What do I do (anorexia nervosa or naturally thin)?
September 18, 2013 6:26 PM   Subscribe

So this is my problem. My doctor thinks I have anorexia nervosa. I'm naturally very thin...I eat...a lot sometimes. Well not that much. I eat an average amount of food, I don't purge, I don't binge...I don't weigh myself often. Sometimes when I'm stressed out I loose weight. How do I get these doctors off my back? They're really heavy to carry you know...
posted by babybowrain to Human Relations (29 answers total) 5 users marked this as a favorite
 
Do you have your medical history from... forever? If this is just how you are, then your history should provide this information. If not, maybe pictures of yourself at different ages?
posted by ancient star at 6:30 PM on September 18, 2013


I feel like we need more information -- did they do bloodwork? Are you underweight? Have they recommended a treatment plan?

Personally I would log my food for a bit and share it with them...not that you have to prove anything, but so you can discuss whether you're getting the right nutrients or what. I feel like there should be more to the diagnosis than your actual weight, but I've never been underweight and sure there will be more knowledgeable commenters who will provide better information there.
posted by sweetkid at 6:34 PM on September 18, 2013 [4 favorites]


Do you meet the diagnostic criteria for anorexia? It's a serious illness, so if you meet it, take it seriously. Are you below the minimum weight for your age, height, body type? If you are female, do you have periods? Do you have enough energy top be reasonably active? Keep a food diary for a week or so, maybe even take pictures of everything you eat, to show the doctor. And, since it sounds like you don't eat a lot, maybe see a nutritionist, to make sure you have a good balance of nutrition in your diet.

I think I sound disapproving - I don't mean to, these are questions I would be asking myself.
posted by theora55 at 6:36 PM on September 18, 2013 [17 favorites]


How long have you been seeing this doctor? If it's a new doctor, they might not know you well enough to say. If it's a doctor who you have been seeing for a while, I'd be inclined to take what they say seriously. What are they encouraging you to do based on this information?
posted by kat518 at 6:40 PM on September 18, 2013


There are signs of severe malnutrition that can result from anorexia nervosa. Have you had a physical exam? Did they look at your vital signs, your nail beds, do blood tests, maybe even X-rays?

If it comes down to it, start bringing snacks or even meals in to your appointments. They might see it as rude, and might tell you to put it away, and might even think you're choosing (in the mind of an anorexic) the lesser of two evils to get them off your back; but if you do it consistently, they'll at least see that you're eating.

A more sane approach might be to take video of yourself eating meals when you can. Put them on your phone if possible, bring them to an appointment, and try to convince the doctor that you are eating, you're not afraid to eat, you just don't gain weight easily, and you lose it quickly when you're stressed.

Ask them to take it seriously. Tell them you're worried about this weight loss and you want it looked at without casting you as the villain (assuming you're trying to get this treated - if it's just incidental to regular checkups and you want them to ignore it, that might be harder to get across to them).

Worst case, you might have to go shopping for a new doctor.
posted by WasabiFlux at 6:43 PM on September 18, 2013


This Web comic/blog describes suffering from an eating disorder while being convinced of not having one - does any of it sound familiar?
posted by *becca* at 6:54 PM on September 18, 2013 [9 favorites]


I agree - we need more info. What, exactly, did the doctor say? What caused him to say it?

I am underweight. Enough that some people can be shocked by it, though I do not have an eating disorder, nor do I really look like I have an eating disorder (though I look very thin, and can look even more so with bad fashion decisions). I've been at this weight consistently for years and years. I am healthy.

There is but one time my doctor mentioned my weight. He did not suggest I was anorexic, and in fact, prefaced his question with a disclaimer that he knows I probably get a lot of jerks who suggest as much, but he can obviously see that is not the case. But I had suddenly lost a rather large number of pounds in a month, and he wanted to see what was going on, because that was unusual for me. So he asked me about it, whether I had been ill, if I was aware of it, etcetera.

I was aware, it was due to a clear and identifiable external cause, it was obvious that it was a temporary loss, and that was that. My weight has never been a topic of conversation since.

So: I am that ridiculously thin person who eats all the things, but who still gets shifty eyed from laypeople who suspect that there has to be more to it than that.

