You can never be too thin....

Wallis Simpson, the beautiful American divorcee who married Prince Edward, Duke of Windsor, formerly King Edward VIII of England, is credited with the popular saying, “A woman can never be too rich or too thin.” Fast forward to the present. As we sit smack-dab in the middle of a recession, I would say that for most of us working stiffs, the notion of being “too rich,” much less just being free from credit card debt, is a remote notion. Being “too thin” seems equally improbable. Quite frankly, I'd settle just for plain old “thin” any day. “Thinness” is not in the eye of the beholder but rather it resides permanently in the heart and mind of the person standing on the bathroom scale each morning. Some (many?) of us, especially women, have a constant internal back-and-forth debate about what we should -- but mostly what we shouldn't -- eat. It goes something like this:

I shouldn't put jelly on my toast in the morning; in fact, I should probably not even have toast in the morning. If I don't have toast, I should then be able to have a snack mid-morning but it should be fruit. But there's is no fruit in the house; perhaps I can have a cookie instead. Oreo? Egad, no! Vanilla wafer? Well, maybe. However, that would mean that I can't have dessert tonight, especially because I'm going out to lunch with friends and most likely will have a glass of wine. But I might be tempted by dessert at lunch so maybe I won't have wine.

On and on and on it goes.

In addition to teaching English to seventh and eighth grade boys, I also tried to find ways to improve their social skills for when they get older. Here's one example. “When you see a woman you haven't seen in awhile (even if only a week), gently grasp her elbow, look her in the eye and quietly ask, ‘Have you lost weight.' I guarantee, unless the person is seriously ill and has unintentionally lost weight, your remark will be received with a big smile.” As the joke goes, if you want to see a woman naked, put a scale in the middle of the living room and ask her to weigh herself. There is almost no woman alive who will not take all her clothes off AND remove her earrings, wedding band, and even a bobby pin to be sure her weight is as low as possible. (For obvious reasons, I didn't teach this to my students.)

Women's relationship to their weight, though, is no laughing matter. We already know that there is an obesity epidemic in this country. In contrast, the National Institute of Mental Health estimates that 0.5 to 3.7 percent of females are diagnosed with anorexia nervosa. Women are caught in a literal feast or famine scenario. It would be both naïve and unkind for me to think that being overweight is just a weakness of will, sort of like how the uninformed think about alcoholism and smoking. If they really wanted to lose weight (quit drinking, quit smoking), then they should just try harder in their efforts. It would be equally ignorant for me to think that someone with an eating disorder is simply trying to buy smaller-sized clothes. Our relationship with food is quite complex and very individualized. It is also determined by many factors – often related more to external stressors than to hunger. We talk about this issue with patients – and perhaps with ourselves -- all the time.

Abbott Laboratories recently had to withdraw its obesity drug sibutramine (Meridia) from the market in light of clinical trial data pointing to an increased risk for stroke and myocardial infarction. The very sad fact is that I know there are people who would want to take the drug, even knowing the risks. We have a long way/weigh to go in helping people get healthier, an effort that should also include helping them establish realistic goals – considerable food for thought. JAAPA