Autoimmune Disease, Diet Challenges, Gut Feelings, Macrobiotics

How My Natural Thinness Contributed To My Chronic Illness

Two carrots draped with sewing tape that's tied around one of the carrots in a bow.

I don’t like seeing celebs looking too skinny, I love it when they look healthy and comfortable in their bodies and embrace their curves. ~ Lily James

Women I admired growing up – Debra Winger, Diane Keaton, Meryl Streep – were all beautiful and thin, but not too thin. There are a lot of actresses who are unhealthy-skinny – much, much too skinny. You can’t Pilates to that. ~ Zooey Deschanel

Really skinny actresses make me hungry – I see them and think, Honey, you need to eat! ~ Miranda Lambert

I was very skinny, but that was just my natural build. I always ate sensibly – being thin was in my genes. ~ Twiggy


I. What It’s Like To Be Skinny (And Self-Conscious)

Growing up skinny, I was told conflicting things about my body. My father, women’s magazines, and society in general told me I was lucky. “Most women would kill to be thin,” Dad said.

But some doctors, and my peers in grade school, and even some peers in adulthood, made comments that made me feel unattractive or unhealthy. I was thinner than many models. Despite the fact that I was healthy, some people saw my thinness as something to “fix.”

It was easy to become confused. Was I attractive or sickly? Was I truly healthy, or was there something wrong with me? In retrospect, I believe that my confusion about my thinness was a major, if subtle, contributor to my eventually developing ulcerative colitis. I’ve written this essay to illustrate what I mean.

I have always been skinny, ever since I was a baby. If you can picture a skinny baby or a lanky toddler, that was me. My mom says people often predicted I’d be a piano player: “Look at those long, slender fingers!”

In middle school, I auditioned for the movie “Even Cowgirls Get the Blues” because the director was looking for a long-necked girl my age to play a flashback of the main character. When I walked into my audition, the casting director exclaimed, “Oh, her neck just goes on forever!”

A year or two later, on an eighth-grade field trip to Washington, D.C., I went swimming with the other kids in our hotel pool. I found myself in the elevator in my swimsuit with two of the popular girls, also in their suits. One of them gaped at me. “You are so skinny.” It wasn’t exactly an insult, but more a gasp of astonishment. The other girl nudged her, admonishing, “That probably doesn’t make her feel very good.” Silent and by now excruciatingly shy, I said nothing.

Like most middle-school-aged girls, I had begun to develop self-consciousness about my body. For me, this self-consciousness centered on my skinniness. By eighth grade, I knew what Dad really meant when he said women would kill to be thin: most women would kill to have a model’s figure. I didn’t have a model’s figure; I was just plain thin. I felt like a failure as a woman.

In my teens and early twenties, I hid what I saw as my freakish body beneath enormous shirts and pants. I never wore shorts because they would reveal my spindly legs, and because I refused to wear shorts, I didn’t play sports either. I felt safest when enveloped in protective folds of cloth, although I was unwittingly making the same tragic mistake of skinny teens the world over: unfortunately, baggy clothes only make you look skinnier.


Despite Americans’ worship of slender-but-curvy young women, I gradually realized there’s also a stigma against skinny women. Especially those who are older, or those who are less conventionally attractive. They are often assumed to be anorexic or unhealthy, and in literature, they’re typically portrayed as high-strung and/or controlling. Harry Potter’s Aunt Petunia is just one of countless examples.

Along with this subtle stigma, in recent decades there’s also been an active backlash against unrealistic body expectations for women in general. I’ve overheard countless judgmental comments about skinny women, especially from other women: “Woah, she is scary skinny.” Such comments make me cringe. They might as well be describing me.

Pop hits like “Baby Got Back” and “All About That Bass” seem almost pro-women in this light, since they rebel against the magazine-cover ideals. There’s an attempt at feminism in such comments and songs. By putting down slender women, people are trying to uplift women with more typical figures or those who are self-conscious about being heavy. No thoughtful person wants women to aspire to thinness if their bodies aren’t made for it. There are indeed many ways to be beautiful.

But I have a better idea. How about no body shaming, of any women, including the skinny ones? How about encouraging all women to be as healthy as we can, however that looks for our bodies?

As a teen, I worried that if people saw me jogging, they’d assume I was anorexic. Why else would someone already so skinny want to do this activity that most people do to lose weight? In reality, I exercised because I loved being in shape and had boundless energy. And I ate like a horse—on at least one occasion, around age sixteen, I easily downed a large pizza by myself. The fact was, like Twiggy, I simply had an extraordinary metabolism.


My body-image problems began to heal when traveling and living in Africa. Volunteering in rural Ghana during college, I found that my whiteness eclipsed everything else that might look strange about me. All white people look alike—rural Ghanaians had trouble telling me from the other two white women in my volunteer group, despite our different hair colors, body shapes, and facial features.

