Thinness And Anorexia
What's the fine line between strict dieting and an eating disorder?
I think when a person is dieting, they are putting themselves at risk for what's called "disordered eating. Along a continuum, you could have healthy eating, balanced nourishment, and then the dieting. Any time that we go on a diet, we have someone outside of ourselves telling us what to do with food. The chances are that we can only maintain that for a certain amount of time, which is why 98% of dieters gain that weight back and then some added weight as well. When you have dieting, what's actually going on, is that you are giving your power up to somebody else, and the dieting is leading to disordered eating. Over time, the more you diet the more your relationship with your body goes down. Then, the more disordered your eating becomes, the more your disordered eating becomes extreme, and then this leads to an eating disorder.
What's wrong with trying to be thin?
There's nothing wrong with trying to be thin, but it's important for us to look at how we can be any size and be well. Wellness is not about thinness. Wellness is about eating the right foods and eating the right amount of the right foods, and having the right amount of exercise in our body, and also having the right kind of stress reduction techniques for our body. When we're looking at wellness, it's really looking at our all-rounded wellbeing, where we're looking at our emotional health, our physical health, our spiritual health and mental health.
Why can't someone with anorexia see how thin they are?
There's a component of anorexia that we call body image distortion. This is where they look at themselves in the mirror and they see themselves as huge. Physiologically, actually what's happening, is that the brain is going through the phase of malnourishment and the brain releases a chemical called leptin. Leptin, when its secreted in high amounts in the brain makes the person have that body image distortion that they have. So leptin is a chemical in the brain. When I have an anorexic patient telling me, "I'm huge, can't you see how big I am?" She is actually seeing that, and she's not making that up. She is seeing herself that big because of leptin, and the excessively high levels of leptin. The way leptin levels start to drop is only through eating. So when she stabilizes with her food, and when she starts eating three meals a day and three snacks, everything we're gently having her do, then as the leptin levels go down then she says, "oh my God, I'm so thin! I never realized how thin I got Dr. Kakyia." So then her body image becomes more realistic, so then she sees herself for really how thin she is, but only after she nourishes herself will what she sees in the mirror begin to change.
What is Body Dysmorphic Disorder or BDD, and does it apply to anorexics?
Body Dysmorphic Disorder is actually an anxiety disorder. It doesn't even come in the category of eating disorders in our manual. It is an anxiety disorder where what the person does is they focus on a certain body part and see a defect in that body part. So where BDD (Body Dysmorphic Disorder) correlates with eating disorders is that some of our patients with eating disorders will perceive their stomachs as being bigger than they really are. So that is where it becomes BDD. Typical BDD would be "Oh my god, my thighs are too big. I need to to get liposuction for my thighs." It could be "I need my ears fixed," or "My breasts are too small and I need them larger." They just focus in on a certain body part, and no matter how much correction they do of that body part, it just doesn't feel good enough. So where, again, it shows up with eating disorders is somebody could go on a diet and lose weight, but no matter how much weight they loose it just still isn't good enough. So that's why with eating disorders we do have an anxiety component with them, so typically we do treat the anxiety that comes along with eating disorders, because BDD is more an anxiety disorder that overlaps with anorexia.
Is it true that some people 'just don't gain weight'?
Eighty percent of our body type is genetically determined. We also live now in a very toxic food culture. So as a result of eating all of this food loaded with preservatives and everything like that, we're training our bodies to become different than what we were genetically given. So your question was "is it true that some people just don't gain weight?" I think it is true that people just won't gain weight because their bodies, if their eating very normally and their eating to their hunger cues and their eating to their fullness cues and everything like that, their bodies, our body weight tends to have like a set point that's determined genetically for us. The way we mess around with that set point is by extreme measures. So dieting is an extreme measure. So that's why a lot of times when people diet a lot over a course of their lifetime, the get fatter as they diet more. So that set point changes. So if you notice that the people who tend to kind of remain at a normal body weight that may be thin or slightly overweight but just so does don't seem to fluctuate a whole lot. If you kind of observe their ways of eating what you'll probably find is they eat according to their hunger cues, they stop when their full, they don't diet and they tend to remain pretty stable in terms of the amount of exercise that they may do in their life.
Should I be concerned if people say I am too skinny?
I really think we have major weight prejudice in our country. We comment about people when they're too fat. We comment about people when they're too thin. We comment about people when they're just right. We have such extreme forms of lookism. And we're constantly preoccupied with watching people's bodies and deciding whether it's the perfect body or not the perfect body. And does it matter with mine, and should I do something about mine? So there's this huge piece that goes on. And I think it's very important that we can look at how we do have prejudice towards really overweight people, and then we also have prejudice against people who are just naturally thin. So there will be lots of people... Because when we have a huge value system based on, you can never be too rich or too thin. So then what you'll find is, you'll find that when somebody is really thin, the majority of us women who may not be that thin feel a little envious about that person. Because how does she seem to do it? And so the way that we deal with envy is we project it out with hostility towards that. So we may make comments, that are actually really prejudicial comments towards really thin people. So I think just as much as we can be prejudice towards really fat people, we tend to be prejudice towards naturally thin people as well.
