cutie the mini orange

Today was a slow day. Downtime between semesters = fewer students on campus = blessed, rare open appointment slots = more time with the few patients who happen be around.

Consequence: actual time to spend on actual health promotion-type counseling. And not only my faves, like safer sex (because I always find time for topics that actually interest me. how many times have I found myself running behind because I can’t seem to get a convo about herpes back on the rails? so many). No, these days, I have no excuses not to talk about things like exercise. And stress management.

And…diet. Ugh, diet.

Unintended consequence: overwhelming sense of profound shame as I realize that while I spent a not-insignificant amount of time today earnestly counseling patients about the benefits of a plant-based diet and loading 50% of your plate with fruits and vegetables and generally not eating processed crap every day of your life, I consumed:

1. 3 cups of coffee in an approximately 3:2 ratio with the sweetest of sweet vanilla flavored creamer (caloric density approximately equal to melted vanilla ice cream – yes, I’ve checked)

2. 1 slice of the neighbor’s holiday pumpkin/walnut/raisin pound cake, breakfast of champions

3. some sort of sad microwaved marinara ziti thing (work lunch, what can I say)

4. a single small mandarin orange (I brought two, but the second one tasted a little funny, so)

5. 2 generous servings of small bits of chicken, breaded, fried, and tossed in a sweet soy glaze (thank you forever for your delicious attempt at recreating General’s chicken, Trader Joe)

6. a glass of wine, because Friday

7. delicious, sticky white rice to go with the salty sweet chicken

8. a cookie, dipped in chocolate and tiny bits of candy cane

9. another half glass of wine, because cookie + wine = yum

10. a generous slice of ridiculously decadent chocolate peppermint cake for second dessert

11. yet another half glass of wine, because you can’t eat chocolate cake without red wine, pretty sure it’s illegal

And that’s my day. 24 hours, and 1 orange for my entire fruit/veg consumption. And we’re not even a talking a regular-sized orange, but one of those tiny things rebranded as “Cuties” in an attempt to improve shelf appeal. Regular oranges scoff at diminutive nicknames like “Cuties”. Not so for my tiny, adorable mid-afternoon snack.

So. When does the semester start again?


Disordered thinking


Dear Future Teenage Daughter,

A new patient came to see me today.

She had the front desk describe the reason for her visit as “question about eating disorder”. As it turns out, the question was, Do I have an eating disorder? Spoiler alert: the answer was yes.

The shocking thing about this visit was that she had to ask the question at all. Here she was, with far too little weight hanging off her lanky frame, over 15 pounds down from when she entered college two months ago – an inverted Freshman Fifteen. She hadn’t had a period since summer. She’d been spending enormous amounts of precious mental bandwidth coming up with ways to keep her daytime calorie count below 200 until allowing herself to “eat whatever” at dinner – as long as “whatever” didn’t include carbs, meat, or human portions.

While her weight had fluctuated over time, this wasn’t even the lowest she’d been; she’d actually hit 5 pounds below this about a year ago. While she was still in high school. Living at home, under her parents’ watchful (?) eyes. Surely they’d noticed the fact that their daughter was wasting away. And, um, not eating. Two big clues that something’s wrong. Right? I mean, one would think.

Nope! In fact, dad suggested she start exercising. Because she was always complaining about feeling tired and dizzy. Surely, exercise would help. No comment from the peanut gallery over here, but… REALLY?

The sad fact is that most anyone working with adolescents and young adults will become a de facto eating disorder quasi-expert. It’s just that prevalent.

And disordered eating is a sneaky, pernicious thing, because most of the time, it’s not even named. Instead, we all talk semi-obsessively about dieting, and exercise, and ideal weight, and relative thinness and fatness and blah blah blah, being absolutely HORRIBLE to ourselves and to each other with our impossible standards of weight acceptability. That is, until someone somehow ends up with a diagnosis, in treatment, and then suddenly everyone’s all “Oh, how absolutely tragic! That poor thing. Eating disorders really are the worst!” Like it’s this thing that only affects “other people”.

So why am I telling you about this visit? I mean, I just told you about how common it is. “So then who cares, mom? Gawd, you’re totally embarrassing me. Can you just drop me off down the street and we can pick this up some other time?” (Don’t lie – that is SO future you. I can see it now, eye roll and all.)

Well, it’s a funny story. I happened to have discovered my diary from high school last week. I easily lost an entire evening escaping into the past. And in between complaining about my totally unfair geometry teacher and crushing on the boy in summer school whose name I couldn’t remember, I’d somehow found the page space to devote to bemoaning how fat I was. Good times.

It made me wonder how much of my life I’d spent being unhappy with my weight. A lot, I realized. Too much. This despite the fact that I have always been a strong, healthy, curvy, feminine and fabulous female. (WOW THAT FELT GOOD.) I may not have engaged in disordered eating – apart from that sad month in high school where I ate nothing but oranges during the day – but I have most definitely engaged in early and ongoing disordered thinking about eating.

This is Not. Okay.

So here’s what I want for you. I would like for all those brain cells that could be devoted to thinking about how fat that cupcake is going to make you to be spared for more important things, like playing, and living, and learning, and maybe saving the world (a little).

I have to be honest. I don’t even know if this is possible anymore. Society is pretty terrible right now when it comes to weight imagery. It’s inescapable, even for kids. Seriously, every girl doll on the shelf at Target has these bizarrely narrow twigs where the arms and legs should be. It’s like the toy designers looked at Barbie and thought “UGH, what a heifer.” And I didn’t even mention the everything else, everywhere else, on TV and beyond.

But I know one thing I can do. I change the way I talk about myself. I can talk about exercise making me strong, and how I like shopping for different clothing colors and patterns, all without using the words “fat” or “skinny”. I can model strength and confidence as independent of my pant size.

I can teach you to be a critical consumer of media, and celebrate what it means to be and feel healthy, and tell you how beautiful you are, just exactly the way you are right now.

If my patient’s parents had done these things, would she still be sitting in front of me, asking me whether starving herself is normal?

I don’t know.┬áBut maybe it would have at least made her parents a bit more aware and perceptive. And maybe they’d have noticed something was wrong a long time ago. Maybe they could have even answered her question themselves.

It’s a decent goal. But for you, I want more. Let’s aim for never needing to ask the question at all.