Katherine A. Fordham, M.D., M.P.H.

December 1997

This month will mark some changes in the structure of this column as my _Oasis_ co-author, Michael Walker, is taking some time off from writing so that he can concentrate on other matters.

As I am left to write the column myself, I will be modifying the format to a small extent. As well as monthly questions, I am instituting monthly "focus topics" which will allow me to address a singular important issue pertinent to adolescent health each month. While this column started out as a platform for sexual health-related information, it is essential to remember that not only are you guys gay teens, but you are also teens, period. You share the same basic health needs that your straight counterparts do and of course, the health of someone who happens to be gay or bisexual should not be regulated to sexual matters alone.

Our first "focus topic" will be dieting. Why dieting, you ask? I chose this topic because it has worked its way into my life lately; one of my friend's sons, who is only fifteen, is worried that he is "too fat" although he is -- by my best assessment -- within the normal weight range for a person of his age and height. Also, I noticed an article in a recent issue of _Teen_ magazine telling the story of a male high-school junior who suffered from both anorexia and bulimia. These two eating disorders have received a lot of media attention in the last few years, but nearly all of the cases you hear about are female. While there are definitely more girls and women suffering from eating disorders than men and boys, it is important to realize that these disorders do affect males as well. Considering the "body-worship" attitude prevalent in the young gay community, it is easy to figure that among the males suffering from eating disorders, a fair number of them may be gay. That's why I decided to talk about this issue.

So what is the difference between anorexia and bulimia? Anorexia is defined as the willful starving or fasting of the body for the purpose of not gaining weight. Bulimia is the systematic bingeing and purging of the body; that is, a person who is bulimic would eat a great deal at one sitting and then vomit the entire meal back up so the food would not be absorbed by there body. Some people -- like the boy in the _Teen_ article -- have what doctors call an "atypical eating disorder" where they are both bulimic and anorexic. Unfortunately, the term "anorexic" is over-used in our society and is no longer used only for people who suffer from this condition for also for people who are extremely thin, such as many female models. Some models who are so thin may indeed be anorexic, by medical definition, but one cannot judge if someone suffers from an eating disorder simply by their outward physical appearance.

How does a person know if they or someone close to them might be suffering from an eating disorder? First, it is important to think about whether one's eating habits seem normal and reasonable or not. A person might ask himself the following questions: do I eat regular meals each day at the same time? do I eat when I feel especially hungry, such as after athletic performance? Do I force myself not to eat on occasion because I am worried about putting on weight? Do I often go without food for more than a day? Do I go without food (fast) for several days at a time? Do I always think that I am too fat, that I should lose some weight and am I convinced that dieting is the only way to accomplish this goal? If you are concerned that you may be suffering from an eating disorder, then I would strongly encourage you to see your family physician or school nurse.

Aside from the eating disorders listed above, some young people put themselves on dangerous diets because they feel that they need to lose weight. Again, this scenario is more commonplace with girls but also affects some males. Dieting in itself is not a bad things -- providing that it's approached in a sensible manner -- it is when diets are too extreme or involve unhealthy components that they become something which could be dangerous. With boys, it is especially important to consider athletic activity when beginning a diet. Obviously, sports and other activities take up a great deal of energy and if that energy is not adequately replenished, a person can find himself/herself in a precarious position. Although people stereotypically picture male high-school athletes attempting to gain -- not lose -- weight, some male athletes such as swimmers, runners, and soccer players _do_ want to shed excess weight to improve their performance. Physical appearance, of course, also plays a crucial role in the decision of a young person to diet, whether they are an athlete or not.

I highly recommend that any adolescent who is planning to start a diet consults their physician, a person who should be able to provide some useful advice about what type of diet is best for the individual. Even if you choose not to consult a doctor, please "do your homework" before jumping into a diet program as their are so many different types of diets out there and believe me, they are not all created equal. It is essential that while dieting you maintain a proper level of nutrition despite the fact that you are taking in less food. Obtaining a balance between gaining the nutrients that your body requires to function and keeping your weight in check can be challenging, but it is possible with the right diet program. Which program is right for you? That's a question --once again -- best answered by a family physician or other health practitioner, someone familiar with your body and your life-style.

Additionally, it is important to ask yourself some questions before considering a diet. Questions such as "do I really need to go on a diet?" Maybe you do, maybe you don't; many teens perceive themselves to be over-weight but their perceptions are tainted with the messages of extreme thinness being fashionable, messages which we find in television, movies, and print publications each and every day. You may not be the exact same weight as your favorite actor, but then do you have his build, his height, his proportions? The figure that someone else possesses may not be a realistic goal, what we all must do is try to achieve the best physical health and wellness -- including ideal weight and body mass -- for who _we_ are, not who someone else is.

Another an entirely separate note, Michael and I received several questions over the past two months concerning the safety of anal sex, a question that we addressed last Spring, but one which is certainly of grave importance to many young gay men. One of these questions concerned the long-term safety of anal sex and the possible negative ramifications of such practices. This is a very good question. The anus is foremost an organ of elimination (of waste products) and the sphincter muscles and anal canal are designed for output, not especially for input. Sexual penetration can be safely achieved with the use of a water-based lubricant designed for that express purpose and a condom (petroleum-based lubricants should not be used with condoms as they can chemically react with the latex, thus encouraging perforation of the condom). However, nothing of greater diameter than around 34mm (1.339") should be inserted into the anus and nothing made of a hard, inflexible material (such as glass, hard plastic, metal, or wood) should ever be used in such penetration. The anal tissue is very susceptible to minor tears and cuts, which introduces blood and an open wound which would encourage the exchange of fluids and the passage of a pathogen such as HIV from one partner to another. Fisting, the practice of inserting the fist or whole hand into the anus, is something which I wholeheartedly oppose as this is quite dangerous and can lead to long-term medical problems.

Although I feel we have covered anal sex in sufficient detail in the past, if readers would like another column concerning this subject and have additional questions on the matter, I would entertain the idea of writing such a column. Please contact me at KFordham@hotmail.com or KAFordhamMD@vespa.net with your questions.

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