Expert: Joanne - 1/9/2009

Question
Hello,
I am 18 years old and am recovering from anorexia. I am 5 feet 4 inches and
have been recovering for about a month, starting at 88 pounds.

I have been suffering severe binges; those in which you feel physical pain
and feel uncapable of doing anything apart from sleeping. I eat constantly-
all day long, feeding basically on nuts, chocolate, cookies, cakes, bread,
peanut butter, cereal and other similar foods. I love to eat healthy, but I just
dont see how eating veggies and fruit Im going to gain back my weight.

So Ive been binging every day for the past month and Im only up to 94
pounds. How can that be?? I do absolutely no exercise (Im in exam period so
I couldnt even if I wanted to..), and I thought that an extra 3500 calories was
an extra pound gained? How can it be Im not gaining weight any faster? On
some days the number on the scale even goes down!!

My other main concern is what is going on with my body. My legs and arms
are still like little twigs, bt my belly- oh my, I look like a pregnant woman.
Before anorexia hit me ( I have only been anorexic for about 5 months, since
this past summer), I had a nice body with typical spanish hour-glass curves,
tiny waist and prominent hips, nice healthy cheeks, and a certain glow about
me. Now Im afraid that because everything is going to my stomach, I will lose
my small waist (my waist has always been 20 inches round), and when will I
gain weight on my face? Will all the weight I put on be fat? I cant do exercise
so I cant put on muscle until february!

Can this past month of unhealthy eating be fixed if I start with a more
controlled plan from tomorow? (It is also difficult because everyone around
me is trying to feed me, basically shoving food down my throat, offering
cookies and chocolate all day long- and if I dont eat that stuff at home, my
mom will think Im relapsing into anorexia).

Also, my mom accompanies me at every meal. It doesn't really bother me,
since I can prove to her that Im eating (excessively), but should she lay off, or
is she doing the correct thing?

If I start swimming in February, will my weight redistribute quickly? When can
you say "I have recovered from anorexia?"
How do you prevent a relapse once you are at your goal weight and want to
maintain (ie. watch what you eat)

Oh my, so many questions! I spend all day thinking about food that I cant
even properly concentrate on my studies.

Could you produce a sample meal plan for one day of what I  should be
eating please?

Thank yo so very much for all your help, I truly appreciate it.
Tate  

Answer
Tate,

Firstly, it is quite common for you to gain weight around your middle when you first begin to gain weight.  This should redistribute in time though.  Basically, your body has loads of fat cells, and even when you starve yourself, these fat cells don't disppear, they just shrink.  When you begin to put weight on again, you are going to refill these cells, for some reason, you seem to notice that the cells around your middle are quite often the first to refill.  There is also a chance that some of this increase in size is also due to a bit of bloating when your digestive system is trying to recover - it may be a bit sluggish just now.

I think that you need to stop worrying about what you have eaten over the last month and focus on what you are going to eat from now on - the past is the past, and you can't change it!  I would recommend eating 2000 calories or possibly even slightly more just now while your body is trying to repair itself, but it is important not to get all these calories from processed foods and foods containing a lot of fat and sugar.  Yes you need to eat these foods, and you should really be trying hard to make sure that you don't stop yourself having indulgences, especially just now, but these should only be part of a good balanced diet, especially since your body has been missing out on so many nutrients up until now.

The weight you gain will not be all fat!  Even without exercise you should rebuild some muscle, but this will be improved when you begin to exercise again.  Although it is your exam period, you may find it helpful to do a bit of exercise as a break - just a short walk maybe helpful to your memory and concentration!  Just be careful not to over exercise at any point, and when you do begin to exericse again, you have to account for that when you are eating - i.e. increase calories so that you are not losing a lot of weight!

As for your slow weight gain, basically your metabolism is a bit messed up - for some they will gain weight a lot faster than expected, for others they will need to eat loads of calories in order to regain the weight.

As for a sample meal plan - these should really be tailored to your individual needs by a nutritionist, but I can give you an idea of what you could be looking at.

Breakfast:  Glass Orange Juice
           Bowl of cereal (muesli or porridge, etc) with 100ml whole
           milk or with yoghurt
           Slice of toast with Jam or peanut butter
           Piece of fruit

Snack:  Handful of nuts are great for you, or possibly a cereal bar
       Glass of milk

Lunch:  Sandwich (2 slices of w/meal bread) spread with mayo or    
       butter with a cooked meat and salad as filling
       Yoghurt
       Banana

Snack:  Your choice, but should be 150-200calories

Dinner:  Serving of protein (e.g chicken breast)
        Baked/Jacket potato
        Veg - preferably stir-fried (or spread your potato with
              butter)
        Dessert? 1 cup ice cream

Snack:   150-200 calories

There may be professionals out there that may think that my plan is all wrong, and I would most likely agree with them!  I did not have professional input with my meal plan when I was recovering, and wish I had!

Basically, you need to be eating quite a lot of calories, and you need to be making sure that they contain servings of fruit and veg (aim for your 5 a day!), eat carbs as they are quite a good source of calories, but try to eat starchy ones rather than a lot of refined foods, make sure you have protein, but if your vegetarian, make sure you have suitable replacements for meat!  And don't forget your fats - you need some in your diet.  Nuts and oily fish both contain fats that are essential and healthy, so try to include things like these in your diet!

Joanne