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“I was diagnosed over 20 years ago, and looking back, I feel privileged that I did meet the stereotype for anorexia and be forced into treatment. However, along the way, I have gained insight that people of all bodies share my struggles. And the use of weight/BMI to determine whether someone is struggling and should have access to treatment results in delayed diagnoses, limitations in access to care, prolonged suffering, invalidation, and shame.”
Jillian Rigert is an oral medicine specialist and radiation oncology research fellow.
She shares her story and discusses her KevinMD article, “Eating disorders thrive in secrecy, so let’s talk about it. Starting with BMI.”
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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, 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. Today on the show, we have Jillian Rigert. She is an oral medicine specialist and radiation oncology research fellow. She wrote the KevinMD article “Eating disorders thrive in secrecy, so let’s talk about it. Starting with BMI.” Jillian, welcome to the show.
Jillian Rigert: Thank you so much, Kevin. I really appreciate the opportunity to be here.
Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?
Jillian Rigert: Yeah, absolutely. And I’ll share the journey that is relevant to the articles I’ve submitted so far for the KevinMD readers. So for my background, I started in undergrad in Illinois, really interested in going into psychology. I love mental health, and at the time it wasn’t favored by my parents, so I tried to do a backdoor way into psychology, and I ended up in dentistry. The correlate is that I thought, what better way to serve a person and to make them feel most confident than by giving them that confident smile, and really impact the way that they see themselves through their identity, which is usually the face?
So I ended up going into dentistry. I did not like dental school. I knew quite quickly it probably wasn’t the best fit for me. At the time, my dental school was associated with an Air Force base, and there were Air Force oral surgeons that came and rotated through our clinics. I said, “That’s what I want to do.” I saw them, I really liked how they composed themselves, and I loved the medicine part of my dentistry training. So I set my sights on being an Air Force oral surgeon. That’s how I got through dental school. I was lucky, or grateful, to have been selected for a six-year oral surgery program. It was through the Air Force, and I commissioned into the Air Force right after dental school.
When I got into the Air Force, I had the career trajectory I thought was the right fit for me, and I quickly was having my head up, realizing it was not the right fit for me. In facing that reality, I developed quite severe depression, which I mentioned in one of the articles about that part of my journey. It was titled high-functioning depression, and I talk a little bit about why that’s kind of a misnomer. My coping skill for that depression started being some eating disorder behaviors, which is anorexia, which I had had issues with when I was an adolescent. At that time, my weight was normal, so I wasn’t really triggered to get help. It did really affect me emotionally. It made my work a lot harder.
I met with the Air Force oral surgery board, and I said, “You know, I’m not sure I should continue.” I had severe depression and was noticing my eating disorder behaviors ramping up, and they said, “Maybe it’s just your self-confidence.” You know, we have that whole arrival fallacy, like, I’m just hoping it’s going to get better. So I was matched into a civilian six-year program, since the Air Force only had four-year programs at that time, and I really wanted to do medical school. I held on to the belief that maybe things would get better in my civilian program. I went to a great program, only to learn that surgery was not the best fit for me, and I really didn’t know what to do at that point, because I felt committed not only to the Air Force, where I had signed a 13-year contract, but to this program that I loved in terms of the people, just not the career trajectory.
And the depression got worse. I was facing a lot of suicidality in my thought process. It was like my mind was hijacked. This was 2014, and I didn’t feel that people were really talking about it. I thought I was the only one. My coping skill then just became a deeper route into anorexia, and I still couldn’t quit. So it took me three years to get to a point where I was being medically discharged from the military, hospitalized for anorexia in a really grave state with depression, to finally say, “All right, I surrender. This isn’t going to go well if I don’t make a huge career pivot.”
So that brings me to kind of where I am today. When I left the Air Force, and this is a lesson I do not recommend for others, I left the Air Force and was retired on October 29, 2017, and I started my next residency the next day, because I couldn’t sit with the grief of losing all the identities I had, and I had lost an ex-boyfriend. It was just too much. So to cope with burnout and all that, I jumped into a new residency, which I laugh at now. It just wasn’t the best idea, but I live alone and depend on myself, and I thought I had to do that.
So I was very fortunate to go to an oral medicine program that was a really good fit for me personally. I had really great mentors there who helped to carry me through. I graduated from that residency last year and was an attending, and it wasn’t a good fit for me. And with COVID happening, a lot of that trust turned for me. It just highlighted that I was not immune to anorexia really taking control again. So I got into another grave state last year and almost lost my life to anorexia through medical complications. You know, it can wipe out your immune system and your heart rate, and mine was quite low.
At that point, I looked up and I said, “Is this all my life is ever going to be?” I had decisions to make, and I was feeling so exhausted from it all. I was so fortunate to find a podcast by an anesthesiologist at Wake Forest. He speaks his truth, and he is into coaching now. Then I found more people who are into coaching, and we hear about it for burnout, and people think, “Oh, is it really that great?” Yes, it saved my life. The intervention is that I met some physicians who were feeling burned out and spoke their truth, so I could relate, and I felt heard and I felt seen despite not knowing them.
I was just so sick of being sick that I said, “I’m finally ready to just take a risk on change.” And I started to really dive into new opportunities, which brings me forward to my current role, which is something I never would have imagined. I’ve taken a break from clinic. I’m a full-time research fellow in radiation oncology, and I picked up my bag and sold everything I owned to move across the country for this new opportunity. It really felt like that reset I needed.
Kevin Pho: So there’s a lot to unpack there in your journey, so many obstacles that you’ve overcome. The one question I want to ask you is, can you go into more detail about some of the things that you did specifically to overcome some of these obstacles that you talked about, whether it’s burnout, whether it’s the eating disorder, whether it’s suicidality? What are the one or two things that you felt you did that made the most difference in your life?
Jillian Rigert: Honestly, I think it’s being surrounded by the people who could fight for me when I didn’t have the ability to fight for myself. I was surrounded by a very supportive community that believes in me and that sees value in my life when I cannot.
Kevin Pho: And you mentioned a little bit of coaching and similar-minded clinicians. Was that the community that you’re talking about that turned things around for you?
Jillian Rigert: Yeah, and it’s in communities along the way. When I was an oral surgery resident, I had a program director who saw me as a human first. Without him, I wouldn’t be here, clearly, because he didn’t make me feel guilty. I was feeling guilty. I still to this day feel guilty about leaving that residency, and he never made me feel that way. He champions me. I just had a conversation, a text message, with him recently. He’s always championing to see me succeed. So it took that.
And I won’t downplay the years of therapy I’ve had along the way. When I was a surgical resident, I was given the ability to see a counselor every Monday, or a psychologist every Monday, and that psychologist was a gift to me. He specializes in eating disorders, and he has a humor to him, but he’s very serious at the same time, and he really helped shape some of my thoughts. When I was severely depressed, I had the thought that I needed to finish my residency or take my own life, and those thoughts were concrete. I was so rigid. I didn’t see another opportunity, another option. And the psychologist would say, “Or what?” And I’m like, “Or what? You know, I cannot be disgraced by quitting, by leaving. And what would that mean for the rest of my career?” And then at a point, it became my career and my life, which I know we can talk about in another opportunity we have together.
But that was the reality I faced. It was like, if I don’t make a decision now. And I don’t want people to get to that point where it’s like, “This is my life.” It wasn’t a clear decision to me, because I was so exhausted and depressed. I was like, “Well, you know,” and you can read between the lines there. It’s like, you know, I don’t know if I have that fight in me. So I really relied on other people helping to fight for me and just being a conduit of support until I had the energy to stand on my own two feet.
Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “Eating disorders thrive in secrecy, so let’s talk about it. Starting with BMI.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Jillian Rigert: Yeah, absolutely. So this came off of an article written by Kara Pepper, Dr. Kara Pepper, an internal medicine physician, who wrote about the issues with BMI as a measurement of health, and how it’s not, and how it’s biased, discriminatory, and flawed. It hit me at the perfect time, because here I am, sick of being sick. I’m sick of being misunderstood, and not only me, but I see how my silence is impacting the ability of others who are silenced by eating disorders to get care. And now, in my journey, I’m at a point where I can speak openly about my eating disorder, and I think I can find value in the pain, where being silenced was not providing any value at all.
And I have that drive to fight, because I see how our medical system and society really do a disservice to people, especially with body image and weight. Eating disorders aside, like these people, in terms of people who are actually diagnosed with eating disorders, I think that our weight-based society and diet culture really do a disservice to most people, mentally, physically, just holistically, in a way that’s not correlated with health. So why do we keep doing it?
How that looked in my life was, early on, I used the BMI as a measurement of whether I was worth getting help for anorexia, because this was 20 years ago, and it was clearly defined in the diagnostic criteria. I knew I had an issue in my head, but my weight was higher on this BMI scale, and so it was very much celebrated that I was trying to lose weight, even though it was right after puberty, when I should have been just appreciating that my body was turning into a woman. Going back to that time and that pain that I felt, I don’t want other people to feel that pain, because here I am, on the higher end of the BMI scale, with a very restrictive eating disorder, which is isolating, which is part of where the title came from. Everything is thriving in secrecy; it takes over in secrecy.
So this BMI number, which was diagnostic criteria, not only became defining for myself but was an obstacle in insurance endeavors. So it took a very long time for me to get help. And I think, you know, it’s shown now that if people can get help and turn the corner quickly, they have a really good chance at a stronger recovery from eating disorders. And here I am 20 years later, almost losing my life to it again, and I’m wondering how much earlier intervention would have spared me the suffering, would have spared others the suffering. And I think it needs to be brought to a discussion.
Kevin Pho: So in your ideal scenario, what would you have changed about the medical establishment to address your situation better?
Jillian Rigert: I think that, for one thing, eating disorders are such a psychological suffering, and it has more to do with identifying them as a mental health condition than a weight-based anything. Just taking weight out of the criteria for that, and accepting that, you know, there’s a weight stigma. I just listened to a conversation with somebody who would be considered, you know, obese, and she has a restrictive eating disorder that may be championed for the rest of her life, and that’s horrible. If people knew the torment and lived one day with a restrictive eating disorder, they’d understand the torment.
But it’s so misunderstood and hard to explain to people who don’t have an eating disorder. That actually was one component of what kept me silent for so long, because I would try to express myself and tell people what I was thinking, and it’s so irrational that they’re like, “That’s crazy. Just go eat something.” And like, that’s not it. So I think the more voices that we can get to explain what role their eating disorder has in their life, the better we can understand the complexities of eating disorders.
Kevin Pho: Is there a story or a case study that you could share with my audience that can kind of illustrate some of these misconceptions that you’re talking about with eating disorders?
Jillian Rigert: I think if you read into, like, Health at Every Size, and just hear testimonials from the people who are affected. The conversation that I had just heard was online. And I knew there was a documentary called Fattitude, which is a lot about weight-based stigma, and that’s one documentary I’d recommend.
Kevin Pho: We’re talking to Jillian Rigert. She is an oral medicine specialist and radiation oncology research fellow. She wrote the KevinMD article “Eating disorders thrive in secrecy, so let’s talk about it. Starting with BMI.” Jillian, for those other clinicians or students going through a medical or dental journey who are also struggling with an eating disorder, what kind of advice can you share with them through your own experiences?
Jillian Rigert: Well, I think one thing that’s very common with all people with eating disorders is kind of a lower self-worth and lack of self-compassion. So that’s really where I’d start: taking a step back and leaning into that, and really developing that inner self-worth and self-value, because you’re valuable, you’re worthy. And so whatever the system’s doing to take that away from you, we have to fight back.
Kevin Pho: You mentioned that the medical establishment in general has work to do when it comes to addressing eating disorders. Any other resources or recommendations that you can advise?
Jillian Rigert: You know, I think community is one thing. I do think there’s strong value in the people who have dedicated their lives to evidence-based research support, so I lean on them. I’ve had some really great providers in North Carolina, but that’s been a small subset. So one thing I would say is that there are times where people go to a higher level of care and they wonder, “Why am I not better? Why is my child not better?” From my personal experience, sometimes those types of facilities may actually exacerbate an eating disorder, and not all facilities should be treated equally in their ability to help someone to recover.
So I think it’s us finding the people who are doing a great service, who are dedicated. You know, I have had those people in my life who have been part of the people who have kept me alive. And then when it comes to outside of the medical establishment, it is really finding the people who see your value, who can help you see your value, and surrounding yourself with them.
Kevin Pho: And from a primary care standpoint, I’m a primary care physician. We have a lot of other primary care clinicians listening to this podcast. What kind of advice can you share with them to help address these treatment gaps when it comes to eating disorders?
Jillian Rigert: Yeah, it’s all about how we talk to patients about weight. Eating disorders, again, are mental health conditions, but we are creating a situation where people are feeling ashamed of their body, and we are overemphasizing weight as a parameter for their medical health, in a way that if I were to have an eating disorder where I would eat for comfort, that might actually increase the chances that you’re stimulating someone to gain weight. So I think being mindful of the why. And I think the one thing we need to do better is listen.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Jillian Rigert: I think that as providers, you know, I know it’s really hard for us to take care of ourselves, and that stimulates the challenges that we face when we take care of patients. So as we promote and prescribe self-compassion for our patients, make sure we’re prescribing that for ourselves, so that we can also pay it forward, rather than try to fill their cup when ours is empty.
Kevin Pho: Jillian, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.
Jillian Rigert: Yeah, thank you so much, Kevin. Appreciate it.
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