My doctors have never mentioned it, except that one time.

But yours did.

Is this a new doctor?
Did you have something come up on a test?
Did you have a sudden change in weight?
Is there something more you left out of your question?
Are there other health issues you are dealing with?

If this is really a misfire from someone who doesn't know you, then I wouldn't worry about it, because they'll realize eventually that our weight is just what it is.

But...if there is a reason he suggested that, then the answer could change, or maybe there is another health concern you actually need to worry about.
posted by sock puppet of mystery! at 7:00 PM on September 18, 2013 [11 favorites]


* I meant they'll realize your weight is what it is, not our weight. I doubt we are seeing the same doctor, or that I am involved in your healthcare in any way!
posted by sock puppet of mystery! at 7:07 PM on September 18, 2013


If your doctor doesn't believe you when you say you are being honest, it's time to switch doctors and find one who can help figure out why you're meeting the diagnostic criteria rather than accuse you of lying.
posted by discopolo at 7:17 PM on September 18, 2013 [3 favorites]


A more sane approach might be to take video of yourself eating meals

...how would that be of diagnostic value?

What happens? "I think you have/are at risk for anorexia" -- okay, then what? You decline referrals for therapy? Or...?

What would be problematic about seeing a specialist for further evaluation, because it doesn't sound like it's even gone that far?

For most of my life I've been thin, and during childhood growth spurts and adult periods of stress and ill health, people-comment-on-it thin, and I have seen a variety of GPs, and also psychiatrists as I used to have a depression problem (and insomnia has also sent me to talk-and-prescribe professionals), and not one of them has ever made any sort of hint about any idea of any suspicion of any sort of eating disorder. So, anecdotally speaking, low BMI alone is apparently not enough for many physicians to float a diagnosis like that. Do you have anything else going on that might ring alarm bells, even unwarranted ones?
posted by kmennie at 7:18 PM on September 18, 2013 [1 favorite]


I'm naturally very thin...I eat...a lot sometimes. Well not that much. I eat an average amount of food

Do you think you have anorexia nervosa? I ask because you don't seem to know yourself, from what you say.

So that means I think you ought to consider that it might be true and investigate. And then decide whether you want to agree or disagree with the decision.

You could keep a food diary for 3 weeks. Write down what you eat and add up the calories.
posted by Ironmouth at 7:30 PM on September 18, 2013 [3 favorites]


This is not a diagnostic tool, but it can be used to identify whether you are at risk for an eating disorder, and you can take it yourself online here: EAT-26. Try that and see what it tells you. You can discuss the results with your doctor.
posted by Ouisch at 7:31 PM on September 18, 2013 [3 favorites]


I was thin in my teens and twenties...size 1 at 5'7, 100 lbs. I ate whatever I wanted and lots of it. My weight was questioned but I knew I was eating enough and blew them off. At 30 I quit smoking and gained weight. Settled into a size 10-12 for the next 20 years.

If you know that you have none of the symptoms of an eating disorder do not let them talk you into having one.

If you have a few of the symptoms but maybe not all of them. Have an open mind about the possibility and research it further.
posted by cairnoflore at 7:51 PM on September 18, 2013 [2 favorites]


If it's something that showed up in your bloodwork, or you have symptoms of a real nutritional deficiency, then you need to address it, of course.

If not - if the doctor just saw you were really thin and then said you are anorexic - you need a new doctor. That's pretty weird and pretty inappropriate. Don't videotape yourself eating or sneak snacks into the doctor's office - the doctor is not the police. Only keep a food diary if you think it would be useful to YOU, not to prove something to the doctor. If you feel like you have to "prove" you're eating, you need a new doctor.
posted by goodbyewaffles at 7:58 PM on September 18, 2013 [3 favorites]


Chiming in as another naturally thin person who has never had a doctor mention my weight. I've had family members fuss over whether I was eating enough, but never a doctor. They do tend to order a lot of blood tests for me though...

