I recently had the pleasure of interviewing a well-renowned, board certified obstetrician-gynecologist, Julie M. Jacobstein, M.D., about her personal and professional experiences with eating disorders, athletes, and body image. It is extremely important to hear the perspective of qualified, successful members of society in hopes to continue raising awareness, educating others, and openly discussing these prevalent issues. In this case, Dr. Jacobstein is a physician who works with women and girls everyday, has kids of her own, and personally experienced pressures surrounding body type throughout her own life. I feel so fortunate to know such an amazing woman, a role model to myself and many, and her courage to speak out publicly is beyond admirable. Thank you, Dr. Jacobstein!

Julie M. Jacobstein, M.D.: Born and raised in Baltimore, Maryland, she attended The Park School. Dr. Jacobstein played competitive tennis starting around the age of 7. Following high school, she went on to play collegiate tennis for Cornell University. After deciding to pursue medicine, she concluded her tennis career. She, then, attended Mt. Sinai School of Medicine, and graduated AOA with awards in Endocrinology. Dr. Jacobstein completed her residency in Ob/gyn at University of Pennsylvania where she discovered her passion for pediatric and adolescent health. She has been in practice for over 10 years at Sinai Hospital of Baltimore where she continues to focus on pediatric and adolescent gynecology.

EKM: In your personal collegiate athletic experiences, were eating disorders common among your peers? If so, were they discussed, noticed, or recognized?

Dr. Julie Jacobstein: I have encountered eating disorders throughout my life. I have watched many of my friends, both athletes and non-athletes, struggle with eating disorders. I, myself, fight, even to this day, to overcome distorted body images. In high school, it was like a competition to see who could eat the least and exercise the most (sad, but true). It was never recognized as a problem; it was almost encouraged. In college, I saw several of my friends secretly battle eating disorders. It was not as much a competition, but more a drive to control something. I, even, watched some of my friends on the wrestling team frequently binge and purge, and then wrap themselves in Saran Wrap and sit in the steam room to control their weight. I observed several of my friends and teammates move the food around on their plates at team meals, and then proceed to train / practice 2-4 hrs / day. I, myself, after gaining the typical freshman weight quickly regained what I saw as control. My coach did ask me a few times over the years if I had an eating disorder, to which I replied, “No,” and that was always the end of it.

EKM: Fertility issues remain a problem for eating disorder patients and those who have once suffered. How often do you see this arise? And, how do you attribute fertility issues to eating disorders?

Dr. Julie Jacobstein: In my practice, it is not infrequent that I encounter fertility issues, but it is difficult to say how often it is related to eating disorders. I, also, frequently encounter young women who either are actively suffering from, living with, recovering from, or denying eating disorders. I counsel my young athletes extensively regarding menses as a vital sign. I often explain that our bodies are incredible at trying to survive, and often in the setting of inadequate fuel it shuts down those systems not “necessary” to survive. The ovaries are often the first system to be shut down. While no one is ever sad to “miss” a period, it is important to remember that can be a sign of hypothalamic amenorrhea, which keeps us in a hypoestrogenic state. We need estrogen for our bones, future fertility, and general health.

EKM: Teenagers face immense pressures; physically, and psychologically, socially. As a mother of a teenager, what do you do to help minimize body image issues, dieting, or even too much exercise?

Dr. Julie Jacobstein: As the mother of a teenager and a physician who works with teens every day, I see the immense pressure we as a society place on our young women. The images our society “values” in the media make this battle even harder! I, on a daily basis, discuss with my daughter healthy lifestyle and choices. We talk about weight as being just a number, and that how we feel is much more important. There is no scale in my house. My pantry is stocked with healthy snacks, as well as, Oreos and Girl Scout cookies! At one of my daughter’s well-child visits the nurse informed her of her height and weight percentile, and for the first time I watched my daughter struggle with those numbers. She looked at me in tears until I explained that her weight percentile did not take into account that her height percentile was >95th percentile. My daughter trains about 2-3 hours on a daily basis, she is stocked with protein bars, but also knows that she needs to put in enough calories in order to perform at the level she desires. We never question her snack choices.

EKM: Did you ever struggle with symptoms of eating disorders or body image issues yourself? If so, what do you attribute the development to? How did you overcome it? And, how have you tried to protect your daughters from developing one or having negative thoughts about their body?

Dr. Julie Jacobstein: Yes, I did suffer from an eating disorder as a teenager and young adult. In fact, I fight these voices from within to this day. There was pressure from home, from my coaches, from friends, from TV and magazines; to fit in, to be thin enough, to succeed. My mom (although I am sure she never knew the impact it had) would ask things like, “Do you really need to eat that Twinkie?” or say things like, “Wow, you are really showing that freshman 15.” The fact that I can still remember those statements shows their significant impact. What started as a desire to be “thin enough” became an unspoken competition to see how thin I could be…. Could I make myself thin enough? What was thin enough? It became a control game until I lost control.
I don’t think that you ever overcome an eating disorder. I think at some point you recognize that drive to be thinner is hurting you, and that those inner voices demanding you run more and eat less need to be confronted and suppressed. That distorted body image lingers and rears its ugly head when you least expect it!

As the mother of 2 girls, one a teenager and the other a preteen, I vowed to never make them feel the way I did! I have taught them about healthy eating, and I have taught them the importance of dessert! I encourage them to exercise and stay fit, but stress part of staying fit means you need to meet your body’s needs! I have taught them that what they see in the magazines and online is not real, and is often photo shopped. I have tried to teach them that everyone’s bodies are different, and that they should be proud of their body shape.
EKM: What advice would you give to someone who is quietly suffering from an eating disorder?

Dr. Julie Jacobstein: I would want them to know that they are not alone, and that it is easy to find help and support. We need to empower young women before they reach a point where these images and pressures are forced on them! My youngest daughter (almost 10) is now playing club lacrosse and travel soccer. We are starting them younger and younger in these competitive sports and pushing them at even younger ages. While I love that they are active and feel empowered, I worry about where this will lead….