Military and medicine: shared risk factors for eating disorder development [PODCAST]

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“To reduce eating disorder risks and to support those who may be suffering in silence, we need to keep talking and promote awareness of the issues while clarifying long-held misconceptions about eating disorders. We can’t help those who do not feel able to speak up. We can’t help people that speak up and can’t access treatment. We can’t help when we constantly contribute to the problem through the cultures we create and perpetuate.

With awareness of these concerns, we must use our voices to improve the culture of medicine and the military, including combating harmful messages around weight that instill shame and avoidance while lacking evidence-based rigor to back up their claims.

We must reduce mental health stigmatization and the shame associated with asking for help. We must create psychological safety to talk about the hard things and end anyone’s suffering in silence.”

Jillian Rigert is an oral medicine specialist and radiation oncology research fellow.

She shares her story and discusses her KevinMD article, “Military and medicine: 10 shared risk factors for eating disorder development.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today we welcome back on the show Jillian Rigert. She is an oral medicine specialist and radiation oncology research fellow. Her latest article is “Military and medicine: 10 shared risk factors for eating disorder development.” Jillian, always great to see you again.

Jillian Rigert: Yes, thank you so much for having me back, Kevin. I love everything that you’re doing, and I appreciate you having me back on the show.

Kevin Pho: Yes, and for those who haven’t listened to our first few episodes together, I highly encourage all of you to seek them out, because they’re all wonderful. So today, I am actually going to jump straight into your latest article, “Military and medicine: 10 shared risk factors for eating disorder development.” Jillian, for those of you who get a chance to read that article, just briefly share the story of why you decided to write it, and walk my audience through it.

Jillian Rigert: Yeah, I decided to write the article because, one, if you go back to our previous articles and our previous podcast opportunities together, part of my story is that I was an Air Force oral surgery resident, and during that time period, I developed pretty severe suicidal ideation. To manage the symptoms of suicidal ideation and major depression, I numbed myself through eating disorder behaviors, which was anorexia. So I had the ability to observe the risk factors that were shared between military and medicine for the development of eating disorders.

At the time, I also had the ability to appreciate the gaps of knowledge that were in both the military and medicine. It was a very interesting point of view to understand that people, I think, are making eating disorders more complex. Anorexia seems to be glorified, and binge eating disorder and things where there are extreme weight biases are causing people a lot of shame, which is very disheartening to me. I think we certainly need to increase our knowledge of eating disorders and our awareness.

And then the third thing was that I also appreciated that there is a lack of evidence-based care models and treatment that is very effective for management of eating disorders. So I really wanted to get these conversations going. I know they’ve been going a little bit, but I wanted to bring my lived experience to the conversations and invite people who have lived experience to share their voices, because eating disorders often lead people to be silent, especially when they’re in systems where it’s not understood, or people think they’re too complex, so they keep referring. And that’s doing a major disservice to many.

Kevin Pho: So you wrote in your article that there are risk factors within the military and medical culture that create perfect storms for developing an eating disorder. So tell me what some of those risk factors are.

Jillian Rigert: Yeah. If we think of eating disorders and what their role is for an individual, what I think they are is coping skills. For me, anorexia came when I was having overwhelming emotions. I was feeling inadequate, and it helped to numb me from the pain of feeling inadequate. When I developed suicidal ideation, lost my appetite, and didn’t think I was worth living, anorexia became kind of a passive suicide. And so it’s really understanding the role of an eating disorder in a person, and then who’s at risk for using that tool as a way to help them cope, or what creates a circumstance that might put somebody in need of such a relief from the pain that they’re experiencing.

I often equate anorexia and eating disorders to an addiction, so if people can’t understand or think that eating disorders are too complex, they might equate it to somebody who’s dealing with an addiction.

As for the risk factors that I identified, of course, there are more. And I also want to say, you know, my initial training was in dentistry. This is applicable to dentistry, it’s applicable in nursing, it’s applicable to being a lawyer, it’s applicable to being a teacher. I’m sure it’s applicable to many different professions. The reason it’s written about medicine and military is because this is where I was at, and this is what I’m currently in my healing journey from. So that’s the perspective that I bring, and of course, translate it to how it applies to wherever the listeners are and whatever career they’re in.

So the risk factors were individual predisposition. Often we think of type A personalities, high achievers who might feel that need to be perfect, which comes in as another risk factor: that striving for perfection, never feeling good enough. So you might use an eating disorder to cope with that and feel that, you know, if I think about especially our weight bias and diet culture, “If I eat less and exercise more, I’ll feel more valuable.” It’s an illusion of increasing your value from being able to do those things.

