Expert: Meg - 8/20/2007

Question
Hi there Meg,
Just a few questions,
I have been in recovery from anorexia since Feb this year, although I only started to properly recover since the end of May, bascially I was refusing to follow the advice of the hospital , but eventually seen a bit of sense and started to muddle through. I first started to gain back some weight at the end of May, this started to completely freak me out as I was eating so healthily and exercising all the time ( you have probably heard this so many time apologies in advance! ) all of a sudden about a month ago my weight seemed to stablise at the 8 stone mark. I am 5"2 and 28. I am eating about 1400/1500 a day and exercise about 6 times a week,I admit some of the reason behind this is to help me feel in control and some of the reason is simply beacuse I enjoy exercise so much, I just try to not over obsess with the exercise too much, although this is very hard ! I am told that the average person needs about 2000 calories a day but I feel fine on the amount I am eating and I have enough energy to exercise and I am not losing weight so does this mean that my body may have found its natural weight it wants to be if Im not gaining/losing anymore? I honestly feel full and I am eating five to six times a day with a very varied healthy diet, even adding the odd bit of fat in there ( thought I would never eat fat again - sounds silly but so proud!)In addtion to the above question does this mean by metabolism has stabilised at last? Do you have to eat 2000 calories a day? I just cant see how say a woman of 5"8 who was a stone heavier would need the same calorie intake as me if you know what I mean? My periods have not yet returned, is this an indicator that I still need to be heavier? Im sorry for so many questions, I am getting outpatient care from the hospital and I am due for my last session with my dietican this week, so Im feeling a little anxious, I also feel as though I am not benefitting from the physcological help, I cant say that I feel any better from it, is this quite common?
Does the urge to exericse lessen over time as you get better? Personally I feel as though this is the only way I can cope with getting better.

Thanks you for your time
Kind Regards

Answer
Hello Alison,

Thanks for your question and I hope that I can be of some help. I apologize for taking a few days to get back to you, I have been having some computer problems.

Anyway, it sounds like you have come incredibly far in terms of your recovery.  It is really not easy to recover from anorexia, so I hope that you're giving yourself a whole lot of credit for getting to the point where you are now.

As far as if your body needs more than 1400/1500 calories a day, I would guess that once it is fully recovered, it might (since you exercise 6 days a week).  That said, it sounds like you are still in early recovery and have only been committed to really working on this since May.  That is a very short period of time and you have made tremendous progress thus far.  If you are stabilized right now at your current calorie levels, I would say that its fine to stay there for a little while and continue to get comfortable and in a healthy eating routine.  From your note, it seems that you are doing a lot of very good things for your body (including eating a varied diet and even including some fat!).  I remember well how scary it was to introduce some fat into my diet when I was recovering, so I totally think you *should* be proud.  Great job :)  I've actually learned that there are so many positive benefits of having some fat in your diet, not only in terms of health but even in preventing wrinkles down the road.  So, keep up the great work with this.

Its hard for me to say for sure if your metabolism has stabilized (sorry, only a medical test can confirm that definitively), but it sounds like it is working again which is a good sign.  

In terms of your optimal calorie intake, there are so many factors that determine how many calories your body needs in a day.  Its true that 2000 is a safe middle ground but its is more of a norm.  Generally, people on diets are advised to consume 1500 or so calories, so because you are not on a diet and trying to maintain, the general rule would be that may need more calories than you are eating.  Also, being an athletic/active person can raise that requirement.  But, it you are stable right now and have energy and are feeling a bit better, then I think its probably fine to wait awhile to increase your calories.

As far as your period coming back, this generally happens when one's body is healthy enough again to carry a baby.  Now, that said, again (sorry, I feel like I keep saying this) everyone's body is different and so there is no standard time for your period to become regular again.  I do know that the more consistency you give your body and the longer you are eating and abstaining from eating disordered behaviors, the sooner your period will come back.  But, as I said, you are still fairly early in your recovery so I would give your  body a bit more time before you start to worry about that.  If, in six months of eating healthfully, you still haven't gotten it back then perhaps check with your doctor.

I hope that your final dietician appointment goes well and recommend asking her (or him) any other questions you have regarding food, YOUR body's requirements, etc.  

As far as feeling better from the help you're getting, I think that this also takes time.  Generally, dealing with an eating disorder is kind of painful and not fun as usually there are things that are difficult to handle that played into your developing an eating disorder in the first place.  Also, as you well know, often eating disorders create a feeling of being in control and so having to give them up can produce feelings of chaos and uncertainty.  So, this stuff makes treating and recovering from an eating disorder hard.  If you are not feeling great about your treatment, you might want to consider if this is because your treatment team is pushing you to let go of your eating disorder, or because you're not clicking with your therapist or having some other problem like that.  I think, in recovering and with therapy, the goal is to understand yourself better and thus be able to make healthier decisions and understand what triggers you when you do make not so great choices.  So, the self understanding part of therapy should hopefully be the exciting part as it really is cool to be able to have a better sense of how you tick.  

If you mean that you're not feeling better in terms of your body image, this often takes time.  Its understandable if you don't feel great about your body right now, as taking care of it and eating healthfully is going against how you lived (with anorexia) for some time.  But, this does improve a lot the longer you are recovered.  For me, it took years to feel totally free of all of the thoughts and behaviors, but the longer I was recovering the less difficult things became until one day, I realized that all of the obsessing had finally stopped.  You can (and will) get there too, but for now just focus on doing your best every day and have faith that it all adds up in the long run.

Yes, the urge to exercise does ease up the healthier you get (physically and mentally).  That said, I think *some* exercise is okay, as long as you are eating enough calories and healthy.   And, for now, just keep your daily calorie intake up and make sure that you are not overdoing it and I think exercising is a fine way to cope.  

Hope this helps and please feel free to write anytime if there is anything else that I can answer or anything in this answer that isn't clear.

Take care,
Meg