When Sarah Rees Brennan lost a lot of weight and started to faint, she went to the doctor. Doctors speculated she was suffering from low blood pressure, which caused her to faint. But the symptoms persisted, eventually affecting her work as a fantasy writer.
“Suddenly, my sentences became blurred,” the 39-year-old writer from Dublin told TODAY.com via email. “Reading it aloud, the way the words are strung together doesn't even make sense. I really care more about my mind than my body.”
As she continued to lose more weight, she recalls doctors having the same reaction — praising her for the weight loss. Three years later, she was diagnosed with stage 4 non-Hodgkin lymphoma, a cancer that begins in the lymphatic system.
It's not uncommon for Dr. Rebecca Puhl, associate director of the Rudd Center for Food Policy and Health at the University of Connecticut, to present unexplained weight loss to health care providers only to ignore the symptoms and be told they look fine, telling TODAY.com.
“People's automatic assumption that if a person is thin, they must be healthy is wrong … and it's worrisome,” Puhl said. “Significant weight loss, especially in people who aren't trying to lose weight…may indicate a very serious health problem.”
“I was told I was a whole new person.”
Brennan usually gets bronchitis, pneumonia or other ailments a few times a year, which her doctor simply treats and sends her home. At one point, she asked if there was a rash around her mouth, and the doctor told her it was an allergic reaction, but she was skeptical.
She recalls that when she sought medical care to lose weight, she was often complimented, even though she didn't change her habits in a way that caused her weight to change.
“One doctor said approvingly that I was healthy, even though I had basically had pneumonia for a year,” she said. “I've been told I'm a whole new person. I don't want to be a whole new guy, but everyone seems to like this new guy better.”
Brennan added that her GP saved her life by sending a sample of her blood for testing and helping her confirm the lymphoma diagnosis. But even a GP “would never guess how sick I was, when I looked this good,” Brennan said.
Brennan lost even more weight after undergoing chemotherapy, and even though she was dangerously thin, she got more praise. Naturally, she begins to have mixed feelings about her appearance. She took pictures during and after the treatment as she gained weight.
Years later, she still thinks about those photos.
“I'd love to say I love how I look in the ‘after' photo, but I don't,” Brennan reflected. “I look at ‘before' pictures and I think I look bad, but I see my stomach is flat. It's not anymore, some part of me thinks it should be. Cancer made me feel bad about what I used to be Unbelievable weight created doubts. … I was hardly at all completely satisfied.”
“Praise instead of investigation.”
A growing body of research shows that weight is not the best indicator of health, despite what many people believe.
Puhl explained: “There is of course growing evidence that people can be healthy in different body sizes, and traditionally using BMI as an indicator of health is not sufficient. We have to be careful about making assumptions based on a person's health status.” .their size, which can be on both ends of the spectrum. We can’t assume someone is neglecting their health just because they’re big, and we can’t assume that someone who’s thin is perfectly healthy.”
For the past two decades, researchers have been studying BMI and mortality and have found that the relationship is not what most people think. For example, a 2016 study published in the Journal of the American Medical Association (JAMA) found that grade 1 obesity (BMI between 30 and less than 35) was associated with higher mortality compared with people of normal weight unrelated, and those classified as overweight actually had a lower mortality rate than those of normal weight.
The study was led by Dr. Katherine Flegal, a former senior scientist at the U.S. Centers for Disease Control and Prevention. Her work on BMI and mortality is the “gold standard,” journalist Virginia Sole-Smith, author of “Eating Instinct: Food Culture, Body Image and Guilt in America,” tells TODAY.com. “[It]shows that body weight doesn't have nearly as much of an effect on mortality as we thought.”
But despite the research, “we live in a culture…with negative stereotypes of people who are heavier or larger…without motivation, self-discipline and willpower, and where individuals are responsible for their weight ,” Puhl said. “These stereotypes are very common and often go unchallenged.
As a result, drastic weight loss is often viewed as “laudable rather than investigated,” Sole-Smith said, adding that health conditions may go untreated if underlying the weight loss. She stresses that this doesn't just happen to underweight people, who lose weight and are praised for being skinny: “It happens especially to fat people, they become less fat.”
“When a fat person loses weight, there is almost universal praise from people in their lives — strangers and doctors alike,” Sole-Smith said. “Anti-fat bias does harm the medical services available to obese people. … If I have an underlying issue that is causing me to lose weight, but my doctor is perfectly happy that my BMI is… two points lower, then they won't investigate further.