And then the next thing was the inability, or the reduced ability, to express our emotions. If we think of eating disorders as a coping skill to really numb ourselves or to feel better, because the emotional experience or the physical trauma that we’re having is very painful, then we might use eating disorder behaviors, whether it’s restriction of food, eating food, or doing anything that is an eating disorder behavior, to help give relief for whatever that other experience is.

And then we talk a lot about moral injury and trauma. That’s another thing that brings a lot of pain for a person, emotionally, spiritually, and physically. And so eating disorder behaviors can come as a way to help that person cope with that experience.

The weight bias is something I’d really like to focus on, because the weight bias is in the military. You have to meet weight standards in order to stay in the military, which causes people to do extreme things before they get weighed. That hyperfocus, and how poor that is for a person’s mental and physical health, is not really discussed. And then when I developed anorexia, I just felt inadequate support and understanding. So people who are in the military, who are facing these weight biases, who are in a culture where weight is highly emphasized, are at higher risk for developing eating disorders. That’s a known entity if you look at articles coming out about the military. And then they don’t feel like they’re able to speak out because of the fear of losing their career.

We translate that to medicine, where we’re constantly harping on our patients about their weight. How does that affect us as the physicians? Because we keep hearing our own messages. We are inundated with messages that people should strive to lose weight. How does it make us feel? And really, is it necessary? Like, what’s the true evidence behind these weight stigmas?

And then there’s our delivery to patients about their weight. Something that just happened to me: Why I started speaking up about my eating disorder is that last year, I almost lost my life to anorexia, and so I was very medically compromised. So over this past year, I’ve gained quite a bit of weight, which is a very good thing. But I went to a primary care physician, and I was concerned about heart failure symptoms. I started the conversation with the heart failure symptoms and gave the symptoms that I was having. Of course, with the background in medicine, I knew what those symptoms were, with an understanding that I was at risk because of anorexia. I was very nervous. She immediately grabbed on to the weight number that I provided as my weight gain and started counseling me on weight management.

This was a televisit, thankfully, because I felt physically safe. But I was just so appalled, because I was like, “Oh my gosh, this person knows. She can see all my medical records.” I’m, you know, ex-military; we have shared medical systems no matter where we’re at. In order to preserve myself from hearing this weight shaming, and as an educational opportunity for her, I told her, “Yes, I’m recovering from anorexia, where I almost lost my life last year.” It was like a moment of celebration, right? Yes, I gained this weight, and I have an article on your platform about it: As I regain weight, I regain my life. And in the moment, all she could think about was, “Oh my gosh, we really need to extinguish this fire of weight gain.” I had called for symptoms of cardiac failure, and then I had to advocate for myself. I’m currently in the middle of a cardiac workup, and I’m feeling better, thankfully.

But people are getting weight-shamed all the time. You hear it all the time. They came in for an asthma attack, and they’re immediately weighed. They came in for something medical, and, you know, it’s likely that society’s been reminding them of their weight all the time, and their shame for their weight, and their medical workup is maybe delayed, or not even performed. So we’re being blinded by our weight stigma.

And so for people in the military and in medicine, where we have all this weight stigma, if a person has an eating disorder where they’re coping because food makes them feel better, well, then we’re increasing their weight, and we’re actually contributing to the weight problem. Or we’re contributing to more eating disorders that are restrictive, no matter what the weight, in order to prevent people from feeling the pain of this weight bias. So that number four, we could talk about for years. That’s such a component of our system that really needs to be changed.

I’ll go quickly through the other ones, because they’re very similar in that the eating disorder shows up as a coping skill. In medicine and the military, we have decreased autonomy, so for feelings of control, we may gravitate toward feeling control of food, our body, and exercise, in the form of feeding certain behaviors. And that shows up with our constant transitions in medicine. You know, we go from rotation to rotation, or we go from education to a career, or a career to a new job, or a new job to then you’re married and you have kids. There are constant transitions that you’re trying to navigate.

And then there’s if we have comorbid medical or mental health conditions, such as, you know, we’re hearing a lot more about suicidal ideation, as I mentioned, and depression. If I need to relieve myself from the darkness of depression or anxiety, it’s tangible for me to focus on food and running, and what it does is it just numbs me out completely. But if you’re numb, you’re numbing yourself from both the positive and the negative emotions, so you just kind of become a shell of a person.

And then, of course, there are the misconceptions that I mentioned, why we wanted to bring this to the attention. And, you know, of course, this is such a robust conversation that we could talk about it for a long time, and I invite that, not only for my voice but for the voices of all who have knowledge and awareness of eating disorders and how this affects them in their life, so that we could really start to break down appropriate next steps in people’s healing.

