Expert: Jeanne Rust, PhD - 5/1/2011

Question
QUESTION: Hello,

I'm a 13-year-old girl, 1.61/5'3" who currently weighs around 40.8-41.3kg/88-90lbs. I used to be bit of a compulsive over-eater so I've never had a healthy relationship with food, especially since my parents don't care about the health side of what me and my brother are eating and rather the price. I was also slightly overweight (almost 60kg) and so I think these 2 factors, along with my shyness (which I'm gradually overcoming), low self esteem and perfectionist attitude, I developed an eating disorder pretty similar to anorexia. I would say I was at my worst point at around December2010-February2011.
Currently, I am eating around 1500-1700 calories a day, after gradually increasing from under 500 since around January (most of the increase happened over a week or two in late March). As I increased, I actually lost more weight as I was paranoid about having a slow metabolism and I think I over-exersized quite a bit. My lowest was around 39.5kg a couple of weeks ago.
I did increase to closer to 1,900-2,000 for a week or so, but I found that I gained too fast for me to cope (I was only prepared for a pound of weight gain so I panicked when it went over) and I almost went back into relapse and dropped from 40.9kg-41.4kg to where I am now.

I would like some advice on how much I should be eating, how to balance my activity level and how to gain muscle mass rather than just fat.

At the moment, I use a base of 1100 (lean body mass BMR formula) - but I'm not quite sure if I have my body fat percentage right. If my periods stopped about half a year ago (when I weighed closer to 43kg), does that mean my body fat has gone under a certain level? And do you roughly what percentage is it that it starts to happen at?
Then I add on activity and take into account the thermic effect of food (+150).

I'm a little confused on my activity level though so I think I tend to over-exersize occassionally. I add on any moderate/higher-intensity exersize to my calorie intake but I'm not sure what general activity factor I should be using and would like to see if I'm on the right track.

Currently, I multiply my base metabolism by 1.3, as I'm definitely not completely sedentary (x1.2) as I've always naturally been quite fidgety (e.g. tapping my feet lightly while sitting on the bus), and at school, I have to walk around a bit and carry around an occassionally quite heavy bag on my shoulder (I think around 1-5kg depending on what's in it).
I would say I spend about 1-hr walking in total (>30-mins around class and break, <30-mins travelling to and from school).
During class, obviously I'm sitting down. We have 5 and each of them lasts an hour. Sometimes I fidget, sometimes I don't - depending on how boring the lesson is. I try not to, but particularly in english and history, I find that I can't help it. >.<
At home, I'm usually either kneeling/sitting doing homework or standing/sitting talking with family, eating food, etc. I tend to fidget a bit less at home (I've been keeping track as much as I can and trying to reduce to make things a little less complicated) because I guess I'm more comfortable and less bored. I practice violin and piano for around 30mins and do about 10mins quite light house work for my parents on some days (e.g. washing dishes, hanging washing).
I go to bed at 9pm and usually get up at around 6am on weekdays.
During the weekends, we tend to do a lot of shopping around simply due to boredom (usually around 1-3hours), but otherwise I'm quite low-active besides playing on my wii (which I add on to my intake seperately anyway).

- Before I forget, I have an exercising habit I can't overcome but I don't think it counts for much and to be honest, it's a bit of a waste of time telling you this, but I just needed to get it out. Every day I usually do 60 (in total) light (as I usually can't handle higher intensity) sit-ups/other calisthenic exersizes as well as 1 minute of running quite fast on the spot (in sets of of 15-30seconds with short breaks in between). I've decreased quite a lot, but I found that without these 2-3 minutes of exersize, I can't manage to eat without breaking down/feeling useless. -

Sorry for taking so long to get to my point, so that makes:
1100+350+150 = 1600+AdditionalExersize - to maintain my weight.
Would you say this is ok, taking into consideration into everything and also the fact that I had my growth spurt and pretty much stopped growing when I was 10-11?

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For the topic of weight gain, I'm still quite unstable/uneasy.

I found that because I'm still not quite sure of how much I need to maintain and worried about going back to old weight and ways of overeating, I refuse to let myself gain weight at a good pace. This sometimes causes my relationship with my parents to break down as I feel that they're always pressuring me to gain weight and eat more and if I tell them that I'm not comfortable/still scared, they'll get angry. I've already half told them, but to me, it seemed as though they thought I was being stupid worrying over not being to stop gaining weight.

I would prefer to build on my lean body mass/muscle, and I was hoping you could explain how to do that rather than gain completely fat. And is it true that you have to eat a lot of protein (e.g. 40-50%)?

