Tuesday, May 15, 2012

Which One Really Needs Help? Call the Doctor!

Even Mica was disturbed by this!

I know, I know—I’ve got another 5 days before my expected post is due, but I just can’t wait. I can’t let Laura’s painful experience go unaddressed. If you haven’t read it, please do so now. But brace yourself—you’re gonna get angry.

It’s not unusual for me to hear and read about inappropriate statements and suggestions that medical providers make. Actually, we all can manage to say stupid things—I know I’m no exception.  (Really, no need for those that know me personally to comment on this statement!) But today I heard two doozies—Laura’s tale and a patient’s story.

I don’t know Laura—except, that is, from her blog comments. What I do know about her is that she has made extraordinary progress in her recovery from anorexia. That she can now enjoy pizza! That she gets it—and she follows through with healthy, normal, eating behaviors. That’s she’s worked hard to put all the disordered thoughts aside and use her wise mind to justify doing the right thing. That she, like many others, have needed to use self-talk to move from the myths, the misinformation, about nutrients and foods and weight. Ahh, she’s done so well. I don’t even know her, but I am so proud of the work she’s done, of how far she’s come!

And then someone she respects, her MD, albeit inexperienced with eating disorder, totally sideswipes her. The respectable doctor projects, I suspect, her own mishugaas—about weight control, about carbs, about fats. Our wise Laura knows better—but of course when the white coat-clad MD begins her critique of Laura’s intake it’s simply devastating.

Yes, you can eat the whole panini if you're hungry!
What I read in this comment is not that it triggered her eating disorder; she concludes by stating that this doctor just didn’t work out. (Hooray for Laura! Time to change doctors—or get her to close her mouth and withhold absurd and inaccurate assessments of Laura’s intake!) 

But, I suspect, it’s the profound sense of disappointment in her doctor, and perhaps in our crazy food-and-weight obsessed society, as a whole. Laura appropriately acknowledges that there are absolutely no grounds for this doctor’s comments—she has zero evidence to conclude that Laura is struggling with her weight, or unhappy with her intake or struggling with eating disorder behaviors. 

Perhaps if she had asked more open ended questions—you know, like “How’ve you been feeling about your eating these past weeks?” or “What concerns would you like to address about your recovery?”, she could have prevented this damage. It would make a lot more sense than projecting that there’s a problem, simply because Dr. Dieter has perhaps struggled with her own weight and her eating!

Hats off to you, Laura, for having the sense to air your feelings and get support—and for sharing your reaction with the doctor. Hopefully, she’ll learn from her mistakes. And hopefully, you’ll find an MD that really gets it!

As for the patient story? Nothing too unusual that you haven’t heard before. It’s a case of an MD who looks at a 20-ish patient and tells her that her weight should be about 50 pounds less than it is—which would bring her to a place she has never seen on her growth curve. It would bring her BMI to a percentile lower than ever before, even since grade school! Fortunately, this young woman appeared to have a good sense of self, knowing darn well that this MD’s goal was crazy.

If she is appropriately nourished and growing
along her curve, must we make her weight
an issue?
But what if she took the doctor’s orders to heart and began to fight her body on what was normal? To push activity to an obsessive level and to restrict her intake to a point that was neither healthy nor maintainable? What if she had the genetic predisposition for an eating disorder and all it took was the encouragement of a doctor to set the ball rolling—given her own frustration with her recent weight increase and being told her BMI was in the obese category? This woman was more fit than most people I know and had no health issues. She ate healthily and exercised. And there likely was an underlying medical explanation for her recent unexplained weight gain, yet to be determined.

See the problem? Do they even realize the power of their words?
Do you even realize the power of yours? If you are on the receiving end of poor advice, do share your concerns. Consider another opinion from someone you trust. Or do like Laura did—contact the MD and respond. And if you need to, move on—and reach out for support.

Feel free to share your own horror stories, or simply to express your opinions.

Thanks for reading.


  1. When I first started recovery for anorexia my RD sent me to my doctor because of my low heart rate and for a bone scan (not to mention I hadn't had a mestrual cycle for well over a year). If my Dr. actually looked at my chart and seen my previous weight compared to the current weight there should have been red flags. She simply told me that I had such a low pulse because I was fit. I ended up wearing a heart monitor for a few days and my hr was in the low 30s at night. My RD was furious that my Doctor did not seem concerned at all about my ED. Thank God for my RD. Because of her I am eating more normally now. I have "treats" everyday and I finally got my period back for the first time in 2yrs. I am now training for a full marathon as long as my weight stays normal (weighed backwards) and I eat what I am told no matter how scary it seems. If I start to fall back into any ED ways then my training stops. If I did not have my RD I know that I would probably be dead or hospitalized becaue I was so sick and my Dr. ignored it.