And then the mental health stigma. Something that always comes to mind when we think of medicine and the military is, “Can I ask for help without fear of blank?” Fear of losing my career was my top fear, and fear of licensure was another fear. And I waited until the question was, “If I don’t get help, I’m going to lose my life.” And as I mentioned to you, it wasn’t clear to me at that time whether or not I would get help, because, like, well, if I leave, I thought my life was pretty much over. So we need to stop putting that pressure on people. It’s not true. You know, it’s not true. Your life is far more valuable than your career, because without your life, your career won’t be there, and the world needs you. So it’s really important to continue these discussions.

Kevin Pho: Now, let’s say I’m a clinician listening to this podcast or reading your article, and they realize that some of these risk factors that you mentioned apply to them. What are some of the next steps that they should take?

Jillian Rigert: Yeah, with the risk factors, if they’re noticing, you know, weight stigma is everywhere, and it’s just noticing where they’re getting their messages and how it’s affecting them in their daily lives. And also just noticing what the role of an eating disorder could be, if we name it. So if I say, “Oh, well, you know, I have eating disorder thoughts all the time,” and if I name the role that they have in my day-to-day life, it’s like, “Oh, yeah, I’m feeling pretty inadequate today.” Well, then I’m going to dive inward and say, “How can I find purpose and value in my life without relying on this coping skill to numb me?”

Kevin Pho: Now, over the last few articles, you’ve been very, very open about your past with eating disorders in general. What has the response been?

Jillian Rigert: I feel like people understand more of the eating disorders that might be binge eating disorder and have a relationship with food that brings some comfort. I have gotten some private messages from people who have lost their children to anorexia. I have felt that that’s a smaller group of individuals that have reached out to me, but I do think it’s because anorexia is kind of glorified, and, you know, especially if it’s something that people hold on a pedestal, there’s a lack of understanding. People often say, “I wish that I had the emotional response to food that when I was feeling this way, I wouldn’t eat.” And so it really highlights the fact that people don’t understand what the heck it is to live with anorexia.

So I did create a video on my new YouTube channel, which, you know, we were talking about before this conversation, and it’s demystifying and deglorifying anorexia nervosa, so that people can really start to understand what it’s like to live with anorexia. And then the people who are affected by it themselves, or have loved ones, can really start to understand what it is, because Hollywood’s done a really strong disservice, and even our medical education keeps promoting the stereotype. I know I’m a Caucasian female, so I do fit the mold of a stereotypical person with anorexia. However, as I mentioned, the role of anorexia was to numb me from my own insecurities and feeling like I wasn’t worth living. It wasn’t because I wanted to be some supermodel. So it’s trying to break those stereotypes.

So, of course, I think anybody who’s going to converse with me and ask me questions, I welcome that. And if there’s any sort of thing that triggers me, well, then that just reinforces that I have more work to do on myself. And then, if someone weight-shames me, or, one of my biggest fears for advocating for anorexia was, like, I’m no longer severely malnourished. Do I have to prove to them that I was that sick? Because that happens a lot, where people show the before and after, which feels like they’re validating that they were super sick, which actually does a disservice for people in bodies that look healthy but are struggling with restrictive eating disorders.

So I thought, if someone were to actually comment on my body, what it took for me to actually lean in and just keep talking was this: I have so much self-compassion for my body after the trauma that I’ve put it through. They can say whatever they want, and it’s more of a reflection of their own internal biases and their own internal struggles, and I can help support them. Not for them, but I use my voice for me. I use my voice for the people who will use their voice eventually but maybe need a kickstart and a little bit of support.

So I think the overall message is just to keep using your voice. People will say things all the time. Anorexia showed up for me when I didn’t know how to speak; I turned everything inward. And so the more I speak, and just keep speaking and letting it out, I think the more it is healing and providing the connections that help support healing for others.

Kevin Pho: We’re talking to Jillian Rigert. Her latest article is “Military and medicine: 10 shared risk factors for eating disorder development.” Jillian, what are some of your take-home messages that you want to leave with the KevinMD audience?

Jillian Rigert: I’m a huge Martha Beck fan, so I have many Martha Beck quotes that are huge takeaways for me. We talked about naming it, like naming the role of the eating disorder, naming whatever the thing is that that person’s struggling with. So I have one of her quotes. This is Martha’s quote: “True freedom starts with absolute honesty. The moment you call a problem by its real name, you’re already learning how to make it less harmful.” Martha Beck, I love her very much. If you’re in a career or life transition and navigating through MI without the labels, then The Way of Integrity is the book I highly recommend.

Kevin Pho: Jillian, thanks again for coming back on the show and sharing your time and insight.

Jillian Rigert: Thank you so much for having me, Kevin. I appreciate you.

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