What would you say would be the lowest weight gain target - or at least the best to gain muscle? At the moment, my parents want me to at least increase every week so after this week, if I can, I think I may increase my intake by around 100 each day to gain 0.1kg (our scale works in minimums of 1/4lbs and 0.1kgs but as we're Chinese/South Asian, we usually use the kg). I know to an extent that this is unreasonably slow, but I think my fear of going to back to how I was before kinda won't let me think properly. >.<

Is there any other advice you could give me on weight gain and coping?

Thanks!
Rose

ANSWER: Dear Rose,  

You're very smart for 13!  You also let me see your perfectionism and little bits of obsessive compulsive disorder.  

Congratulations on your weight gain.  You did it very scientifically -- and it's quite rare for someone to be as precise as you are.

A good, healthy normal weight gain is 1/2 to 1 pound a week.  Some people try to pack the weight on anorexics, and I believe that can be damaging.  A person needs to have a slow weight gain so they can internalize what's happening to their bodies.  If the weight gain is too fast, they can't keep up with it psychologically.  Slow is good --

I have a couple of questions for you.  What was going on in your life when you developed the eating disorder?  We need to find out what your issues are underneath the eating disorder -- if you can't tell, go to www.mirasol.net and look for the section that has all of the information about eating disorders.  Let me know what you identify with.  

The goal is for you to learn to eat normally without having to obsess over each bite of food or each exercise.  Protein definitely 40-50% -- this is what builds muscles and strong bones!  Peanut butter, eggs, cheese, chicken, fish, etc.

Please keep in touch and let me know how you do!

Warmly,
Jeanne Rust, PhD
CEO/Founder
Mirasol, Inc.
www.mirasol.net
www.edrecovery.com
888-520-1700





---------- FOLLOW-UP ----------

QUESTION: Thanks for the reply, advice and comments!

For protein - do you have any suggestions for snacks to take to school? I've already got the fish, poultry, eggs and dairy/soy covered but we don't really have many high-protein snacks at home (we have some nuts but I've found that I usually don't enjoy eating them xD). And being in the UK, supermarkets don't really sell protein bars. >.<

For your question, I would say I had a compulsive eating disorder when I was younger/growing up.
My parents put a lot of pressure on me when I was young to become 'number one', 'at the top', etc. or at least as close to it as I could be - I know it's not their fault, as when they grew up in China, they both had 'must-be-number-1' and 'education-is-most-important' attitudes planted into them.
They often thought I wasn't working hard enough and would shout at me (I think this made my self-esteem and confidence pretty low) and tell me to try harder.
But I was a kid, I wanted to play with all the other kids, have nice clothes and dresses like all the other girls, and education just wasn't top on my list. I think they didn't really give me the chance to play and socialize that much because they pretty much disapproved of anything they didn't really understand or related with - which was/is pretty much everything in modern english culture and lifestyles. Because of this, my low self-esteem and a few cases of bullying (due to my race, appearance, mistakes, etc.), I gradually became shyer and less open and found it hard to make friends.
Thanks to my piano teacher who worked her magic into my life at the end of year 6, they're a bit better now, but I still can't shake off the need to achieve perfection in everything or some of the feeling that I'm never good enough.
The over-eating part came simply because my parents don't give anything for the nutrition and health side of food - to them, it's almost all about the money, followed by taste. This led to loads of junk-food around the house, which I used as comfort food and my grandparents (who came over to look after us for about a year or so when my parents' work got really busy) used as treats for me and my brother every day. To put it simply, I was never really taught good and healthy eating habits so I've never had a healthy relationship with food and eating. I never learnt how to control portions, I was taught about healthy eating but never really encouraged and it just spiralled out of control and made my self-image and esteem worse and worse.

I hated myself and my body, and the more I hated, the worse I treated them. By year 6, I was 1.55-1.60m and already over 50kg. Then there's fact I was surrounded by skinny people and pro-Anna magazines and websites. It wasn't just me either, I had a couple of friends who shared similar problems and we would always be exchanging dieting myths and fad-diet-tips too.
Then I moved up to secondary school, which meant my 4th school exchange (my parents moved around a lot for the sake of work, rents, etc, but also for me and my brother... well, at least our educations). It also meant having to make brand new friends as I was the only person who managed to get into the grammar school that my parents wanted me to go to from my Primary school... it's obvious what that led to... and the constant charity cake sales did not really help either...
By the middle of year 7, I was 1.60m and almost 60kg.
Now, if my self-esteem and image weren't bad enough already, it only got worse.
My friend, who although was far from perfect, was prettier, thinner and in my opinion, better than me in almost every way (besides a few school related things) developed anorexia near the beginning-middle of the year.
It started off almost unnoticable, but soon she had started constantly starving, binging and self-harming.
Me and my other fairly big friend (but she was bit better off than me) felt pretty crap as you could imagine, but we didn't really blame her as we knew she couldn't help it after the bullying she faced from pro-Anna girls in her old school.
We told the school nurse along with a few other friends and she started her long road to recovery (she's completely recovered now, which is great - it took her about 6-9 months which was quite fast considering how much she reduced herself in terms of mind and eating, but I think the fact that the physical effects weren't too strong meant that she managed to recover).

