Thin and losing weight? You’re not sick, you’re anorexic or bulemic.

Marg writes:

Hi,

I don’t know if this story is appropriate for the blog as it is looking at medical prejudice from the opposite end of the spectrum but there were so many parallels with fat prejudice in the medical system – doctors making assumptions based on weight/appearance, doctors not listening to patients, not administering basic obvious tests that could have easily diagnosed the real health issue, this negligence leading to long-term problems due to incorrect/non-treatment – that I really want to share this story.

My colleague – I’ll call her Lee (not her real name) – is naturally petite, small and slender and has a natural, healthy weight that puts her just inside the underweight BMI category – she doesn’t diet or do anything silly, it’s just the way she was born. All her family are the same.

About two years ago she suddenly started suffering from severe stomach cramps that left her lying on the floor in agony. She found it difficult to eat and suffered from severe stomach reflux that led to her vomiting up nearly everything she swallowed. Not surprisingly she lost weight. After two weeks of this, she went to her local doctor for advice.

The doctor took one look at her, put her on the scale and asked her how long she had been anorexic for. In vain Lee tried to explain she wasn’t anorexic, she wasn’t deliberately avoiding food and throwing it up, she was suffering from severe abdominal cramps and there was something wrong. The next thing she knew, she knew she was leaving the doctor’s office with a referral to a psychiatrist. She didn’t make another appointment.

The next month Lee’s mother was in town and dragged her off to second doctor. By this stage Lee’s weight had dropped five kilos to about 37kg. The second doctor also started asking Lee questions about how long she had been anorexic. In vain Lee tried to explain that she wasn’t anorexic, these abdominal cramps had come on suddenly and were making it difficult to swallow food and she was throwing up whatever she ate and this was why she had lost weight. The doctor refused to believe that she could have become so skinny in just six weeks and when Lee’s mother tried to explain that Lee had always been tiny, that everyone in the family was tiny, the doctor accused her of enabling Lee’s anorexia and putting her own obvious insecurities about weight onto her daughter.

The next visit was to a Chinese herbalist who gave her herbs to be made up as tea. This was actually the first thing that helped. The Chinese herb tea soothed her stomach and made it possible to eat a little bit again – although she still threw up any time she consumed milk or meat or anything too fatty. Not surprisingly she stopped eating these products. Nonetheless she managed to stabilise her weight but she still suffered from cramps, threw up several times a week and knew there was something wrong.

Over the next 12 months she visited a gynaecologist who confirmed there were no cysts or anything in her reproductive system that looked at of place – and told her that her periods should return once she put on some weight. A dentist then told her off for her “bulimia”, saying the constant throwing up was destroying her teeth and he could see damage in the back of her throat. This scared her enough to see a third doctor who listened to her long enough to send her for tests for colon cancer and ulcers. These came back clear but with comments about how damaged her stomach and intestines were and urging the GP to address her “bulimia”. When the GP read this to her, Lee burst into tears.

“I’m not anorexic! I wish I could eat normally and not throw up. There is something wrong inside me!” she said.

The doctor sighed and said he would send her for some blood tests and see if they showed anything. Almost as an afterthought he added in tests of her urine and faeces.

A week later his secretary called Lee and said she had to come in for an appointment right now. By this stage Lee was convinced she had cancer and braced herself for the worst. Instead the GP was smiling and waving around her tests. It turned out that for the past 18 months Lee had been carrying around a rather persistent – but common – bacterial bug in her stomach that had made its way into her bowels and intestines and destroyed her natural stomach lining. The constant irritation from the stomach acids had started to literally eat away her insides and the damaged skin was vulnerable to infections. Somehow along the way Lee had also developed a lactose intolerance, adding to the problem. The best news – this could all be easily treated with common antibiotics.

No anorexia, no bulimia, just a simple untreated stomach bug and allergy. That after 18 months of non-treatment had led to permanent internal damaged of her gastronomic system. That could have been diagnosed during her first visit to a doctor if he had just ordered some simple blood tests.

I’m posting this because any kind of size prejudice that leads to inadequate medical care needs to be called out. vesta44

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9 Comments

  1. Meira

     /  September 23, 2009

    I think it’s perfectly appropriate here — just as with fat patients, the doctor needs to treat the PERSON, not the number on the scale.

    Reply
  2. A classic example of when very thin people lose weight, it’s seen as a medical problem (however misguided). Yet if a fat person were to present with the same symptoms, they’d be congratulated and encouraged on. Also a classic example of how we assume eating disorders to be characterized by an unhealthy weight, while, of course, people who don’t meet the stereotype fly under the radar. And finally, a classic example of how people who are assumed to have an eating disorder are patronized by paternalistic doctors who refuse to listen to them.