And young, white, American women are interesting and attractive in much of Africa, which is a symptom of both crushing poverty and of racism’s awful pervasiveness throughout the world, but which admittedly helped boost my self-esteem as a self-conscious young woman. It’s hard not to feel at least somewhat attractive when you get several marriage proposals in the span of a month.

Even in Africa, though, I sometimes felt exceptional and freakish. A few years after my first trip to Ghana, during Peace Corps in Tanzania, I learned that weight was generally considered attractive there, a sign of health and prosperity. A slender figure was seen as worrisome. In my Peace Corps village, when someone returned from a long trip, a polite greeting was, “Oh, you look great! You’ve gained weight!” When friends were worried about me, they might intone, “You’ve lost weight,” with notes of concern in their voices.

Other American Peace Corps women were often irked at Tanzanians’ matter-of-fact observations about our appearance. Nothing was more offensive to one of my friends than the occasional: “You are fatter than Katie!” The locals, of course, meant this as a compliment—to her, not to me. They were often bemused by our angry protests that “fat” was a serious insult to an American woman.

I was also sometimes told that, coupled with my frightening white skin, I looked like a wraith to the untrained eye. A few times, babies or toddlers burst into tears at the sight of me. Nearby adults would giggle, explaining that the kids thought I was a ghost, since ghosts in local stories were described as both white and skinny.

So even living in Africa, my appearance was a mixed bag.


Only when I finally started dating, midway through Peace Corps, did I begin fully recognizing and confronting my body-image issues. Ron, who is now my husband, was the volunteer down the road and my first boyfriend. Aware of my deep self-consciousness about my appearance, he took pains to assure me that I was pretty. He started describing me as svelte, which I loved.

(He also found ways to gently tease me about my self-consciousness. Our joke was that I would sometimes ask him, “Does this make me look skinny?” Actually, I think I did ask that at least once!)

Later in my twenties, with therapy, I finally overcame my body-image issues. Part of that therapy was collecting mental images of women with bodies like mine who were considered beautiful, or who I thought were beautiful. I had been unconsciously collecting such images in my mind for years, I realized. Occasionally, I would encounter a slight-framed woman in art, film, or literature who was beloved and admired. I loved finding these women, and gradually, I came to see myself as reasonably attractive, too.

I know that, in our country and many others, heavy people have a great many struggles, and that my struggles are dwarfed by theirs. The stigmas for skinny women and girls are far subtler than those for heavier women and girls. I was never, for example, subjected to outright bullying about this issue.

And my slenderness has given me countless little privileges that are hard for me to even recognize, just like the subtle privilege that has always come with my white skin, my straight sexual orientation, or my health (until I lost it). Slimmer people get more respect than heavier people, especially slimmer women compared with heavier women.

For all the slights I experienced as a slender woman, society is far crueler to larger people. Just look, again, at Harry Potter—I love J.K. Rowling in general, but she’s relentless when it comes to her treatment of Aunt Petunia’s “fat” son Dudley. I wonder if she now regrets this, and I suspect that, being a conscientious person, she might. Perhaps she didn’t realize, when she wrote her books, that she’d have countless young readers who were struggling with body image and weight.

So the point of this little history is not to complain about being skinny as opposed to being overweight or even average. It’s just to let you, the non-skinny person, know that thinness can have its disadvantages. And it’s to let you, the fellow skinny person, know that you weren’t alone in your self-consciousness.

Predictably, in our society that so mercilessly objectifies women, as a teen I found ways to decide I didn’t measure up to the supermodels. This poor self-image also had major implications for how I made health decisions all my life.


II. Not All Health Advice Applies To Me

Growing up and into adulthood, it always seemed clear that I “needed” to gain weight. According to various doctors and nurses and body mass index charts, I was underweight. I didn’t yet understand that doctors don’t know everything (and often disagree with each other), and that body mass index is a generality and there are other ways to measure health.

In terms of energy levels, physical strength, immune function, sense of happiness and well-being, and any other measure besides body mass index, for most of my life, my health was exceptional. But unfortunately, it was body mass index that sometimes caught the eye of medical practitioners, contributing to my belief that there must be something wrong with me.

As a health-conscious adult, I would often become confused when reading nutritional advice. I would be reading about the benefits of eggs, say, or of a plant-based diet, or of taking this or that vitamin or supplement. And just when I had become convinced to try it, I would reach the inevitable: “It also helps you lose weight!” This statement always made me balk. I would be left wondering whether this particular food or supplement or diet was right for me.

Virtually all diet advice in America is written with the assumption that the reader wants to lose weight. Since I’ve long had the opposite desire, it was not unreasonable for me to wonder, for most of my youth, if I should do the opposite of what was recommended for most people. If avoiding carbs helps you lose weight, then shouldn’t I be pigging out on pasta? If cutting meat and dairy and sugar was advisable in order to lose weight, then shouldn’t I pile on the cheeseburgers and ice cream?

A close-up of of a pepperoni pizza.