But as she travelled down the road to recovery, I started travelling in the other direction. (I think my other friend joined me for a while, but she knew when to stop.)
I think that's when my over-eating started taking a turn to anorexia.

I think it wasn't too bad at first. I became unbelievably frustrated with my weight and being in between almost-overweight and overweight. I wanted to lose weight and also become healthier - after all, I couldn't even run for more than 2 minutes for God's sake! The goal I set was a little too much - down to around 50-52.5kg from about 58-59kg by the end of the year/before the 2nd term of Year 8 (less than 10kg in about 6-8 months) - but it wasn't so bad.

(Actually, what I truly always wanted was around 45-47kg which is my target now - due to my smaller Asian frame. In year 7, I didn't think I could either achieve it so I settled for less (well, technically, more).)

I started to exersize a little and limited my daily food intake, but I found myself giving in to ice cream and cake quite a lot so I ate pretty unhealthily (not having lunch to make up for 6-8 cupcakes, etc.).
I think I started 'dieting' officially slightly before the Summer holidays. (By then, my friend had almost recovered, but her perfectionist attitude still kept her a little down occassionally (e.g. she still had an odd day sometimes) - however, she was stable and happier now, which was good.)
At first it was ok, I didn't really exersize that much and just tried a few fad - but fairly safe - diets.
Then we went away for a while, and after gaining back some of the weight I had lost - despite not really eating that much - I became desperate. I was also fed up with my slow progress - I had only managed to lose 1-2kg in about 4 months which wasn't enough in my mind.
I started looking up and trying everything, but generally, I think I stuck to the calorie-cycling idea (eat to maintain metabolism and weight 1 day, eat to lose the next and so on). It wasn't so bad at first, I wouldn't deprive myself when I was unbelievably hungry, but it was clear my parents weren't that happy.

Then, I started to think 'maybe if I could reduce more...' and that's how it started to spiral out of control.

I started to pick off foods and not finish servings to reduce calorie intake. It was ok at first, and at reasonable amounts, but it gradually grew and grew and grew...
I also started to limit how much I ate a lot. This also became worse and worse and worse...
So from September/August to December, my maintainance intake had dropped from 1600-1700 to 1200-1300 - often, in fact, ALWAYS (sorry, there's no italics button...) not including the bits I picked off. I would just 'forget' to note it in my food diary... I don't even want to revisit my reduce days. I recorded 500-600 on extremely limited days, but considering how I didn't eat what I planned properly...

For me, what happened afterwards is a bit of a blank. I just can't really remember. I kept going around in circles - determined to get better, but at the same, never being able to and always returning to my eating habits. I didn't really keep track of my weight or eating, but I can say that until late February, I kept myself locked up and used studying/school-work, occassional trips to the gym and my ability to limit my food to keep myself satisfied/happen - but I wasn't.

I think I've already told you about what happened when I finally started to recover properly and I'm sorry if I repeated anything. There's a possibilty part of the reason I've taken so long to recover is that I've done quite a lot of it myself, especially with the eating and lifestyle monitoring (as my parents don't quite understand how I feel no matter how I try to explain and we haven't really had any professional help except a couple of disastrous visits to the GP - one more recently, but as it was with a different GP who tried to help, but didn't know anything on the topic of eating disorers (she even half-admitted it herself).

(A side note: This is also probably why I seem smart for my age - I've had to do a lot of research for my recovery due to the lack of a dietitician/nutritionalist and so that's probably why my knowledge/approach is pretty 'scientific'. xD I think that nutrition may be one of my career paths when I recover - along with design and dance.)

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Thanks again for your quick reply and time! And sorry if I've missed out anything or bored you to death~ >.<

Answer
Dear Rose,

You have had hard things in your life for someone so young - who writes like she's 30!  :o)

Snacks to take to school -- a piece of low fat cheese and a piece of fruit --  Protein is the answer -- it will keep you full longer and help you build strong bones (not fat bones -- but strong bones!).

Please keep in touch.  Is there anyone out there where you could find some support?  What about your friends that are in recovery now?

You can also think about being a writer when you're older -- or even now -- you have a way with words that is unusual!

Warmly,
Jeannie