I know, it’s crazy, but I don’t have an eating disorder.
Last autumn, I forked out a chunk of cash and got the surgery I’d been dying to have for the last 12 years: a circumferential beltlift to remove over 6 pounds of excess skin after losing more than half of my body weight. It was incredibly freeing, no longer carrying a constant reminder that once upon a time I had made poor decisions.
Shortly after surgery, I ended up in the ER. It turns out that I had a small bowel blockage and none of my food had moved out of my stomach in 3 days, causing a ton of pain and my stomach to stretch to ungodly limits. My final diagnosis was SMA Syndrome, which is a very rare disorder characterized by an abnormally acute angle between the aorta and the superior mesenteric artery that pinches the duodenum (the beginning of the small intestine that leads from the stomach). The issue: normally this angle is fine due to a pad of fat that cushions the arteries. An acute onset is usually due to either trauma or rapid weight loss, sometimes due to gastric bypass surgery and also due to anorexia.
This was my first experience trying to defend against doctors that no, I do not have an eating disorder.
When I lost 135 lbs back in 2002–2003, I had done it by ball-park counting my calories. For a while, that was enough. But from 2007–2008, I became lax and put on 20 pounds. So in 2009 I started logging my food intake and tracking my calories for real. I learned through that experience that I need the sort of accountability that comes with tracking. Also with my food log, I could focus on swapping out out foods that would better support strength training, something I got into heavily starting in 2012.
For those in the fitness universe, this isn’t abnormal in the slightest. For doctors coming across an incredibly rare digestive disorder in an individual such as myself, all eyes are on my “obsessive” behaviors.
Thankfully, during that hospital stay, I was able to somehow demonstrate that I did not have an eating disorder. I was heavily grilled twice by doctors (once “alone” so I could “speak freely”) and they brought in a dietitian to speak with me as well. I kept saying that I train for strength and I don’t track my calories to restrict as much as to stay at a target. I need to eat to support muscle growth. I understand you have to troubleshoot as anorexia is often a precursor to an acute SMA Syndrome event. But for crying out loud, I just had surgery and gastric motility is always an issue after general anesthesia. Sometimes it’s just that simple.
Fast forward 9 months. By this time I was fully recovered from surgery and back on a regimen for strength, making great progress beyond what I could do pre-surgery. And that’s when I got some sort of evil intestinal bug of destruction that wiped me out, killing my ability to train. Symptoms continued for weeks, as did the fatigue. Finally at the 3 week point, I decided to go to the doctor to make sure there wasn’t some critter in there that needed killing.
Instead, the first 10 minutes of our conversation focused on stress and anxiety — typical triggers for many people who have gastrointestinal distress. During that line of questioning, I repeatedly mentioned my concerns that went above and beyond stress-related GI issues: fatigue levels causing my strength to dip even though I was still eating the same number of calories AND my weight was dropping. I didn’t want to be dismissed as nothing more than a head case.
And that’s when the topic shifted to eating disorders.
It’s not that I don’t understand where the doctor is coming from. Anyone with a history of weight loss, “fanatical” behaviors relating to weight, and a current problem that is causing weight loss would be a red flag to be investigated. But what bothered me is that I stated the number of calories I was eating and it was far from low. I stated my weight had dropped two pounds in two weeks and it was alarming to me. These are not words that come out of the mouth of an anorexic. And yet simply tracking these things, simply having that information at the tip of my tongue, was seen as a cause for concern.
What the doctors don’t seem to understand is that by not processing the data I’m giving them and instead focusing on the behavior, they are feeding into a greater cycle of psychological stress for those of us who have lost a great deal of weight.
For years — starting with nearly day 1 of healthy eating before the first pound was even lost, to 13 years later where I continue to make healthy choices — people often feel the need to make a comment that implies something is wrong with me. “Why are you eating bird food?” “She’s so picky, I don’t think she’ll eat at the types of places WE like to go.” “Yeah I could lose weight too if I ate nothing but vegetables like you do.” And that’s before we get into the numerous rumor mills about my alleged anorexia… doctors were far from the first to accuse me of having an eating disorder, that’s for sure.
For every “congratulations, that’s amazing!” spoken by someone, half of the time it’s followed by questions prodding to find what dangerous, irresponsible, disordered thing I did to achieve my goal.
And what blows my mind the most about all of this? I’m just under 5'4" and I weigh 125 lbs. I have noticeable muscle mass, wide shoulders and plenty of leg girth to spare. I certainly don’t look like I’d blow away in a stiff breeze. To have doctors twice over ignore what’s plainly visible and the data I’ve provided to instead pursue ED concerns simply based on the fact that I track my calories and weight… that stings just as much, if not more, than any ignorant jerk’s BS commentary on my choices.
One of the greatest assets doctors have is information from their patients to choose the correct paths of testing for diagnosis. Now I worry that with future visits, I have to make a choice between providing meaningful information to my doctor and go through this all over again, or keep my mouth shut to avoid another eating disorder discussion and simply hope the exam and/or testing will be enough. That shouldn’t be a decision I have to make.
Instead, doctor, if I tell you I eat 1900 calories a day, maybe pay attention to that number and not the fact that I know that number. If you don’t understand whether that number is good or bad, educate yourself. Rather than add to the frustrations I’ve had when it comes to living a healthy lifestyle, become a better doctor.