If this is one doctor and you are positive you don't have an eating disorder, get a new doctor. If it's a problem you have had with several Dr's, start keeping a food journal and track how much you are eating. You aren't sure if you eat a lot or not, maybe you do need to start adding to your meals

A friend growing up had a sister with a severe and obvious eating disorder. She and her mother would verbally attack anyone who even thought of mentioning it. Denial and anorexia are completely intertwined, so if Dr's aren't taking you at your word don't take it personally.
posted by Dynex at 9:47 PM on September 18, 2013 [3 favorites]


I only got that when it was a new doctor. I told him off and found another doctor.
posted by EmpressCallipygos at 10:03 PM on September 18, 2013


It seems to me that based on what you chose to title your question and how to tag it, you might think it is a possibility you have anorexia.

Maybe ask your doctor what his or her reasons are for believing you might be anorexic. Maybe get a second opinion.

If you feel it is even an inkling of a possibility that you might have an eating disorder, what would it hurt to look into pursuing treatment? Just FYI, not all eating disorders are cut and dry anorexia or bulimia. Sometimes disordered eating doesn't fall into those two patterns and is often called ED-NOS (eating disorder- not otherwise specified) if you are looking for information.
posted by tweedle at 10:57 PM on September 18, 2013 [1 favorite]


There's something weirdly cagey about the phrasing of your question that makes me wonder if there's more to it. In my experience, very thin people with healthy eating habits react to accusations of anorexia with a lot more eye-rolling, annoyance, or disgust. I mean, everyone's different and your reaction isn't wrong, but most people without eating disorders know they don't have eating disorders.

There's two ways to go here, and it's up to you to decide: Do you believe that your relationship with food and your body is healthy and stable? On an average day, do you get enough calories (at least 1200, maybe more depending on your frame and activity level) without stress or guilt or agonizing? If so, find a new doctor. But if you have doubts, if feeding yourself or weighing yourself is stressful, if you find yourself struggling with your appetite regularly, if you think there might be some truth to the anorexia suggestion, go to a therapist who specializes in eating disorders. You don't have to have an ED to benefit from therapy! And a therapist will have better answers and approach your questions with a lot more tact and consideration. (Also, find a new doctor anyway.)
posted by Metroid Baby at 3:47 AM on September 19, 2013 [2 favorites]


There's so much emphasis placed on the dangers of obesity these days that a lot of people forget that being too thin is harmful for your body, regardless of the reason why. It will put all of your system under more stress than if you had a normal weight, and if you get ill it will be harder for you to recover. Whether or not you're anorexic in the psychiatric sense, if your doctor is telling you you are too thin, you need to gain weight, probably by eating more and more regularly and by eating more calorific foods. If the thought of this stresses you out, well... I think you know what comes next.
posted by Acheman at 3:50 AM on September 19, 2013 [1 favorite]


Did he actually say anorexia nervosa or just anorexia?
posted by dogmom at 4:59 AM on September 19, 2013


Hmmm. I am super thin. One of my fears is that people will think I have anorexia nervosa, although I clearly do not look like I am anorexic. So this is a touchy subject for me.

I will say that I have generalized anxiety, which did a damn good job of tamping down my appetite. I legitimately thought I was eating plenty and, you know, just eating what I was hungry for whenever I was hungry, and then stopping when I was full. Once I got on an SSRI, I was AMAZED at how hungry I was, all the time! I could eat all the foods! I could CONTINUE to eat, even when I wasn't actually hungry, and not feel nauseous! Wow!

So, I gained 20 pounds and then kinda leveled out. I'm still thin, but looking back I was not at all in good health. I used to not sweat! Like, I didn't weigh enough to sweat when I got hot! Also I got maddening heat rashes. And then there was that constant nausea all the time. The SSRI and gaining 20 pounds has been life changing.

I think maybe, since this is stressing you out, and since you admit that you lose weight when stressed, that you should discuss things with a therapist, and see if that doesn't indirectly solve your problem.
posted by chainsofreedom at 5:37 AM on September 19, 2013 [2 favorites]


You can press for a definitive diagnosis based upon observable data.