    Reply
  3. Tell your friend that the lactose intolerance might go away. My sister developed a similar problem after she had a particularly violent stomach flu – she became totally unable to eat dairy products. As the only reason she isn’t a full-on vegan is cheese, this was distressing to her. Her GI said that sometimes, when all the gut bacteria gets destroyed like that, it causes you to be unable to eat dairy, but as the bacteria grows back, she should be able to do so again.

    And seriously, WTF is wrong with doctors?

    Reply
  4. I want to point out (in response to comment #2) that it’s not always true that a very thin person losing weight is viewed as having a medial problem. A lot of doctors seem to think you can never be too thin, only too fat.

    I lost 30 lbs and grew 2 inches through starving myself, which meant I went from thin to anorexic, and was at least 20 lbs underweight by any chart, and 25-30 lbs by other charts (and yes, I know charts are stupid). I went to multiple doctors and tried to explain that I had an eating disorder. They didn’t give a flying fuck because apparently I wasn’t “that thin.” Apparently having a BMI of 17 means you’re just pretty thin, not dangerously thin like those anorexics with 14 or 15 BMIs!

    My therapist was always sending me to the doctor to get blood work done because I was seriously unhealthy with a fluttering heartbeat, fainting spells, fatigue, etc, and they always looked irritated to see me and never told me to gain weight or diagnosed me with anorexia. A year later I went to an actual eating disorder doctor. He wasn’t too concerned because I didn’t have organ failure, but I did have orthostatic hypotension (which caused the fainting), bradycardia (slow heart rate), anemia, hypoglycemia, and osteopenia as a direct result of malnutrition. As it turned out, the doctors I’d been to before didn’t do some relevant tests, either – for example, someone with an ED should always have their pulse checked sitting and then standing. If they had done that simple test the first time I went, they would have diagnosed the orthostatic hypotension right away. And since my eating was so crazy, I should have been having bloodwork done every month, because someone with an ED’s blood can change very quickly.

    Now that I’m “overweight” they’re telling me to lose weight. In my personal experience, doctors have never cared about me losing weight even as a thin or anorexic person, but they’re sure to admonish my weight gain.

    I definitely agree that eating disorders happen at all sizes – but I do think that symptoms of starvation should be part of an anorexia diagnosis (the symptoms, however, shouldn’t be defined by BMI or amenorrhea).

    Reply
  5. Sarah

     /  September 24, 2009

    I think this fits just fine in here – the root problem is fat-phobia and a person doesn’t have to be fat in order to be harmed by it. Another part of the problem is the “doctor knows best” combined with “patients lie.” If something is anomalous, its because the patient lied, not because the medical data is wrong. I’ve heard stories like this from people of all body sizes – they say something is wrong, the docs basically say its all in your head. Usually after years of doc visits some doc finally gives in and orders some ‘useless’ tests just to appease you. Then lo and behold, they find out that something really is wrong. Its so very frustrating, and heart-breaking when the delay turns out to have caused permanent damage.

    Reply
  6. bloomingpsycho

     /  October 7, 2009

    I agree–they need to look at the problem, not at the weight of the person. It is quite appropriate to post this.

    Reply
  7. RachelB

     /  October 13, 2009

    “Yet if a fat person were to present with the same symptoms, they’d be congratulated and encouraged on.”

    Yes.

    My aunt was fat (and dieting) for most of her life, and her doctor kept nagging her to lose weight. I wish that doctor had said to her, when she stopped feeling like eating, “You know, significant and unexplained changes in appetite and unexplained weight loss can be a sign of an underlying problem,” rather than, “I see you’re losing weight– congratulations.” They might have found the colon cancer before it metastasized.

    I miss her, and I’m really angry that fat phobia– her doctor’s, and her own internalized version– played such a significant role in her death.

    Reply
  8. Liz

     /  December 24, 2009

    I had a somewhat similar experience. My senior year of high school I weight 98 pounds at 5’3″ — this was just a couple years after I’d had my thyroid removed due to cancer and was on an extremely high dose of Synthroid to discourage any remaining thyroid tissue to grow/spread.

    GP refused at first to believe I wasn’t anorexic, which was honestly ridiculous as I was eating almost all the time just to satisfy my hunger. Nevermind I was hovering just above “dangerously underweight,” it was more important for her to get me to admit I was starving myself. Finally she gave in and left it alone.

    Several years later I had gained weight and was around 130 (I guess my metabolism had started to slow down despite the meds), and had developed migraines. She wanted to put me on Topomax, which severely curbed my appetite, but that was a bad thing — I also suffer from depression and anxiety and already had a severely reduced appetite. I had to call and beg for something else because I had stopped eating all together; anything I tried to eat made me sick to my stomach, because I can’t eat when I’m not hungry.

    Needless to say, I don’t see her anymore, and my experiences with her have made me afraid of finding a new GP.

    Reply
  1. The thin paradox « Fatties United!

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