmation by someone I loved. But I became happier with myself, accepting of myself, and started to walk around with confidence. And those extra pounds melted off.

So maybe the focus should be on body image, and not weight. After all, there is also such a thing as being too skinny.

When Food Becomes the Enemy

This week is National Eating Disorder Awareness Week, so it feels fitting that this week's blog be about eating disorders. There are roughly 30 million people (10 million men and 20 million women) in the US who suffer from an eating disorder sometime during their lifetime. That's roughly 10%. The highest risk group are the 15-19 year olds, but those as young as 6 concerns over their body weight or shape.

What is an eating disorder? An eating disorder is an abnormal way of eating that leads to some sort of impairment and is usually related to concern over weight or body image. There are several types of eating disorders, all of which have slightly different characteristics.

Anorexia nervosa is one of the more common eating disorders. It is characterized by restriction of food intake, an intense fear of gaining weight, and abnormal body image (not feeling that they are underweight despite being underweight).

It is also the eating disorder with the highest risk of death. Due to starvation, the body's systems begin to shut down. One of the first signs of severe disease is the loss of menses (periods) in women. Other problems include muscle loss and weakness, changes in hair and skin, and changes in the heart muscle, which can lead to heart failure and death.

Anorexia is very much about control. These individuals will closely monitor how much they eat, may exercise excessively to burn additional calories, and tend to have other psychiatric disorders as well. Sometimes they are victims of abuse, and feel that anorexia is the only way that they can control their lives.

In some ways, anorexia has become glorified. There are "Pro-ana" websites out there, such as (TRIGGER WARNING) this one that promote anorexic behavior. There have been a number of celebrities with anorexia, including Karen Carpenter (died from complications of anorexia), Mary-Kate Olson, and Evanna Lynch (known for playing Luna Lovegood in the Harry Potter movies). Thankfully, most of these celebrities have sought treatment.

Bulimia nervosa is the other commonly known eating disorder, and is characterized by binging (eating large amounts of food), followed by behaviors to limit weight gain, such as purging (self-induced vomiting) or excessive exercise. These individuals are typically of a normal weight or slightly overweight (contrasted to those with anorexia, who are usually underweight). While anorexia is all about control, bulimia is more about loss of control, which leads to these binging episodes, followed by guilt, which leads to the behaviors to limit weight gain.

Bulimia comes with it's own host of health problems, most of which are associated with the purging: body chemistry imbalances (which can lead to heart failure and death), tooth decay, risk of tearing the esophagus, GI ulcers, and bad breath.

Note that not all people who purge suffer from bulimia; you can also be anorexic and purge.

Notable individuals who have suffered from bulimia include Demi Lovato, Katie Couric, and Lady Gaga.

There are other eating disorders as well, including Binge Eating disorder, which is characterized by binging without purging, and EDNOS or OSFED, which is a catch-all category for other forms of disordered eating that impair functioning.

The problem with all eating disorders, and the difficulty that lies in their treatment, is that we must all eat to survive, and those with an abnormal relationship with food have difficulty correcting it. It's not like smoking or drinking, where you can avoid the source of the problem with enough self-control. It truly takes a whole team to manage an eating disorder: a general physician to monitor overall health, a therapist to deal with the body image issues, and sometimes inpatient treatment to ensure that they don't kill themselves in the process of recovery (refeeding syndrome can be a problem in the treatment of severe anorexia).

If you or anyone you know has an eating disorder, seek help. NEDA has many resources available, and has a phone number and e-mail (located on the left sidebar below the menu) for anyone who needs help.