Being thin doesn't mean you're anorexic. But there are a constellation of observable data that does (Per the Mayo clinic)

Physical signs and symptoms of anorexia include:

Extreme weight loss
Thin appearance
Abnormal blood counts
Fatigue
Insomnia
Dizziness or fainting
A bluish discoloration of the fingers
Hair that thins, breaks or falls out
Soft, downy hair covering the body
Absence of menstruation
Constipation
Dry skin
Intolerance of cold
Irregular heart rhythms
Low blood pressure
Dehydration
Osteoporosis
Swelling of arms or legs

So unless your doctor is reacting to any of the above, he's talking out of his ass and you need a new doctor.

Your question is concerning because of this phrasing:

I'm naturally very thin...I eat...a lot sometimes. Well not that much. Either you are consuming an apropriate amount of food, or you're not. This is a cutesy way of skirting a very real issue.

Then you say: How do I get these doctors off my back?

This isn't just one doctor, it's Doctors, PLURAL. My Dad has a saying, if one man calls you an ass, hit him, if two men call you an ass, buy a saddle. (He's a therapist, he knows shit)

So, if you have been told by multiple folks in the medical profession that your weight is unhealthy, you either need to take that information on-board and work to correct it (working with a nutritionist, being mindful of eating enough, strength training) or accept that these folks may be onto something.

You are a grown person, if you don't like what a medical professional is telling you, if you feel that person is making snap judgements based on faulty observations, then don't see that doctor any more. Seek a second opinion.

It really begs the question, why would an adult woman need to get doctors off her back?
posted by Ruthless Bunny at 5:44 AM on September 19, 2013 [1 favorite]


There has to be something more to this; I've been slightly-to-seriously underweight all of my life and no one in the medical profession has suggested I have an eating disorder. They have suggested I gain some weight in case I get the flu or some other infection that would cause me to lose more weight. However, my bloodwork is fine and the medical problems I do have are not weight related at all. Ask the doctor why she thinks you have an eating disorder and address those issues point-by-point.
posted by desjardins at 8:14 AM on September 19, 2013 [2 favorites]


I am very skinny (always have been) and I have gotten "accused" of an eating disorder by every stupid website that I have plugged my weight and height into. However, I have never been accused by a doctor, let alone multiple doctors (which I understand you have been, unless you used plural "doctors" by accident), even during my pregnancy when they look at your eating habits with a magnifying glass. Something else is going on here. Only you can tell us what it is.
posted by rada at 8:14 AM on September 19, 2013 [3 favorites]


I can relate to not eating when stressed. I have huge periods of my life (like now) where I am constantly stressed and i don't have any desire to eat, dont think about it at all. I do eat because the bell rings and it's grazing time, but I don't recognize hunger. I ,most of the time, am not a healthy person. but here's what I have been learning to recognize and address in response to stressorexia (?)

If I am tired and my brain is fried and its like 2 pm - probably need to eat and the "stress" will dilute itself to a workable level.

If I am nervous and feel like I'm going to puke from nerves - probably need to eat and give the stomach something to digest.

This is not "eating my feelings" or anything like that, its that the physiological signs of hunger are the same as my physiological responses to stress and i confuse them. So when I get fatigue / nauseaus from stress I eat something healthy (I've been on a nuts / cheese / meat/ eggs kick lately because of the cooling temperatures, but i just came off of a fruit stint) I elsewise don't really control or monitor what I eat. I find making sure I eat when stressed to really change things for the better, especially since I am not a "meal" person and more of a grazer. I went through way too many days where the only thing I ate all day was breakfast then the stress would take over, causing unrecognized hunger, creating more stress in a big ugly cycle. Now that I realize that hunger can feel like stress, I eat accordingly and things don't spiral so bad.
posted by WeekendJen at 11:04 AM on September 19, 2013 [1 favorite]


Chiming in as a naturally thin person who has had doctors insinuate that I have an eating disorder. I do not, and I never have. My weight has stayed within a ten pound range for the past, I don't know, ten years? (I'm twenty-five). Find another doctor.

There's so much emphasis placed on the dangers of obesity these days that a lot of people forget that being too thin is harmful for your body, regardless of the reason why. It will put all of your system under more stress than if you had a normal weight, and if you get ill it will be harder for you to recover.