Weight stigma primarily affects larger people and can lead people to avoid health care because they may not want to be ashamed of their weight or praised for losing weight.
“What the anti-obesity bias really wants is to consistently push fat people not to be fat, so fat people are the most vulnerable to this problem,” Sole-Smith said. What to do to manage weight?’ You can walk in with a stuffy nose and expect weight loss talk.”
“I felt disrespected. I felt like no one heard.”
Ashley Teague, 30, of Indianapolis, did seek medical care for unexplained weight loss, but her concerns went unheeded.
She hit her peak weight in 2018 after her mom underwent cancer treatment and her uncle passed away. At the end of the second year, she began to lose weight, but she didn't expect it. Then in 2020, she noticed blood in her stool and went to the doctor.
“I thought, ‘Hey, doc, I'm losing weight for no apparent reason,'” Teague told TODAY.com. “They did a blood test, but for whatever reason, it came back fine.”
At this time, Tigger saw that her face was obviously thinner, and she was a little worried. Her mom has Lynch Syndrome, a genetic disorder that increases the chances of several different cancers, including colon cancer. Teague told her doctors about it, but they insisted she was healthy.
“I try to subconsciously tell myself, ‘Well, you're fine. You look good,'” she says.
But she still had blood in her stools, and her toilet habits had changed.
“Everything I eat, it could be a kale salad, some fresh fruit, it could even be a brownie or an ice cream sundae, wherever it is on the food spectrum … within 15 to 20 minutes at the most, I have to Run to the bathroom,” she said.
A Google search for her symptoms led Teague to think she had colon cancer, and she requested a colonoscopy, which was denied.
“[The provider]literally repeated to me that I looked fine and they wouldn't allow a 28-year-old to have a colonoscopy,” she said. “She said, ‘I'm going to write you a prescription for IBS. We're going to treat that.'”
After that appointment, Teague started having side pains that caused her to be hunched over, so she went to the emergency room, where several scans were performed but found nothing wrong. But she was officially considered at high risk for colon cancer after her father underwent a colonoscopy that revealed cancerous polyps.
“I said, ‘I have the same pain on one side. I've lost a lot of weight. I see blood in my stool a lot now and I just talked to my dad who just had a cancerous polyp removed from his colon. Immediate family Is that enough?'” Teague recalled. “From then on, it was like, ‘Oh my God, let's scramble.'”
Teague was diagnosed with aggressive stage 2 colon cancer and underwent surgery to remove most of his colon. Fortunately, her lymph nodes were not cancerous, but she was shocked that so many people told her she was fine despite her weight loss and bloody stools.
“I felt disrespected. I felt like no one heard,” she said. “I don't understand. I'm literally overwhelmed.”
“At least you'll never be fat.”
Victoria, a 34-year-old London-based lawyer who asked TODAY.com not to use her surname, has struggled with people praising her for losing significant weight due to Crohn's disease, which she has suffered since she was 15. disease. Crohn's disease causes swelling of the digestive tract, leading to stomach pain, diarrhea, fatigue, malnutrition, and more.
“I was a fat kid and people would say, ‘Oh, it's puppy fat, you're going to grow up.' So, I think part of the time people thought[when I first lost weight]'Oh , she's grown up,' she told TODAY.com. “As I get older, I get a lot of comments like, ‘Oh wow, you look amazing,' and at the same time I feel the worst. “
In 2022, Victoria became “thin” and “nearly died” after a horrific bout of Crohn's disease, she recalls.
“I was very sick physically. Some days I threw up 30 times a day. I was nourished through my veins,” she explained. “There was very little glamor in my life back then, and I still got comments like, ‘Oh well, you look great.'”
Victoria spread the word about Crohn's disease to friends and family on social media. Sometimes, when people complimented her on being so skinny, she would confront them and say illness had caused her to drop the weight. But even people who knew she was very ill praised her body.
“The comment I've heard so many times is, ‘Oh, well, you have Crohn's disease, which sucks, but at least you're never going to gain weight,'” says Victoria. “I just think it's weird to say that.”
As Victoria, Teague and Brennan have all seen first-hand, people are quick to believe that being thin means that one looks “great” and that “everything (about their health) must be fine,” says Puhl. “That's a very dangerous assumption.”
