Psych med weight gain and women’s self-image

Like every woman in this culture, I’m surrounded by images telling me what is beautiful and healthy.  From supermarket  magazine covers, to Hollywood starlets, even to the women anchors who deliver serious news and analysis, the unanimous  Message is that you will only be successful, attractive, popular and in charge of your life if you’re thin or fit the typical women’s self-image.

While being overweight and obese do put you at greater risk for lifestyle illnesses (though there is still debate about whether being slightly overweight really does carry danger), the types of images we see around us don’t reflect the whole range of healthy weights, but only the low end – or even underweight.

The problem with using BMI and other numbers to measure health:

To get a better picture, imagine a 5’6″ woman – which I happen to be (well, plus a quarter inch, but close enough).  “Healthy” BMI ranges from 18.5 to 24.9, which translates into 115 to 155 lbs or so, for a woman this height.

You can also wear your weight dramatically differently depending on how much muscle you have.  When I was a skinny, anemic vegan, I was 130 lbs and the same size as when I was doing vigorous yoga 4-6 times a week and weighed 145 lbs.  Which is why the guidelines say that BMI is not a perfect measure, especially for people who are more muscular or athletic or have bigger bones. Yet women’s self-image often relies on numbers like this that are irrelevant to health.

What is beauty in our culture? Is it Christy's arm scar from a farming accident and how she covered it with a tatoo? Or her "Safety Third" T-shirt? She says anything you want can first or second.

What is beauty in our culture? Is it Christy’s arm scar from a farming accident and how she covered it with a tatoo? Or her “Safety Third” T-shirt? She says anything you want can first or second.

When I was skinny – as a vegan and later as a yogini – I felt happy that I was so small I could wear a size 8.  I remember buying jeans with a size 29 waist once, at the height of my yoga days.  It was so liberating to be able to go to the store and fit into such a wide range of clothes, and to not be self-conscious about my tummy.  I once bought an “extra small” pair of shorts at Winner’s, and felt… well, like a winner.

At the time, I never questioned the impulse that made me want to be a size 8 instead of a 10 or 12.  And looking back at those old photos, I now see a young woman who was looking rather bony   Pointy chin, spare body, not much chest left.  I now think to myself, “I would have looked better with curves.”  My total idea of women’s self-image has changed.

So at my very thinnest, I was nowhere near the bottom of the BMI range.  And yet I looked too skinny.

And the scary thing with BMI is that now, technically, at 196 or 197 lbs, I qualify as obese.  Yes, my BMI is in the obese range.  Yet I wear a size 16 top and 16 or 18 bottom, and no one would call me “obese”, even though I’m clearly overweight and far from the norm expected by our thin beauty ideals.  People often underestimate my weight, too, just because of how I carry it.

Psych med weight gain and women’s self-image:

Which goes to show that women’s self-image should have nothing to do with numbers. You can’t judge your appearance by clothing sizes or weight or BMI, looking strictly at numbers.  Even a measure designed to promote “health” instead of some arbitrary aesthetic standard has its limits.

Those limits are especially obvious when you gain weight due to being on psych drugs.  Many websites in the mainstream mental health world imply that weight gain is our fault and that all we need to do is diet and exercise and we can be healthy again.  But for many of us, personal experience contradicts this received wisdom.

Psych med wieght gain is a huge factor in women's self-image that doctors like to ignore

Psych med wieght gain is a huge factor in women’s self-image that doctors like to ignore

As so many of us know, weight gain from psych drugs is immune to reason.  It’s not like regular weight gain.  We can be the healthiest eaters, and still pack on 10, 20 or more pounds in a year.  Gianna Kali has written some informative pieces about psych meds and fat, on her blog Beyond Meds. One of the best points out how SAMHSA’s Wellness Campaign wants to look at lifestyle changes but ignore any need from coming off the medications that caused the weight gain in the first place.

The good news, shown here in this slide from the NAMHPD longevity study, is that people usually lose the weight fairly quickly when they come off the medication that has affected them.

Personally, I went from a baseline of 160-165 lbs without eating well or exercising, to a situation where I can’t seem to stop gaining weight.  Even though I’m down from 300 to 200 mg of Seroquel, I am at least 196 lbs lbs, and just when I think my weight is stabilized, every so often I have a mysterious “jump” of 2-3 lbs, and there’s no looking back!  Doctors who can’t make this connection between women’s self-image and happiness aren’t listening very well to their patients.

The great news is that with the last two reductions from 225 to 212.5 mg and 212.5 mg to 200 mg, I feel less lobotomized, and I have had more motivation to incorporate exercise into my life.  For a month, I attended something like 15 yoga classes, most of them hot yoga.  I gave up out of frustration with being so out of shape and not being able to keep up, but at least it was a start.  I am now looking into working with a private teacher to create a short routine I can do 4-5 times a week to gradually get myself in shape, as I do not have 2+ hours a day (between walking to class, the class itself, showering and walking home) to devote to a group class that is too hard for me.

Weight and women’s self-image

Even after all that yoga, my weight didn’t budge.

I wasn’t any closer to being “healthy”.  I wasn’t closer to being slim, “attractive” as the world has trained us for the typical women’s self-image.  I was still a big woman, with my oversize proportions raising my risk of diabetes and heart disease.

But what I do know is that I’ve been driving myself absolutely crazy, these past few years, getting upset about how big I am.  And all this talk of BMI and psych meds and wishing to be a healthy weight obscures an issue we all have to start thinking about more seriously: Women in this culture are asked to stake our self-esteem and self-image on external appearances. We are especially judged by the standards of a media where “thin is in” and the “thinnest is innest.”

Yet we are also asked to be happy, even-tempered, and not be emotional. This might be why 1 in 4 American middle aged women has been sold on antidepressants, even though they don’t “work” as advertised. And then our women’s self-image takes a huge tumble due to weight gain problems. We are caught in a catch-22.

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