How Do I Tell My GF She's Too Skinny?

CountryDude

So, my GF has always been slim.

In recent years though, her weight has dropped into the "clinically underweight" category.

She is 39 and weighs 42kg (so that's about 92 pounds).  She is 155cm.  Her BMI is 17.4. 

A lot of her bones are visible, especially around her chest.  Not just collar bones, but bones in the middle of her chest too.  Her rib cage is fairly visible all the way around.

I don't think she has a serious illness.  Not that long ago, she had a full health check up, including blood work, urine analyses, xrays, ultrasounds and PAP smear.

But they didn't check her thyroid and I don't think they checked her hormone levels.

Looking back at previous pictures, she was clearly a few KGs heavier and she says she used to be 47-50kg.

She says she feels fine, but there was a very strange occurrence.  About a year ago, she went to the dentist for a scale and he nicked her gum line. She didn't stop bleeding for 2 days.  I took the day off work.  She was weak and had spat out several bowls of blood already (probably mostly saliva, but still).

I looked back at her test result to check platelets (which were fine).  But then I noticed her hemoglobin was on the low side of normal, which I know from being a blood donor has something to do with clotting.  This can be related with low body weight and anemia.

She went to the doctor (Thai village doctor), he just told her to go speak with the dentist. These doctors don't have a good reputation and I urged her to speak with a different  one, but then the bleeding stopped and she didn't want to. 

She is going for more dental treatment and even says she is worried about the bleeding again.

She gets quite irritable if I mention going to the doctor and especially mentioning her weight.  She says, the doctor will think she is stupid cos she has no symptoms of sickness yet she is going to him anyway.  I don't want to wait til she has another bleeding problem.

I feel that when I mention it to her, I don't frame it in the best way.  I am basically looking for advise on how to frame it.

Even if she doesn't have another bleeding problem, I know she is clinically underweight and I am sure it isn't healthy.  She has tried gaining weight too (by eating high calorie foods), but nothing goes on her.  Though she doesn't try consistently.

She says her ideal weight would be 47kg.  I agree.  (Even if she was 60kg, I wouldn't mind).

I just don't now how to support her without annoying her (framing it in the wrong way).  That, and she doesn't really seem to care much about gaining weight anyway.  I mean, she says it would be ideal if she could gain a little more and has tried and failed. But she won't see the doc, not until she feels ill. 

She is getting her tooth out next week so we will be what happens.  It could be related, or maybe not.  We don't know.  But I can't drag her to the doctor to find out.

I feel that overactive thyroid would explain it all. 

Angeline

@Scarlet @Jellybean @Templar ;
She sounds not just thin, but dangerously so. Is she secretive about food? Refresh my memory, do you live together? Would you know if she was anorexic or purging? 

CountryDude

She eats lots. She loves to eat.

We live together. Where we live people are very social eaters and she is too.

She actually sells food for a living. Talented cook.

We go out to eat regularly.

She eats 3 meals per day, plus some snacking.

We often eat healthy and often eat unhealthy.

Growing up she was poor and had to survive off an unbelievably small salary, so there was no luxury eating. Now we can afford high calorie snacks and she does eat them.

So, it is strange to see her thinner now than 20 years ago (at age 18 or so).

Her diet is mostly:

White rice with plenty of meat and some veg on the side. She will eat a variation of that 3 times a day. Sometimes noodles instead.

Fruit every day.

Coffee (with milk n sugar) a couple of times a day

Often a Pepsi or two.

Usually another snack (crackers with cream cheese is her favorite these days).

I am sure she doesn't drink enough water though. She doesn't exercise.

I don't think she has a food disorder. Sometimes I wonder if she actually sees how thin she is (what I see), but she has mentioned it a couple of times.

I think gaining weight is too much hard work for her and in general she feels fine. So she doesn't bother with it. She doesn't seem to think its a big problem.

HildaCorners

Eating a lot of food doesn't mean she doesn't have an eating disorder. She could be purging in secret. But it doesn't sound like it.

But the bleeding doesn't sound normal. Combined with the weight loss, there could be a serious issue.

I suggest you Captain up, find the best doctor within your area (if there are none, choose a larger area) and have her sit with you while you make the appointment. Then you go with her. If she's not trying to lose weight, she might be very scared, and she'll need you to help her deal with things.

Maria

I agree that the weight loss is concerning.

I've always been VERY thin, despite eating plenty and balanced, even thinner than your girfriend (46-48kg at a height of166cm between age 16 and 40). And I've always been very healthy and not bulimic or anorexic. And yes, you could have cut yourself on my hipbones and clavicles and to this day my ribcage is visible. Luckily I'm finally more padded around the other areas.
Lots of sports in the last years have led to more muscle mass and so I'm now weighing an astonishing 50kg :-) But it was hard work to gain!!!