Over the years, plenty of people, including medical professionals, have urged me to bulk up by eating foods that for most people would be considered unhealthy. In my teens, at least one doctor agreed with my mother that a nice, big bowl of ice cream each night was a good idea. Advice like this was always welcomed by me, of course, since these foods were the tastiest!

Later, especially in the 2000s as cooking with real, unprocessed food began making a nationwide comeback, doctors and nurses began recommending healthier fats to me, such as peanut butter and avocados. They would caution that fat quality is important…but I liked cheese and bacon far more than avocados. And, I reasoned, I could eat much more of those tasty foods than I could stomach of the healthy fats, because I enjoyed them so much more. Wasn’t fat quantity important, too?

So in my day-to-day decisions about what to eat, my exceptional metabolism and the conflicting advice I’d heard over the years made it easy to rationalize often opting for the tastier fats.


The same confusion prevailed around exercise. If high-intensity interval workouts were good for weight loss, then I probably shouldn’t do them too often—right? Especially in 2013, when my goal was to become healthy enough to have a baby, and “healthier” for me primarily meant “heavier.”

Early that year, I mentioned to a nurse that I hoped to get pregnant soon, and she advised me to put on some weight. Apparently, the only thing wrong with my health was my body mass index. So it stood to reason that for me, “healthy behavior” meant eating lots of carbs and cheese and ice cream and not exercising overly much. And that was exactly what I did.

And by the end of that year, I had ulcerative colitis.

After diagnosis with my new autoimmune gut disease, I of course came to recognize the folly of my thinking about diet. Before UC, I hadn’t known anything about digestion or the risks of eating tons of inflammatory food while not exercising. The less-tasty fats were, it turns out, the ones I should have been choosing most of the time. No one knows the causes of my disease, but after diagnosis, I realized that I had essentially been abusing my colon for years. My natural thinness had allowed me to get away with it. Till now.


III. Learning to Discern: Picking and Choosing the Right Advice for My Body

In 2014, with my colitis, my health goals became rearranged. I had fallen into a hole and my main goal was to climb back up to to where I had started. Before I got pregnant, I first needed to get my health back.

Just as it had all my life, my skinniness added another level of complexity to my quest for health. For instance, while it’s generally okay to get pregnant with ulcerative colitis, for me it seemed unsafe because of my still-low weight. And while macrobiotics was working well for me, I fretted about losing more weight on this new diet—which, of course, comes with the cheerful benefit that “It’s also great for losing weight!”

The perpetually low-fat proportions of the macrobiotic recipes made me ravenous at first. But fortunately, Ron knows a thing or two about nutrition, and he helped me learn how to adjust the meals for my thin body’s special needs.

I finally began learning to eat those healthy fats the doctors had sometimes recommended. If a recipe called for a tablespoon of sesame oil, I would add three. I would also add olive oil, toasted sesame oil, coconut oil, tahini, or sugar-free almond butter as a topping to many meals, and I was learning which oils and nut butters tasted best with which recipes. I often ate avocados, and I learned to tell when they were perfectly ripe, so that the skin easily peeled off and the taste was sweetly delicious.

When I added enough fats and oils to my macrobiotic meals, I didn’t wind up hungry at the end. And I was beginning to enjoy and even crave their tastes the way I had once craved cheeses and meats, though I still sometimes craved and missed those, too.


It took a discerning eye to ferret out which diet advice should be my diet advice. Most of the things Virginia Harper or any other macrobiotic proponent wrote about macrobiotics did apply to me, but whenever weight loss was used as a justification for a particular element of the diet, I had to do a little more thinking.

For instance, take dairy. Macrobiotics forbids dairy, especially cow-milk products, because—Harper explains—the poor digestion of lactose can cause discomfort in many people. The milk protein casein is likewise inflammatory, even sometimes stimulating Type I diabetes in sensitive people. She goes on to describe the problem of added fat:

A quart of milk contains 35 grams of fat, with 60 percent of whole milk being saturated fat. These 35 grams represent about half of all the fat an average 150-pound man should consume in one day.

That passage struck me as a scare tactic. Who drinks a quart of milk, anyway? I penciled a protest into the margin: fat = good for me. (Although it is possible to be “skinny fat”, I doubted I was in that category, especially now with my lost weight.) I wasn’t certain I was either lactose or casein intolerant. If I wasn’t, then did I, personally, really need to avoid dairy?

I decided to stay off my beloved cheeses and milk products for now, since I couldn’t be sure whether they caused me inflammation. Once my health stabilized, I could experiment with them. But I knew that in my case, avoiding fat wasn’t a good enough reason to abstain from them.


Until colitis, I had never understood how dangerous it had been to take my health for granted. I had also not understood how mistaken doctors can be. Over the years, I had gotten the message that I was somehow unhealthy even when I had felt vital and fit and happy, simply because I was thinner than average. I wish I had just trusted my own feelings of vitality instead of trying to “fix” something that wasn’t broken.

Once I got colitis, I belatedly began taking my health very seriously. I just hoped it wasn’t too late to salvage it.

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