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Wednesday, December 18, 2013

The Physical Weight of IBD

7:32 PM Posted by Stephanie Horgan , , ,
Weight no more...I finally am writing a blog entry on the physical weight of IBD. I had mentioned it in an earlier post and was reminded of this topic by a brilliant entry by Christina at The Crohn's Diaries and a video by our friends at the Great Bowel Movement called the Weight of IBD.

In a culture obsessed with appearances, what's a patient to do? When diagnosed with a chronic illness, patients young and old want to know, "Am I going to look different?" The answer with IBD is usually yes, at least at times. The classic example is when a patient is on Prednisone. You want to see weight gain?! You want to see water retention?! In regards to appearance, these powerful steroids can fluctuate weight significantly, as well as create the moon face phenomenon. I liked to call it "chipmunk cheeks" and this was something I personally endured for about a year in college. Literally every day I would get asked, "Did you just get your wisdom teeth out?" By the end of that year, I was about ready to punch anyone that asked that insensitive question in their non-moonface so that they would join me. I won't go into all the mental or emotional side effects that go along with Prednisone, but I love this fake ad.

Even if you never come into contact with Prednisone, your weight may still fluctuate significantly. As IBD patients, we have chronic diarrhea which takes a toll on nutrition. Many patients can be underweight and have stunted growth. When in a flare, a patient may have a very limited diet which they could eat. Some doctors recommend a "brat" diet (bananas, rice, applesauce, toast) if you are needing to go easy on your gut. For each person with IBD, there is a various diet or version of a diet that exists. Everyone's restrictions are different and can fluctuate throughout their life. 
Because food can push someone over the edge into a flare, or cause a blockage or exacerbate a stricture, it sometimes becomes the enemy. Restricting food can make patients feel like they have control over their illness, and sometimes can get pretty extreme. With all the anxiety around eating and restrictions over food, this can cause much stress and look more and more like an eating disorder. Even patients who are not restricting food may get accused of having an eating disorder because of their inability to keep weight on, as their body is not absorbing nutrients. 

On the other hand, food is a comfort for many people. When patients are dealing with the stress of a chronic illness like IBD, food is a way to numb out. Instead of feeling sad about not being able to go out with friends, you may eat to feel full. Will feeling physically full make you feel emotionally and socially full, like your life before IBD? No. But it will sure give you some endorphins to make you forget about that. Said perfectly by Christina at The Crohn's Diaries blog, "I have yet to read a journal article or medical study that links Crohn's disease and ulcerative colitis to eating disorders, but how can we not have a complicated relationship with food?"

Some patients find themselves overeating or stuffing themselves with their "safe foods" as a way to fill the void they feel from depriving themselves from other foods. Some other patients may get angry about feeling limited by what they can eat and binge on their "unsafe foods" almost as a form of punishing their uncooperative body. Considering IBD is a disorder all about the digestive track, no wonder we have eating issues! I think its importance patients with IBD get assess for disordered eating and if it becomes an issue, to get treatment around the mental and emotional impact of having a disease where food and digestion is so central.

I have met many people with IBD who also struggle with keeping weight off. Many people with IBD can't eat the fresh fruits and veggies, and can eat unlimited carbs. And that doesn't take a nutritionist to predict a weight gain. So this is a shout-out to all those struggling with keeping weight off in the face of IBD, and to the shame they may have. I have had more than one person ask me, "how can someone with Crohn's be overweight?! Isn't that impossible?" And my answer is a resounding NO! Because of the variability in disease activity, medications, and food restrictions, there can be very obese people with IBD. There is no IBD body type, and those patients that do struggle with their weight in the midst of IBD, do not need an additional stigma to deal with. The moral of the story is this: IBD bodies do not look the same way. We are not all tiny, skeletal bodies; we are all shapes and sizes. So together, let's look in the mirror and embrace whatever size we are, whatever body we have, and think about the amazing things we have overcome. Its not about our weight, its not about the scars, its about the resiliency and wisdom we have gained from having IBD.