 I'd be very worried if I lost a couple of kilos without apparent reason. That's always a red flag. 
A thyroid check would definitely be in order.

As far as I know hemoglobin has nothing to do with clotting, that's platelets and plasma proteins, but your girlfriend should definitely mention the long bleeding to the dentist before he starts extracting her tooth.

CountryDude

Thanks everyone for your advice.

I will do my best to captain up and get her to the doc. She will resist though because she isn't sick.

I will keep you posted on how it goes.

Serenity

Take a look and see if this rings a bell.

http://www.thalassemia.org/learn-about-thalassemia/about-thalassemia/

Thalassemia is quite common in people of Asian descent, particularly southeastern Asia. There are different levels of severity, from being a carrier, with very few symptoms, to more severe, with extreme symptoms. 

When you look at your wife's blood work, see if they measured her reticulocytes (baby red blood cells). Those are normally going to be elevated with thalassemia, as the body struggles to produce more hemoglobin.

My daughter is from China and has thalassemia. She has an on-going battle to maintain her weight, even on appetite stimulants. With thalassemia, the body constantly produces more red blood cells in an effort to replace the missing hemoglobin, so metabolism is continually ramped up. 

JellyBean

Does she have signs of gastric distress? Perhaps she has a parasite.

Templar

If she has no obvious signs besides weight loss as a mature adult and prolonged bleeding a year ago, you won't likely get a diagnosis here. The prolonged bleeding is a concern and can point to the source of the problem more than weight loss, typically. If it were me, I'd go to a reputable doctor with these concerns. Not sure of the medical scene in your neck of the woods. May need to go to a bigger city. Wouldn't expect bulemia to be a root problem if she was normal weight a year ago but was not clotting normally. As you know, one of the trade offs of living in a beautiful country like Thailand is that there quite a number of diseases there which are not present in the US. Without knowing if she ever has diarrhea, sweats, etc, and then speculating from thousands of miles away, I would have her see a doc BEFORE the tooth extraction. You don't want your wife to be hospitalized for something like an extraction that could be put off a couple days to determine if she is still not clotting and/or if she has some other systemic illness.

Athol_Kay

I think the opening is "I'm worried the weight loss is a symptom of a medical issue".

CountryDude

JellyBean said:

Does she have signs of gastric distress? Perhaps she has a parasite.

I have been thinking about that as well. 

Common over here, mostly due to adding home made fermented fish sauce to their Papaya Salad which is a favourite. If the fish sauce hasn't been contained properly it can get parasites in it.

No sign of gastric distress though. I wont rule it out though. It could very well be a parasite.

CountryDude

Serenity said:

Take a look and see if this rings a bell.

http://www.thalassemia.org/learn-about-thalassemia/about-thalassemia/

Thalassemia is quite common in people of Asian descent, particularly southeastern Asia. There are different levels of severity, from being a carrier, with very few symptoms, to more severe, with extreme symptoms. 

When you look at your wife's blood work, see if they measured her reticulocytes (baby red blood cells). Those are normally going to be elevated with thalassemia, as the body struggles to produce more hemoglobin.

My daughter is from China and has thalassemia. She has an on-going battle to maintain her weight, even on appetite stimulants. With thalassemia, the body constantly produces more red blood cells in an effort to replace the missing hemoglobin, so metabolism is continually ramped up. 

I had never heard of this before, but could certainly fit, that's for sure.

Her main "symptom" is struggling to put weight on ( which definitely fits this).

I will take a look over her blood work again too see.

I wonder if they screened her at pregnancy. I read it would commonly be done and we used a higher-end private hospital, but I can't know for sure.

CountryDude

So, last night we were looking through old pictures of when we met and when our daughter was a baby. It was nice.

We were comparing how much different we looked and she noticed her weight. I had hoped she would. I told her that I was worried about and mentioned how strange it seemed that she is losing weight as she ages. She agreed.

I told her I'd like us to go back together for another full health check since it has been about a year and a half. And my cholesterol was high.

She wasn't keen on the full health check so I told her she is due another PAP smear anyway and she has to keep up to date on that.

She agreed. I then told her I would really like to check her thyroid and explained it could be linked with weight loss. She seemed agreeable and didn't know thyroid was linked with that.

I really just wanna frame it as, "Honey, I am concerned about your health and your low weight. I wanna talk to the doctor with  you and have him investigate. It could be various things causing it, or maybe nothing at all - but we should find out."

Cos I don't wanna just have her thyroid checked and if its OK, then we forget about everything else. Like others have said, it could be a parasite or Thalassaemia.

CountryDude

Just to clarify. Her weight has been at a constant 42kg for probably 5 years or more.

The main symptom is high metabolism and not gaining. There has been no sudden drop.