  2. Thanks for this, Lori. I feel very supported :) I hope to meet you in person one day!

  3. When I was first receiving treatment for anorexia, I was sent to a cardiologist. He told me that there was no way I was eating as little as I reported, and still exercising so much. He also told me that some people are just slim and have runner's bodies. I sat there and couldn't believe what he was saying. He didn't know how miserable I was, or how hard it was to get through a day without breaking down because I had "eaten too much", or just how painful and awful anorexia was for my husband. It made me question whether I really had anorexia, or if I really was too small. Any other human being could clearly see that my skin was pale, my cheekbones were sunken and my limbs were simply skin and bones. Luckily, I didn't have to go back to him and I was able to figure out that he had no idea what anorexia looks like and feels like.

    My MD, on the other hand, is amazing! She listens to me and gently, but firmly pushes me in the right direction. I enjoy appointments with her because I can be totally honest and it feels like I am just having a conversation with a trusted friend.

  4. I don't know why medical professionals use BMI because it's a load of doody.

  5. I have unfortunately had a bad experience as well. A nurse that I saw wasn't concerned and didn't say anything to me when I lost a lot of weight in a short amount of time, due to my eating disorder. But felt the need to comment on the fact that I had gained a decent amount of weight the next time she saw me. (months after being in treatment)This was also after her putting up a fight when I asked if she could weigh be backwards to the scale so I couldn't see the number. Mind you, the weight then was a much healthier place for me and if she had even bothered to look at my chart would have realized that I was in treatment for anorexia and at a healthy weight for my body. She offered me advice about how to lose weight and felt that I should have been concerned about the time period that I had gained weight in, which then of course instantly feel like I should be concerned. Although I burst into tears at the time and couldn't really bring myself to attempt to educate her or explain to her how harmful the information she was giving me was, I did eventually (a few weeks after) write her and my doctors office a letter about the incident.

  6. This drives me nuts. When I was in high school, I worked out about 2 hours a day because of the crew team and was extremely fit. 3 mile run, 30 minutes calisthenics or weight lifting, then get into the boat. I weighed 168lbs at 5'8". By BMI, the top of my "normal" was 164.5, so I was 3.5 lbs "overweight". I went in for an annual checkup, and was told I was too heavy and needed to lose 25lbs. Why put more emphasis on the weight than the fitness/health level?

  7. Thanks Lori for your words in this post and for the comments on my blog, my students really enjoyed your comments, it really was a great surprise for me and them. Have a nice time in Barcelona it a very nice city and hopefully you won't see many 'NG tubed people' strolling around

  8. Very impressive, important post Lori...As "Anonymous", I too had a doctor, an endocrinologist, who "proffered" various insights such as explaining a low pulse as due to being "a runner"...and pitting oedema (post-binge/laxatifs)as "not being as bad as some of his diabetic patients" or as "not the worst" he had seen. Also "offered"...being told that I was "not as severely anorexic" as some of his "younger" patients had been...Needless to say, these are precisely the dangerous kinds of comments that can trigger a relapse in recovery, and should definitely send one in search of competency in the ED realm!

  9. Thank you all for sharing your unfortunate experiences, and for supporting Laura in the process. It is my hope that I will someday soon be in a position to educate physicians and medical residents about the impact on their statement, and the facts about eating disorders and weight stigma.

  10. Not exactly the same thing but I did once have a med student tell me my acne was caused by carbs and drinking sodas. I told him I didn't drink soda, like ever and he said, "well do you drink juice?" and I confessed to having a glass of cranberry juice most mornings with breakfast. He then said juice is the same thing as soda and lectured me about that (I felt like I admitted to smoking a pack of cigars every day rather than juice with breakfast). Icing on the cake is before I left he wrote down the website for some quack doctor he followed (Dr. Perricone I think) and told me, "remember, no more carbs and no more soda," on his way out the door. Lol.

    Speaking of terrible diet advice from healthcare professionals, what are your thoughts on Dr. Oz?

    1. I do not have respect for Dr Oz as he is all about making monies for the networks. I totally lost respect when he was featured on some show and he was all over the "Biophotonic Scanner" by biopharma. It is a scam and a way to sell expensive supplements and he did not even seem to question its validity. By by Dr Oz.

    2. I must confess, I have never actually watched a show. That said, even on the grounds of his outrageously ignorant handling of "educating" the public on eating disorders and pro-Ana sites, I have little respect for him.

  11. The first time I met my psychologist, when I started recovering from anorexia, I told her I hate myself every time I eat junk food, like (dark) chocolate or ice cream. She told me that both of those foods can have a nourishing effect on me. Dark chocolate has antioxidants and ice cream has calcium.
    About a year later, I tell her that I'm sometimes bingeing due to depriving myself from the higher calorie (chocolate, cookies, ice cream) things I truly want. Her advice? When you feel like eating something like that, eat an apple and drink water. When I said that that will feel depriving to me (and setting me up for another binge), she said, I quote: "You know, doctors would never advise empty calories like chocolate or ice cream. An apple is much healthier."
    I stopped seeing her after that.