i see a really nice thirty-something couple in my practice. when i first met them, he weighed a little over 300 pounds, clearly obese despite his tall frame, and already suffering the consequences with several weight related problems. she weighed around 150, just a little heavy for her height. together they embarked on a diet. they made dramatic changes to their dietary and exercise patterns and they really stuck with it. over the course of a year he lost almost 100 pounds, she a more modest 25 pounds. he came off most of his medications. life was good and all seemed well.
about 6 months later, she came in for a routine follow-up and i saw that she had lost another 10 pounds. this put her just under the lower limits of normal for her height, but she assured me that she was done dieting and was going to just stay at this weight now, which she did for several years. her husband was not as good about keeping up with his visits and i didn't see him for another year, at which point he had sadly regained most of the weight he'd lost. life goes on.
recently she came back in for a check up. she weighed a startling 98 pounds. she was lost in her paper gown, her collarbones and shoulder blades standing a little too proud of their skin.
after her exam, we had a long talk about what was going on in their lives, and more importantly what was going wrong. she was, if not intentionally then at least subconsciously, still dieting for her husband, thinking that by sticking to it he would somehow get back on board with her. but did she know that at twenty percent below weight she was now swimming in the dangerous waters of anorexia? at some level she did, because she admitted to being as equally scared of regaining weight as she was of watching the scale creep steadily down. she declined counseling, which i was encouraging, but we set a small weight gain goal and she will see me back soon.
so here are two very different and equally unhealthy end results of what seemed like a good plan in the beginning. why? in an effort to corral her husband's uncontrolled eating she also lost control, not of her appetite, but of her health. i will think about this for a long time, but not have the answers. but i do know this, it doesn't matter if you are 100 pounds or 300 pounds, most of us struggle at some point in our lives to create and maintain a healthy relationship with food. if this comes easily to you, then consider yourself fortunate. if it does not, then please do not consider yourself alone.
on a lighter note, why don't 'height' and 'weight' rhyme?