But when I met her, she was definately within the healthy weight bracket and all her younger pictures show that as well.

MrsB

I wouldn't worry unless she doesn't feel well. I'm clinically underweight (my non pregnant BMI is under 17) and have been told by every doctor/friend/work colleague/family member that I'm too thin. I'm diabetic, but other than that I'm healthy. It's annoying to be scrutinized for your weight, especially when people accuse you of having an eating disorder or something. Sudden weight loss can be indicative of an underlying illness, but if she's been the same weight for years, she's probably ok. 
That being said, it never hurts to get checked I guess.

CountryDude

So, went to the doctor.

I framed it just as I wanted to and she agreed, but still seemed a bit annoyed that I was taking her to the doc for no reason.

I took her to the best private hospital in the city (that ain't saying much for our city though....we would have to go to Bangkok for a proper private hospital)

So, they weighed her and took her blood pressure (as they do for everyone).

She explained to the nurse why I brought her her and said that I had mentioned concerns about her thyroid (among other things).

We went through to the doctor together.

I don't exactly know how to describe what happened next, so I will just tell it like it happened.

My GF explained told him what she told the nurse. She asked to inspect her hands (presumably looking for gaundice in her fingernails).

He then turned to me and said, "You know skinny people have a long life. Just look at insects".

I replied, "Sorry?".

He said, " You know insects, like cockroaches, they have been here since dinosaur times."

I ignored that and went on to explain the bleeding incident. And raised my concerns about Anaemia.

He said, "Probably vitamin K deficiency. She should eat more vegetables".

I went on to explain that where I come from when someone is underweight we think there could be  an illness causing it.

He replied, " That's because in your country it is very cold and you need fat to keep you warm. In Thailand it is hot and we don't need any fat."

By this point everyone was laughing at me, including the nurses standing at the door.

Then he said,"But you are a very good husband. You care about her health".

He agreed to do blood tests to check thyroid function.

The results came back and they called her to tell her that her thyroid is normal later in the day.

We went out for lunch, shopping, and a massage. It was a nice day. She said thank you to me and that today she felt like I really care for her.

I don't feel like there is much else I can do, so long as she is feeling fine.

I didn't even get to mention parasites or Thalasaemia.

But at the end of the day she did say she would try taking Haemo-vit. Which is a vitamin for people with mild Anaemia (and increases appetite) that I bought for her after the bleedind incident, though she never took them.

Though her appetite is fine, they are supposed to raise Haemoglobin levels which I knew were on the low side for her.

She told me she took them before with her friend when they were younger and trying to gain a little weight. Though from what I can see her friend was never underweight and probably didn't need them. Apparently they helped my GF gain a little.

Anyway. I was going to write this last night, but couldn't bring myself to, lol.

What an experience. Thailand never fails to surprise me.

Thanks to everyone who posted on this thread.

wanderingTheDesert

I'd like to chime in, supporting seemingly conflicting opinions here.

First of all, good on you for taking action to protect your wife. Don't let this resistance keep you from getting to the bottom of it. If you really believe there is a health issue, keep an eye on it. I'd like to suggest that you gather some data of your own by calorie counting. If her thyroid is normal, then you'd likely be able to estimate the calories she needs daily, and reconcile that against what goes in. If it's a parasite, the calories shouldn't add up. I use myfitnesspal, and can recommend it.

On the other hand, until my mid- to late-twenties, I had a BMI of 17.2, while eating like a horse. As a man, the questions were constant and exhausting. I can understand that if your wife is naturally that thin, she could easily see your questions as an annoyance. 

Bottom line, I'd go underground for a bit and collect your own data and if you don't find anything, relax and keep a casual eye on it. Realize that for her, this could be a DHV that you saved her from a medical condition, or a DLV that you nagged her while she was perfectly healthy. 

CountryDude

Thanks @wanderingTheDesert

Yeah. I agree. I have to stay quiet until I have some compelling evidence.

I used cron-o-meter to track my calories before. I may start that with her.

I know these trackers calculate your basal metabolic rate, but will that be accurate with someone who has a fast metabolism? They seem to just calculate it off your profile data (height, weight, gender, age ...) don't they?

I may. It will provide some insight into her calorie in / body weight out relationship.

Thanks

wanderingTheDesert

@CountryDude You're right, calorie counting won't be as accurate as you'd like, but it's probably the best you can do for now. I guess I'd be looking for changes. If it's really a parasite, or other degenerative medical condition, it should get change over time. Since we know her thyroid is in the normal range, her metabolism should also be in the normal range, though I understand it's more complex than that.

Good luck. 

CountryDude

Thanks

Athol_Kay

Totally missed that she was Thai. They do tend toward being slimmer than the rest of us "normal" people.

What's her size measurements and height?