Expert: Meg - 5/29/2011

Question
First, some background info: I am a 17 year old female, 5'5.5", and weigh between 118-120 lbs. Since January I have lost around 30 pounds. Since my freshman year of high school, 2007-2008, I have lost a little over 50 lbs. My original plan was to stop at 130 lbs. But then I wanted to have a 5 lbs safety range "just in case". So I went to 125 lbs. My doctor told me I was at the perfect weight when I reached here. But then I didn't want to stop. I began eating less and exercising more. I began going to the gym 6 times a week, and not 7 only because my gym is closed on Sundays. I burned around 1200 calories each day on exercise, and sometimes more. My calorie intake slowly decreased to 1000, then to 800, and a couple weeks ago it hit 500 and below. I was literally scared to eat. I began to feel tired all the time, my hands look awful and dry and cracked, I'm also freezing, my heart rate is maybe 36 bpm, and my period stopped late march.I have bruises on both my hips, and my ribs are starting to show. the knobs on my back are visible and my hair has lost a little bit of "lust". I also get cranky a bit more especially when food is around or after I eat. I am so lost.
My biggest thing is that I'm still at a healthy weight so if I try and get out of starvation mode, won't I gain? Yesterday and today, I ate a lot more than usual because my body was just starving for food and I know I need to eat more but I'm so scared to look at the scale because I REALLY don't want to gain because I don't need to. 118 is a good weight. I also haven't gone to the gym for 2 days due to conflicts. As a recovering anorexic, I know you're supposed to stop exercising for awhile but thats only if you need to gain weight right?
My entire family says I've gotten very skinny, and though I still look okay I need to eat more. My body agrees but my mind is so scared of food. I don't think I've gotten that skinny honestly. I still see a fat tummy in the mirror. My mom says if I don't start eating more protein, she's going to take me to the doctor. Again, I need to know how, how much, and what I can start eating again so I can take my body out of starvation mode and be normal again. I just want to be able to eat something sweet sometimes or splurge like my friends and not hate myself. What would be a good meal plan for a recovering anorexic who DOESN'T need to gain weight? Sorry I know this is a long message but thank you.

Answer
Hi Megan,

First off, my sincere apologies for being a little slow this week.  It's been a hectic one for me.

I am so sorry that you are having to go through all of this and hope that I can be of some help.  Your story sounds really familiar and much of what you said about wanting to lose a certain amount and then not feeling satisfied and needing to lose more and maintain a safety zone reminds me of what I myself went through and have talked about with others.  This is the way that an eating disorder pulls one in.  At first, it feels like you're in control and you get almost a high from losing weight.  However, it is never enough and even when you are barely eating and working out religiously.  Even when you have all those scary physical symptoms that are warning signs from your body (ie:  your period stopping, feeling cold and tired, bad circulation, bruises, hair loss, etc) you still feel scared to eat and unable to stop doing what you're doing.  This, sadly, *is* the eating disorder and its why so many people get stuck in the cycle.  

As for what to eat as you recover, the most important thing in my opinion right now is getting your body healthier.  Its impossible for me to say if that means adding any weight or not, as everyone's body is different.  What I do know is that with all of the physical symptoms you mention, clearly your body is letting you know that it is not well and can not function as it should.  No matter what your weight is (and I actually feel like your weight is already on the low side), when your period stops, you know that your body is under excess stress and things have gotten serious.  

I think you know this, and its great that you are actively looking at ways to get healthier.  That speaks loads about your maturity and ability to fight this.  

While this won't be the most popular idea, I am guessing, my honest opinion is to put the scale away for awhile and truly work on taking steps towards getting healthier again.  Until your body is able to behave normally and you are healthier, its true that you might be in starvation mode and your  body probably won't react like a healthy body would to any type of diet or exercise program.  This might seem unfair (certainly, it did to me when I was in the midst of my anorexia) but having come out the other side, I now feel like this is how our body tries to safeguard our health and keep us from falling too far into the disease or even dying.  

I don't necessarily think you need to totally stop exercising as you work on getting healthier.  However, you do need to be sure that you're taking good care of your body when you are going to work out.  Your Mom is correct that its important to eat protein as many of your vital organs, including the heart can begin to waste due to anorexia.  However, I would suggest slowing building a healthy diet that includes not only protein but also a good balance of carbs, some fat and nutrient rich vegetables and fruits.  

Because I'm not a dietitian nor do I know what your body needs, its hard for me to recommend an overall healthy eating plan.  I would suggest a set amount of regular meals (3 at least) as well as snacks if you need them that total a non restrictive number of calories.  In my opinion, the minimum your body probably needs is about 2000 per day.  Its important, though, not to get too caught up in weighing yourself in early recovery as your body may fluctuate with a lot of water weight as it gets balanced out.  So, I would recommend trying to eat regular meals and enough calories as this is the surest way to get your body working normally and out of starvation mode.  

As for wanting to be able to eat sweets and not feel guilty and wanting to feel okay about your body, these are the more complicated and less technical issues.  This is the "work" if you will, in your recovery.  As I know your weight (from your telling me), you are already on the small size for your height.  So, at least keep in your brain that your feeling like you are fat is part of the eating disorder and is not based in reality.  The most important thing to do is to ditch the scale for awhile (scary, I know) and focus on health as no matter what you weigh, you probably won't feel thin enough right now.  

In terms of eating sweets, its fine to have a treat now and then as your friend's do.  Sadly, this seems not fine when you're in the midst of anorexia and I know its going to take some work to feel okay with it again.  Healthy, normal people have treats and it doesn't make them fat and (as with everything in life), sweets are great in moderation.  That said, often those of us with eating disorders have trouble with the moderation part.  Especially as you are working on recovery and your body is wanting to get healthy.  It is possible that during this time, you may eat more and thus feel that "out of control, so I need to restrict again" feeling.  Let me reiterate, its okay to have a treat and even if you have some days when you eat more than you feel like should, you won't get fat from that and it will even out once your body is healthy again.  As to how long that will take, its hard to guess as everyone's body is different.

I hope this helps some.  Please keep fighting and reach out for real help (or even speak with a dietitian if your parents are willing to help you out with that).  I'm going to attach a few links that might be of help and please write anytime if there is more I can help with.

http://www.something-fishy.org/treatmentfinder/

http://www.something-fishy.org/whatarethey/anorexia.php

http://eatingdisorderrecovery.com/

Take care, you sound like you're at the beginning of the right path and your health, your well being and YOU are worth taking that path.

Best,
Meg