Expert: Ryan Hale - 6/14/2009

Question
QUESTION: Hello Ryan, my name is Julianne and I am 15 years old and I'm scared.
For the past 2 years I have been overly self conscious about my body image. 3 years ago I started a work out program that promised fast results for a flat tummy, I did it for a few months and actually lost some weight. I just wanted to loose a little more and I started trying every workout plan that I was able to get my hands on. I have done online searches to find new and more efficient one that work best. I tried out for the school volleyball team and made it. I wasn't as skinny as some of the other girls on the team so I would work out a little harder and a little longer. The year after that I was on the track team. This is when I became obsessed with peoples flat stomachs. I was always looking at peoples stomachs to see how thin they were. Last year I went though a depression I guess all of my friends said that I did at least. During that time I had thoughts . . . ( I wont go in to detail as to spare you the liability to help me) that might concern most people and doctors. I think I am now out of that stage but have entered a new one.
I always wear big sweat shirts and t shirts because I feel so self concious in anything tight. But that's not all I've stopped eating. At first it was just breakfast, I told my self it was just because I didn't have time, but I also liked the fact that I didn't feel fat when I arrived to school. During my lacrosse season my team mates would comment about how little I ate but I just thought they were crazy.
I've now stopped eating lunch too. I wake up in the morning get dressed and go to the bus stop, and I attend lunch I just don't eat. Yea I'm a little hungry but its nothing  I cant handle for 3 more hours until schools out. When I arrive home I find that I'm no longer hungry. But my mom will force me to eat something anyway. It makes me feel sick, like I want to go puke sick, when I eat a normal sized meal. I seem to be extremely mood also. I cant stand being around my family for too long, and I hate it when they ask questions about me not being hungry. My friends have also commented about my lack of eating but I just blow them off and say its nothing or him just not hungry.
I can now go 24 hours with out eating and be just fine. .  as long as I have my coffee.
I am always extremely tired using every free second I have to sleep. Even if its only 5 minutes its still better than nothing. And always being tired makes it hard to keep up my grades. Last year they used to be all A's but as time goes on I just don't seem to care as much and they have been slipping.
I have always looked at peoples and models stomachs to compare my to theirs saying that I will one day look like that. I looking in the mirror a lot, and look at my stomach alot always wishing I was skinner and always saying I have to find workout program that will make me skinner. I run all the time, it helps with my sports and lacrosse but I also hope that it helps to make my stomach look smaller. I have now taken on the challenge of being on the swim team, coaches recommendation. Swimmers are always skinny so I said why not? I enjoy working out, and they have two practices a day. Before the season our coach said that he wants us all to get in shape and if possible to have six packs in 3 months. I have been dieting for someone to tell me this it gave me the perfect excuse to go out and work out as hard as I can. I have just been given the p90x work out dvd and I really hope they work. But I wont tell any one that I'm doing this like always. I have always been very secretive about when I work out.
I am writing to you because I want to know if you think that I have an issue. I have never thought twice about what I did until the other day when my sister commented that it was odd she hadn't seen me eat all day and when I told her that I wasn't really hungry she said that any normal person wouldn't be able to go 36 hour with out eating and not be hungry.
I started looking up some web pages on eating disorders, and ya I have some of the symptoms like seeing stars not being hungry always looking in the mirror and measuring my waist, but none of them really fit me.
I'm also writing you because I cant go see a doctor, I just don't have the money to waste.
I'm really scared about what I could have done to my body...And why I cant eat with out feeing sick. If you could please give me your option that would put my mind at ease.
Thank you so much
Julianne

ANSWER: Julianne- first of all, I'm not sure what web sites you've consulted, but it sounds to me like you have an issue here.  Also, as someone who works specifically with athletes, I have seen people with similar signs, symptoms, and behaviors.

I would like to stress to you that getting help is not a waste of money.  This is a situation that will require a multidisciplinary approach...that means that it will the the expertise of a physician (for your overall health), a nutritionist (for healthy eating), your family, friends and coaches (for support), and a counselor (for the behaviors and other issues).  You really need to see someone and get the ball rolling.  That may mean going to the school counselor or nurse, talking to your family doctor, telling your school's health teacher or a coach.  

