In today’s post I’m going to be covering how the medical community and my personal medical diagnoses affected my eating disorders and mental health. As well as how certain aspects of the “healthy body” concept provided by many medical professions can harm those living with eating disorders, body dysmorphia, and other mental illness.
Body Dysmorphic Disorder is defined as a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance.
Yesterday, I wrote about a medical condition that caused me to struggle with my weight. When I was only 12 years old I had my first ovarian cyst, it was so painful that I was in and out of the hospital for a few days. Finally they found it and we scheduled to have it removed - I was so young and already having surgery on my ovaries. I would learn with time that these painful cysts were just one symptom of a disorder I would later be diagnosed with known as PCOS (Polycystic Ovarian Syndrome).
PCOS is a hormonal disorder that is defined as the chronically abnormal ovarian function and hyperandrogenism (abnormally elevated androgen levels). For me it caused painful and irregular periods, hair growth, weight gain, ovarian cysts, and insulin resistance. Insulin resistance is often the result of too much insulin being created by the pancreas, making the processing of sugars difficult. As I aged I learned more about PCOS, most of which would have been helpful to have learned when I was originally diagnosed. Over the years I have learned carbs are hard for my body to regulate causing more weight gain. This means bread, desserts, pasta, and even fruit can be hard at times. But now, recovering from an eating disorder - restricting my diet in such a way could cause more harm than good. So I am constantly balancing what is best for my eating disorder and what is best for my body’s regularity of insulin. The medication known as Metformin has been helpful in regulating me.
I have met other young women who also have PCOS, but were told about their body’s difficulty with carbs when they were first diagnosed. I have always wondered why I was not told, why I didn’t hear about it. It is hard for me not to blame doctors for things that have happened - but I think this comes from some of the pain and hurt caused by other doctors in my life.
If you have never been to a doctor while also having your body classified as obese it can be difficult to understand the hesitation and fear that comes with it. When I walk into a doctors office, I am immediately faced with my weight. Even now, having my eating disorders marked in my chart as a diagnosis - they still weigh. I could ask for a blind weight, but the reality is they still put it on my health summary sheet when I leave. So I sit down, vitals complete, and I wait. All is fine. But, then the doctor comes. 9 times out of 10, no matter why I’ve come there, doctors bring up my weight. If I’ve gained, or lost. What I’m doing to lose more… and so on. Finally we may get to why I’m actually there, and somehow it almost always manages to be blamed on being overweight.
Depression - caused by obesity. Back Pain - obesity. Shoulder Injuries - obesity. Urinary Tract Infection - obesity… Almost anything.
They always manage to take it back to that, this one defining feature of my body. Rarely can I leave a doctor's office without being told that I need to, “drop some pounds” as if I don’t already know and think about it constantly. So much of this is caused by the BMI Scale (Body Mass Index).
Let me break down just why the BMI Scale is an antiquated, inadequate and inaccurate measure of people.
The BMI Scale was originally conducted on a group of all white men. Not surprising for the date when this happened (1830).
If the test was done on only white men, that means it doesn't account for differences in race, ethnicity, or gender. Despite that fact that we know now that weight and height vary among different races, ethnic groups and genders.
The BMI Scale cannot tell the difference between fat and muscle.
The BMI Scale is simple, and only has two factors put in weight and height. But your weight can vary for many reasons including: muscle tone, water weight, bloating due to illness or season, and even what you ate today or if you’ve gone to the bathroom.
We also know muscle weighs more than fat, so someone could have an incredibly high muscle percentage and low fat percentage, but still be categorized as overweight or even obese.
Example: when I first started college I had my first body composition test done. At the time I weighed around 190 pounds. The test finished and the person looked at me and asked me to step back into the machine because he wanted to “double check” that it was correct. So we ran it again. Same results. I was carrying around 40 pounds of muscle on my body. If we assume that 50% of our weight is water, that means 40 pounds accounted for my bones and body fat at the time. Now it’s not perfect, I could have had less water weight that day and other possibilities but it was the first time I understood that a BMI didn’t mean much. As someone of my age and height, I should have weighed around 135-140. That would mean I had to drop muscle in order to match that. OR the BMI Scale doesn’t account for those who have high muscle tone and may be of a larger frame.
