When Hannah was 9, she sat on a school bus clutching a stuffed animal. It was a soft little pig. A boy on the bus gave her a sidelong glance. “Why do you have a pig?" He asked. "Is it because you’re fat like a pig?”
That was the first time someone told Hannah about her body.
Hannah’s family never commented on her weight. When clothes for girls didn’t fit, her mother cheerfully lead them to the women’s section. Hannah knew that she didn't dress like her peers - that she couldn't.
Despite her parents' support, Hannah couldn't help but observe the ripple effects of being in a larger body. Her sister, four years older, had regular meltdowns in the dressing room. Low body esteem was not her sister's problem; rather, she struggled with severe mental illness. Unfortunately, to eleven-year-old Hannah, that distinction wasn't clear. Larger people are unhappy, she inferred. Their loved ones worry.
And so do their doctors. Hannah’s pediatrician told her that her BMI was too high and that she was at risk for type 2 diabetes. What was she to do with that?
Like most people who feel unsafe, Hannah hatched a plan to protect herself. At 15, she began going to the gym. By her senior year of high school, she obsessively counted calories. She got smaller. Suddenly, she was met with approval from the popular girls. She could walk into dressing rooms and walk out in one piece. For once, her doctor stayed quiet. Starvation had "worked."
The first semester of college saw Hannah partying, drinking, and getting late-night food with the girls in her dorm. She enjoyed the lifestyle, but hated what she perceived as the effects on her body. She abruptly switched dorms and abandoned her friends for “health reasons.” The dark mood which overtook her was only exacerbated by her body hatred. Far from “getting healthy,” isolation enabled her to begin binging, purging, and restricting in earnest.
The following summer symbolized a “fresh start.” She would begin her sophomore year at a brand-new college. For nearly every disordered eater, a “fresh start” means a brand-new body to go with it. That summer, she ran miles upon miles in the Texas heat.
I first met Hannah the following year. Some of our mutual acquaintances took her under their wing. In our mostly-secular school, these girls represented the small religious minority. Although Hannah had never identified as religious, their message felt good. You’re always loved. Your soul is what makes you beautiful - not your body. As the new girl, she didn’t want to draw attention to herself in the cafeteria by eating only a salad. If others were eating chicken strips, so would she.
One thing I hear again and again is this very sacrifice: even people deep in their disease often prioritize social eating over restricting in isolation. I don’t think this is a coincidence. If the roots of disordered eating are, to some extent, in social approval, in belonging, the swap is obvious. I’ll starve myself later if for now we can be friends.
In part to compensate for her newfound social life, Hannah continued to exercise obsessively. Her Christian friends were just as bent on staying fit, although the talk of disordered eating was less explicit. It was, in Hannah’s words, “generic girl stuff.”
“Wow, I ate so bad last night.”
“My stomach feels so big.”
Apparently, their beautiful souls only counted for so much.
Eventually, Hannah found her way into a group of friends that were a better fit for her beliefs. She began taking Prozac, which effectively diminished her hypercritical thoughts about her body. She relaxed into a new lifestyle and a loving relationship. By her senior year, she surveyed the "damage": she concluded that happiness had not been good for her, and promptly stopped taking her meds. She wanted to be happy, but not if it cost her a higher weight.
Hannah and her boyfriend moved to California after graduation, where she began to pursue weight loss with new resolve. Her boyfriend (now husband) has always loved the way she looks, and Hannah has to remind herself that they began dating at her highest-ever weight. While she can harbor her own, merciless judgements about her body, telling her partner that his opinion is wrong feels disrespectful. In learning to accept his opinion, she must offer a small degree of acceptance to herself.
Unfortunately, her dealings with the medical system make acceptance more difficult. This year, Hannah and her partner got married. She began the process of trying to “slim down” well before her wedding, and her strict exercise regimen lead to an injury. Exasperated, she went to the doctor.
For her knee injury, the doctor prescribed weight loss.
For her lower back pain, the doctor prescribed weight loss.
In fact: every time her BMI reads over 25, her visit summary reads "weight loss consultation" - no matter her presenting concern.
Not only is this irresponsible care, but it’s irrational. Hannah acquired the knee injury because she was pursuing weight loss. Her doctor did not bother to ask about her current diet or exercise habits. If she had, she would have learned that Hannah is quite healthy (which may explain in part why her vitals are perfect). Aside from the injuries acquired in pursuit of weight loss, Hannah is in great shape. Probably better than most.
I asked Hannah what the medical community could do differently. She said she would prefer a holistic assessment of her health. She wants her doctor to ask about her own history and that of her family members. She wants a chance to explain herself: what she’s tried, what hasn’t worked, and where it has lead her instead.
She once saw a nutritionist in LA who actually listened to her, and even provided a bit of much-needed perspective. When she stepped on the scale, he told her that she didn’t look her number. It was obvious to him that Hannah stores a lot of muscle. He asked what weight she thought she should be. The number she gave was absurd, and he told her as much: “You’re never gonna get there - nor should you.” He told her a healthier weight would be 45 pounds higher than the number she'd given.
In these interviews, I typically ask people about what they perceive as the deeper and more existential contributors to their eating disorder. After all: it isn't usually about the weight. For Hannah, however, the existential concerns cannot be so neatly separated from weight.
"Being an overweight kid changes you," she says. "You always feel different. You're always trying to overcome that."
Of course, like many people with disordered eating, Hannah also struggles with perfectionism. But it isn't just her disordered mind which tells her that her body is a failure; all around her is modeled the idea that to lose weight is to be successful. To accept her body as-is seems complacent.
At her wedding this year, Hannah’s mom gave a toast. “We’re glad she found you,” she said, nodding to Hannah’s husband-to-be, “because we never had any idea what to do with Hannah.”
This surprised the bride. What to do with me? I wasn’t a tough kid. I practically raised myself!
That much is true. While her sister battled severe mental illness and her parents responded to crises, Hannah created an elaborate inner world, a world with an escape route, a rigidly drawn path to safety. She inferred the pathways to success and failure, safe and unsafe, too much and not enough. She learned to be private, self-sufficient. She learned not to be the problem. She learned to deal quietly with trauma and prejudice that would destroy or infuriate most.
As I talk to Hannah, I realize I have been granted access something very special - something that many people do not get to hear at all.
At what personal cost has she remained quiet? At what cost to her family and friends has her pain been muted? At what cost to society do stories like hers go untold?