This is a ridiculous, bullshit blanket statement. That's not to say that there aren't health risks associated with some aspects of being underweight and/or underlying causes of being underweight - osteoporosis, nutritent absorption issues, etc. - but the idea that skinny people are frail and unhealthy is, uh, not super scientific.

The idea that everyone must fall on the normal range of the BMI chart is insanely stupid. If you're short or tall, for example, BMI is useless. I am very small-boned and short, so I am not that skinny for my body, but according to BMI, I am ZOMG underweight. Really athletic people can come up as "obese." Body fat percentage is a better indicator of general health, but it's hard to get an accurate number and I doubt that your doctor took the trouble to do so.

I had a very, very skinny coworker who ended up being diagnosed with celiac disease, but her weight was not the main symptom that lead to her diagnosis. At one point in my life, I had an intestinal parasite and lost a bunch of weight. You could have an underlying medical condition, and if you are concerned, find a doctor that will help you find the underlying cause of what's going on and not accuse of you having an eating disorder. Having a doctor who doesn't listen to you and isn't on your side is an exercise in frustration. My pediatrician decided that I should "drink more milkshakes." WTF.

If you tend to lose weight when stressed - which I do, too - make it really easy for you to eat. If you can anticipate a stressful time in your life, stock up on almonds, make a batch of hardboiled eggs, keep cheese and crackers on hand, and just make sure that there's a ton of easy to consume food around your house and in your backpack or whatever.

I eat...a lot sometimes. Well not that much. I eat an average amount of food

I understand your confusion. It's hard to gauge how much you eat compared to other people. I feel like I eat a ton, but apparently, I don't. But sometimes I do. Eh. Who knows?
posted by ablazingsaddle at 10:33 PM on September 19, 2013 [3 favorites]


This is a ridiculous, bullshit blanket statement. That's not to say that there aren't health risks associated with some aspects of being underweight and/or underlying causes of being underweight - osteoporosis, nutritent absorption issues, etc. - but the idea that skinny people are frail and unhealthy is, uh, not super scientific.

It's super scientific. Look at the tables on the fourth page. If you correct for smoking, the mortality risk associated with being underweight is equivalent to that of being morbidly obese. This is a far more robust effect than that associated with being somewhat overweight.

The NHS warns specifically that people who are underweight have poorly-functioning immune systems; that if their food intake is inadequate they may be deficient in important nutrients; and that it's particularly dangerous for older adults.

All these things are complex, and if your doctor reckons you're at a stable weight that's working for you, you should probably not worry too much. However, that's not the case for the OP. Even for them, the solution isn't to panic, it's to make an effort to eat more. Luckily, it's easier for most people to gain weight than to lose it, unless they have specific psychological problems which need to treated.
posted by Acheman at 3:14 AM on September 20, 2013 [1 favorite]


Oh, doctor is determined you have an eating disorder, that's always fun. Happened to my tiny scrawny early 20-something ass too after I caught a horrible stomach bug and then really got dangerously thin because of the sickness. That my younger sister actually had anorexia shortly before didn't help any either. I'm afraid you'll probably not be able to convince the health professionals that you eat just like anyone else and still have a BMI that's somewhat creepy (16-17) until you turn 30 and finally reach almost normal weight (19-20) and then go on to 40 and become obviously overweight as in waist circumference goes boom (with a BMI that's now square in the normal range i.e 22-23, Yeah sometimes it's not just athletes and bodybuilders for which BMI doesn't work. All extreme body types have problems here, I think). My diet didn't change in any substancial way over all this time, until this year, which obviusly had too much beer and candy added *harrumph*.
posted by ZeroAmbition at 12:22 PM on September 20, 2013


WasabiFlux: "If it comes down to it, start bringing snacks or even meals in to your appointments. They might see it as rude, and might tell you to put it away, and might even think you're choosing (in the mind of an anorexic) the lesser of two evils to get them off your back; but if you do it consistently, they'll at least see that you're eating."

This would only prove that the OP is eating while others are judgmentally watching. I can't imagine a doctor so naive that they wouldn't realize OP could be purging after leaving the office.

So, probably not helpful.
posted by IAmBroom at 10:04 AM on September 24, 2013


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