Body Image Issues: Is It Obesity Phobia or Something Deeper?

Q: Body Image Issues: Is It Obesity Phobia or Something Deeper?

Hello Jiafen： Based on the information you provided, your sister is likely suffering from what Western medicine refers to as "Anorexia Nervosa." Let's take a look at a video about anorexia patients： http：//www.youtube.com/watch?v=qFbYW6bNViw. <br>As mentioned in the video, every

Obesophobia?

Hello Dr.
Chen: My sister is in her second year of high school and is very thin, weighing only 36 kilograms, yet she feels that she is overweight.
Since starting high school, she has stopped eating breakfast and lunch, and for dinner, she only eats cookies instead of rice.
She lacks the energy to participate in physical education classes, and her teacher called my mom to express concern.
My mom has been scolding her, but she still refuses to eat.
I've noticed a lot of hair in our bathroom, and I suspect it’s my sister’s, but she insists she hasn’t been pulling her hair out.
However, the hair is definitely hers, and she has also been losing hair on her head.
I tell her that she is already very thin, but she is terrified of gaining weight.
Is this a case of anorexia or a fear of food? Is it really okay for her to not eat? She locks herself in her room at night and seems to be crying.
My mom consulted a doctor at a clinic, who suggested seeing a psychiatrist.
Is a fear of gaining weight considered a mental illness? My mom is very angry and believes my sister is just being stubborn and that it’s not a mental illness.
How can I help my sister? Could this be a phase of rebellion? Will she get better on her own? Does she really need to see a psychiatrist?

Yunlin Jiafen, 20~29 year old female. Ask Date: 2009/06/14

Dr. Chen Yuying reply Psychiatry

Hello Jiafen: Based on the information you provided, your sister is likely suffering from what Western medicine refers to as "Anorexia Nervosa." Let's take a look at a video about anorexia patients: http://www.youtube.com/watch?v=qFbYW6bNViw.
As mentioned in the video, every anorexia patient, even when they appear emaciated and look like a skeleton to others, still perceives themselves as overweight and sees only "excess fat" when they look in the mirror.
If anorexia is not addressed and treated, it can gradually cause harm to the body.
The first consequence is a loss of physical strength due to insufficient calories, leaving your sister too weak to participate in physical education classes.
Following that, due to nutritional deficiencies, her skin and hair may become dry, she may experience hair loss, and her gums and joints may become painful.
Once she becomes excessively thin, her menstrual cycle may stop (perhaps you can ask your mother to check if your sister hasn't used sanitary pads for a long time).
Her body may bruise easily from slight contact, her nails may lose their luster, and her feet may experience numbness or cramps due to certain sitting positions.
Ultimately, she may suffer from stomach pain, abdominal pain, and diarrhea.
If her heartbeat starts to become irregular, that is a dangerous warning sign for her life.
Since you live in Yunlin, there happens to be a doctor, Dr.
Tseng Mei-Chih, at National Taiwan University Yunlin Hospital who specializes in anorexia.
I recommend that your family take your sister to see Dr.
Tseng for professional treatment, as this is the best way you can help her.
Wishing your sister a speedy recovery.

Reply Date: 2009/06/14

More Info

Your sister's situation is concerning and reflects a complex interplay of psychological and physical health issues. Based on the information provided, it appears that she may be experiencing symptoms consistent with an eating disorder, possibly anorexia nervosa or body dysmorphic disorder, rather than simply obesity phobia.
Eating disorders are serious mental health conditions characterized by an unhealthy preoccupation with food, body weight, and body shape. In your sister's case, her extreme weight loss (36 kg is significantly below the healthy weight range for a high school student) and her distorted perception of her body image (believing she is overweight despite being underweight) are red flags. The fact that she is skipping meals and only consuming snacks like cookies indicates a restrictive eating pattern, which can lead to severe nutritional deficiencies and health complications.

The hair loss you mentioned could be a sign of malnutrition or stress, both of which are common in individuals with eating disorders. It's also important to note that the emotional distress she is experiencing, such as crying and isolating herself, suggests that she may be struggling with anxiety or depression, which often co-occur with eating disorders.

Your mother's reaction, while understandable, may not be the most helpful approach. It's crucial to approach your sister with empathy and understanding rather than judgment. Encouraging open communication about her feelings and concerns can help her feel supported. It’s important to validate her feelings without reinforcing her fears about weight and body image.

Regarding the suggestion to see a psychiatrist, this is a necessary step. Eating disorders are complex and often require a multidisciplinary approach for treatment, including medical, nutritional, and psychological support. A mental health professional can provide a proper assessment and determine the best course of action. This may include therapy, such as cognitive-behavioral therapy (CBT), which is effective for treating eating disorders, as well as possibly involving a dietitian who specializes in eating disorders to help her develop a healthier relationship with food.

It's also worth noting that adolescence is a critical time for mental health development, and many individuals experience body image issues during this period. However, when these issues lead to harmful behaviors, such as extreme dieting or self-isolation, professional intervention is essential.

In summary, your sister's situation is serious and requires immediate attention. Encourage her to seek help from a mental health professional, and support her in this process. It’s important to create a safe and supportive environment where she feels comfortable discussing her feelings and fears. With the right treatment and support, recovery is possible, and she can develop a healthier relationship with her body and food.

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