I'm concerned about your swimming coach's attitude about "everyone having a six pack."  One of the things I stress when I teach coaches is that it is not helpful to have weights or measurements for your athletes that you just pull out of thin air for no reason at all.  In today's day and age, it is easy to research and find what healthy eights and measurements are.  Body mass index and body composition measurements are easy to find and recommendations should be based on science, not someone's opinion.

For example, the wrestlers I work with can lode or gain as much weight as they want, as long as their body fat measurements are within a certain range of healthy measurements that medicine and science says are healthy.  The goal isn't to look a certain way or have a six pack, it's to be as fit and healthy as possible.

As an athlete, food is your fuel.  You are avoiding food to keep your calories down, but you have no energy and sleep a lot which does not burn very many calories (while you sleep).  Your attempts are counter productive.  You'd be better off fueling your body throughout the day with small amounts of food rather than withholding your body's fuel.  You'll also be able to burn more calories when you are working out since you'll have the energy to burn.  Look at Michael Phelps.  His breakfast alone is over 1,000 calories...but he needs that fuel.

I am also concerned about 2 things in particular: first, I suspect that there is someone else or others who are also dealing with eating issues on your team or in your school?  If I am correct, you need to get out of a toxic environment with people who reinforce and promote these eating issues.  Second, I am curious about other issues you may be having with depression, abuse (physical or otherwise), or control in your life.  Do you feel like others are super controlling?  Maybe your parents or other areas of your life?  This can often be a part of an eating disorder.  Either way, a good counselor will be able to help you sort through some of these issues and can help get everyone in your life on the same page.  If you feel like someone or something is really controlling your life, they can help.

It is of the utmost importance to see a counselor about this though.  You are young and can be doing real damage to your body that can last the rest of your life.  Please promise yourself to just get the ball rolling by talking to a counselor about this.

When you've come out the other side, you'll be thankful you did because you will be healthier without having to withhold food or run your life around an eating disorder, and your relationships will hopefully be better for it too.  You can do it!!

---------- FOLLOW-UP ----------

QUESTION: But I have tried to talk to my mother and others about whats going on, and some issues that I'm having. Most of them didn't care in the least and said that I just need to grow up. They also turned it in to a joke and would tease me about it and I felt I had no one I could even confide in because none of them even knew me any more. I have a large family issue that puts a lot of stress on me for various reason and it really is dividing up my family. But because of past experiences with trying to get help and it failing I don't think that talking to them now would be of any help at all and I don't know who to turn to. I'm not the type of girl any one would expect to be depressed- and I think I may be- have family issues or have eating issues. And I'm sure they would just chalk it up to me wanting attention.

I don't know of any one on my team who has an eating issue- or that is open about it if the did- but I'm just not close enough with any person to go to them with this problem. As a last resort with my family matters I turned to a guy I knew to help me out, so I didn't do anything stupid like I had thought about so many times. I have to admit he got me to a much healthier mental state, but I just don't think I would ever be able to go to him about this.

I don't think that going to a doctor would help much  because my BMI is a 17.1. That's why I came to you, is because I was hoping you could give me some suggestions to help me get my life back on track with out having to go see some one who with get my parents involved.
Thank you for all of your help I honestly cant believe some one who I have never met could actually care about me.
Thank You.

Answer
Julianne- it is impossible for me to give you the kind of help you need over the Internet.  That's not to say I can't help... my way of helping is trying to steer you to the kind of help you need.

In a counseling relationship, you'll be able to go over all of the situations going on, not just eating.  Your life has many dimensions and so does your situation.  The counselor will be able to sort all of that out: relationships, stresses, past experiences, the feeling you are having, and the eating.  It won't happen all at once though, it will take time to develop a relationship with a counselor... a relationship where you can talk about some of these things that are difficult to address.  It will be a safe and trusting environment.  You won't have to worry that they are judging you or thinking that you just want attention or are screwed up or something.

You'll have to give it a few sessions and even then you might decide you need to see someone else who you might click with better.  You really need to do this though.  Star with your school's counselor.  Hopefully they can direct you to someone with special experience with eating disorders.  It's important you do this though.  It's the necessary first step.  I know you want more from your life than being controlled by this.  Seeking counseling is step one.