Dear Provider,
I monitor my weight and food intake, and I exercise daily, no matter how busy I am. I’m satisfied with my weight if I can exercise enough and do not overeat. I have to be vigilant about maintaining my appearance because of my large mid-section.
The other day, a trainer at my gym pulled me aside and said she thought I needed to gain weight. Today, I was a little light-headed during drill only because it was a hot day; however, my commanding officer spent nearly an hour grilling me about my weight. Sometimes, I have low energy and need to consume more caffeine to push through, but I am doing quite well in my military career.
I live a very healthful lifestyle, but when people comment that I am too thin, it feels like they’re ignoring my large mid-section. My friends are stressing me out when they constantly insist that I need to see a doctor and they are worried about me. They’re also saying I may benefit from talking to someone about my thoughts. I must confess that I do think about my weight and appearance a lot. What should I do?
-- U.S. Marine Corps Master Sgt. Ima Slender
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Dear Master Sarge,
I’m so glad you asked your question. I understand it’s upsetting when people tell you you’re too thin, especially when you work hard to maintain a healthful lifestyle and excel in your career. You also noted you have concerns about the appearance of your mid-section that others do not seem to acknowledge. It is important to recognize you may see things in your appearance that bother you quite a bit that others don’t notice. A healthful lifestyle that includes good nutrition and food choices is critical to Total Force Fitness, and any issue with your food intake could hinder your optimal health.
I’ve found several experts to respond to your questions.
Nancy Skopp is a research psychologist at the Defense Health Agency’s Psychological Health Center of Excellence and has a doctorate in clinical psychology. Kayla Kangiser is a registered dietitian at the nutrition clinic at Naval Hospital Bremerton in Washington. U.S. Navy Lt. Lorna Brown is a registered dietitian and department head for nutrition management at the same naval hospital.
Skopp: The first thing I advise is to seek a medical evaluation to rule out whether your mid-section, current weight, and lightheadedness are caused by a medical condition. I would also recommend making an appointment with a registered dietician to discuss your diet and exercise routine. Registered dietitians can make sure you’re eating a balance of nutritious foods and in the right quantities.
Second, consider your relationship and focus on food and exercise. Sometimes, we have one image of what we look like and how healthy we are, but these images and beliefs can be off the mark from how others see us.
Some of the thoughts and behaviors you mentioned could be characteristic of an eating disorder. Individuals with eating disorders often have concerns about their shape and weight, exercise frequently, and have a fear of gaining weight.
Given your focus on your mid-section, it is also important to consider whether you may have body dysmorphic disorder—a condition characterized by excessive worrying about perceived appearance flaws that are often unnoticeable to others. I would recommend seeking an appointment with a mental health professional to discuss some of your thoughts and feelings around your body, exercise, and eating.
Ask yourself these questions:
- Do I severely control and reduce my calorie count to maintain or lose weight?
- How do I view food?
- Did some event or comment make me focus on my mid-section?
- How often do I think about that?
- Am I overdoing it in the gym?
- Do I try to hide my appearance with baggy uniforms and clothes?
- Do I regularly feel dizzy, or do I have changes to my physical appearance such as hair loss, or do I have memory lapses?
- Do my worries or concerns impair my social or work life?
If you are experiencing an eating disorder or body dysmorphic disorder, there are effective treatments available that include psychotherapy and behavior modification, as well as close follow-up with a nutritionist and primary care provider. In some cases, medication may be helpful.
Kangiser: I agree the concerns you noted may be indicators that you are struggling with what is called disordered eating.
These behaviors may increase significantly around annual Body Composition Assessment windows—the physical readiness test 10-week notice—that can be a trigger for many people who struggle with their relationship with food.
Sometimes, service members will restrict food intake, over-exercise, or use other unhealthy means to lower their weight and decrease body measurements so they can pass the assessment.
Brown: A registered dietitian is part of a multidisciplinary team that addresses medical, psychological, behavioral, and social concerns. Specifically, the registered dietitian designs a person-centric treatment that involves identifying the severity of malnutrition, the specific disordered eating habits, potential nutrient deficiencies, and any nutrition skill and knowledge deficits.
We work with patients to improve their overall health through education and counseling so they can understand nutrition-related concepts, eliminate negative behaviors, and develop a healthy relationship with food.
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Bottom line, master sergeant, is that you may have symptoms of an eating disorder or body dysmorphic disorder and could benefit from a comprehensive assessment to rule these out. Eating disorders are serious mental health conditions that may be accompanied by significant medical risks. The experts recommend you see a physician, registered dietitian, and a mental health care professional to make sure you are achieving optimal health. The experts also recommend visiting these resources from the National Institute of Mental Health for some insight: