When I first thought about writing this blog I had patients with anorexia nervosa in mind. Patients with AN often struggle to find their voice, regardless of how smart, competent and encouraged they may be by others. On the other hand, our patients of high body weight for whom metabolic problems have lead to obesity, can have the same problem: shame and self-loathing has made them reluctant to use their voice, to fight back.

Unfortunately, “finding their voice”, a commonly stated treatment objective, may not be enough, both groups of kids actually have to find their sass.

Why? Because for both diagnoses there is abundant negative feedback and shaming coming from the environment, to say nothing of the negative voices coming from within.

Kids with anorexia nervosa hear that they are “superficial” “attention seeking” “and just want to look like a model” and that they are “ruining their parents’ lives”.

Kids of high body weight are told they are “lazy” “gluttonous” and “obviously don’t care about their health”. They are shamed in every way imaginable and just about everywhere they go.

But not at Kartini Clinic.

We treat kids with all conditions of disordered eating, just as another clinic might treat all conditions of disordered metabolism (endocrinology) or all conditions of childhood cancers (oncology) with no effort made to segregate these kids from each other. They are all just kids, and have a remarkable ability to find resonance with and compassion for other kids who have eating issues, even when those issues appear to be very different than their own. We adults could learn from them.

But back to finding their sass:

It is not enough to recognize how people and institutions shame you for your condition, one you did not ask to have and did not choose and one your parents did not cause, either. It is also important to learn to fight back. “Finding your voice” may be a polite way to respond to misguided comments from others, but you will discover soon enough that people fight back when their cherished beliefs about body weight, eating disorders and mental health are challenged. Why, if they are to believe that it happened to you -- and that you didn’t choose it -- then it could happen to them too or to someone they love, and that is scary. In the great game of “46 card draw” (aka your genome), we all get genes for complex illnesses… or not. Virtue is rarely the determining factor.

So when an adult, say a teacher, promotes messages that imply that eating disorders are a result of poor parenting or a “choice to get too thin” or that severe high body weight is caused by “poor food choices” and being “too lazy to move around”, you are going to have to call them out. How polite you are about doing this depends on who is it and where you are. You may need to be downright sassy to be heard. You may need reinforcements (parents), but you should not go quietly! I write this blog to be useful, for example, not only to help Kartini families, but also to have something concrete to give to people who need educating or at least to hear a voice with a different, informed, point of view.

To fight back you will need not only your voice, but your sass. Find it!