Weight is not the only measure of health.
Health is a full body picture, not just one piece of a puzzle.
Health is based on lack of disease, mental and emotional well being, physical activity, physical strengths and more. It is not just one point.
With all that in mind, WHY do we put so much worth into that qualitative number and category? Health is incredibly difficult to measure for anyone. Someone could be listed as “healthy” but never step near a vegetable or leave their house. While another person listed as “overweight” may run marathons, eat a clean diet and avoid potential risk factors. It just doesn’t work.
There are other options, body scans and other such tests are much more accurate representations of body composition - however they still may not accurately represent how healthy someone is. The reason I’m explaining all of this is because doctors rely so heavily on these forms of measuring a human body, they often forget their humanity. If a doctor could spend the time to ask the questions of patients, I really believe so many things surrounding health could be spotted and discussed. Social habits, physical activity, work environment, getting out in the world, and loving what you do can all change your health dramatically.
So much of my eating disorders were directly connected to how I viewed my life and my body. I don’t blame doctors for not spotting my eating disorders but there is something to be said about perpetuating societal expectations of beauty and weight over TOTAL body health. I have worked hard to find doctors who value who I am, know my history, and recognize my progress. Doctors who don’t make me weigh in and ask about how I’m doing. My OBGYN is a perfect example of someone who puts patients needs first. I have been having an issue this past week and called late in the afternoon Monday to leave a message with her nurse. A half hour later, I was on the phone with my OB, who also happens to me the Medical Director of this clinic, to discuss my concerns. We spoke for about seven minutes and made a plan of action. This type of care looks past my statistics and sees me for all that I am.
Recently in a session with my therapist she validated me in a way I never knew I needed. She said to me that I seem to have experienced medical trauma. At first, I thought, “What? No! Nothing else.” But, it wasn’t a diagnosis really, it was just a fact. It brought me peace to hear all I have been through in my life medically did affect me. More than I may want to admit. My PCOS is just one part of a large medical history, one that I’m not really proud of and many people shame me for. Most of these experiences were made worse by a negative view of my body and weight by doctors and myself.
As a young girl, I can’t remember the first time my pediatrician said I was overweight - but I know it happened more than once, and on most visits. Hearing this from someone I cared about, the doctor who delivered me, affected me more than I thought. I wonder what it would have been like to never have heard all my own negative thoughts confirmed by another trusted adult in my life because the reality is, she was just another one. Many adults around me made a point to note my weight. These comments just fueled my desire to diet and change my body in any way possible.
Diet culture is a problem. I don’t know how else to say it. Just in the last week I have seen in multiple public settings advertisements for Keto, Whole30, Intermittent Fasting, Atkins, WW (previously Weight Watchers), Noom, and more. This culture is sustained by the medical community, shows with prominent doctors propose fad diets, abrupt physical changes, and weight loss supplements. Communities designed for those in recovery of eating disorders such as on social media are used to promote programs such as detox teas, BeachBody, ItWorks and more. Each of these are problematic in their own way, putting weight loss over health. So many individuals I have met with eating disorders, including myself, have hidden behind “dieting” to avoid facing the reality of our disorders. I briefly spoke about it yesterday, but I have restriction tendencies, and have used it as punishment when I have binged. I have gone two or three days without eating more than a few hundred calories to punish myself and pray I lost the weight I gained from bingeing. I would say I was fasting, or detoxing, or dieting… all lies.
I truly believe changes need to be made in so many spaces to make a difference in the world to advocate for better mental health and those struggling with negative body image and more. Working alongside the medical community to create active changes could be a great step in the right direction.
One small idea I have thought about is simple but could truly create a difference. Many Hospital Systems in Kansas City and around the world use a system called EPIC, a healthcare software. If there was an option doctors or patients could click to simply hide their weight and BMI on health summaries (online and paper copies) it could make an impact on those who need it. It is a small change that truly could break one pattern of these disorders.
Thanks for sticking around this week and learning more about my experiences and how they have affected me. I think we can continue to open this pathway for communication and make waves in the medical community.