How Can You Get Enough Nutrients If You Don’t Eat Very Much?

Some of the more popular reality shows on television display various mental health pathologies such as super rich housewives always fighting with each other (when they are not having their hair done and drinking wine), or a show about hoarding to the point of suffocation, or even a view into living inside a 600-pound body that is so heavy, any movement is difficult and painful. The latter program is particularly sad, in that it shows how obsessive eating is almost always the result of early trauma, and how difficult it is for the overeater to deal with the pain of such trauma when the emotionally deadening effect of food is removed.

 

What has not been depicted so far is a reality program on the struggles of people at the other end of the eating spectrum. These are the people who believe that, like the Duchess of Windsor, one can never be too rich or too thin. These are the people whose body weight is so low that they run the risk of death. These are the people whose obsession with being extremely thin is as unshakable as the 600-pound individual who seems to be addicted to food.  

 

Perhaps the stories of the too thin are not told because the viewer may not be interested in watching an anorectic chase an almost invisible morsel of food around the plate, before grudgingly eating it and then exercising for three hours to work off the 3 calories the food may have contained. Or perhaps it is because the fashion industry has convinced us that thinness is something to be coveted, even if the price of a too thin body may be malnutrition or, if it becomes anorexia, even death.

 

A few weeks ago I walked past a facility holding a fundraising event. What caught my attention was a group of extremely tall women wearing gowns that would have looked appropriate on someone’s red carpet. They must have been models; they had perfect features, either from genes or a plastic surgeon. I confess I stared at them, not just because they looked so exotic in my neighborhood but also because they were so THIN. They were not skeletal but just on the other side of being all bones and no flesh. Another woman stopped and looked with me. She said, “They don’t look quite real, do they? But it must be nice to be so thin.”

 

Somehow we don’t think of being model thin as associated with health issues. The warnings about the risks of eating too much or the wrong kinds of food are well known, they are hard to escape: Don’t eat too much, don’t eat too much sugar, exercise frequently, and get rid of belly fat.  But how many of us know what medical woes are awaiting the very thin? One has to go searching for them. And some can be as deadly as those associated with morbid obesity.

 

When very little food is eaten, as must be the case if someone is to maintain a weight 20 or so pounds less than normal, an inadequate consumption of nutrients can result. Calcium and vitamin D deficiencies are common, and can result in osteoporosis. This disease, which is mainly silent until the first of many bone fractures occurs, is characterized by the loss of bone mass. This disease usually shows itself around menopause, but the bone loss due to nutrient deficiencies may start decades earlier. Other symptoms of nutrient inadequacy such as thinning hair, fatigue, dry skin and bruising of the skin also may not show up for several years, but can be traced back to a very low nutrient sparse diet. A study of the nutritional adequacy of the Mediterranean Diet in Spain among thin women indicated that they were deficient in vitamins A, D, E, B2, B6 and folic acid, as well as several minerals such as iron. (Ortega, R, Lopez Sobaler, A, et al  Arch Latinoam Nutr. 2004 Jun54; 87-91.)

 

Even athletes, whom one assumes eat healthfully, may be nutrient deficient if they are dieting. Female volleyball players who play the game in the scantiest of uniforms were found to be deficient in a variety of vitamins and minerals, due to their dieting in order to reach a figure perfect weight. (Beals, K,  J Am Diet Assoc. 2002;102:1293–1296). And dancers who must maintain low weight and low body fat are particularly vulnerable to nutrient deficiencies ( Sousa, M, Carvalho, P et al ,Med Probl Perform Art 2013 28: 119-123).

 

Models, dancers and some athletes accept the necessity of maintaining an abnormally low weight as one of the demands of their profession. They may be able to compensate for their restricted calorie, and thus nutrient, intake with the use of supplements. However, supplements rarely provide all the nutrients they would get from food, if only they were allowed to eat more. 

 

Thinness is also prized among women whose weight is irrelevant to their profession but not to their social standing. And its potential nutritional toll and subsequent health problems may be ignored as thoroughly as by an obese individual who cannot stop overeating. A quasi-sociological analyses of the lifestyle of women who live in the rarified neighborhood of New York’s Upper East Side points this out. In her book, The Primates of the Upper East Side, Dr. Wednesday Martin describes the non-eating that takes place at social events. Women diet continually and subject their bodies to workouts that would make a Marine recruit weep in order to have a perfect body. So many foods are eliminated from their diet in order to achieve the desired thin state? It is a wonder that the residents of this neighborhood don’t suffer from scurvy, anemia and other nutrient deficiencies. They are not addicted to food, but rather they are addicted to their almost pathologically thin bodies.

 

And yet this bizarre eating behavior is not the subject of reality television, or urgent messages from health organizations warning about its long-term consequences of nutrient deficiency. We see the consequences of the massive overeating of the 600-pound individual and tsk tsk at what that person has done to his or her body. Maybe it is time to tsk tsk over the damage the too thin are also doing to their health.   

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