Expert: Meg - 4/10/2006

Question
Meg -

I am currently seeing a counselor and a nutritionist for my eating disorder. I am anorexic and i have an obsession with exercising as well. I am 21 years old, 5'3" and 116 lbs. Technically my calculated BMI is normal (about 20.5), but I have not had a period in 6 months and I am also experiencing hair loss. The bulk of my weight is definitely muscle - I have very little fat on my body. Here is my issue: my nutritionist has my eating goal set at 1800 calories a day and working out no more than 45 minutes 5 times a week. Is this safe weight gain? I find myself feeling like I'm vastly over eating because at the end of the day I have not yet met my goal and I just keep eating! I feel uncomfortably full and feel guilty about eating late at night. Is it ok that I'm doing this? I count my calories on an online calorie counter, and I feel like I'm just eating and eating until I hit that number. Is this healthy?

Also - is 1800 cals/day and such light working out safe for weight gain? How much should I be gaining a week? All I know how to do is lose weight, so this aspect of gaining weight is completely foreign to me. I'm scared to death that I will lose control and balloon - however, I do NOT like how small I am and how small I look now. My arms are boney and veiny and loved-ones have expressed concern for how small I am (this time last year I was about 135 lbs).

Please help me try and sort these thoughts and let me know whether or not my current plan is leading to safe weight gain. I feel like I dont trust my nutritionist, but is that just because she is asking me to do something I'm not comfortable with?

I'm so tired of the constant worry - its tearing my life into shreds. I have so much respect and admiration for you and what you do here at this website - you are so kind to volunteer your time to so many people that have problems! Thank you so much - I look forward to hearing from you!

Scared,
Kelly

Answer
Hi Kelly,

Thanks for your note and I'm sorry that you are going through this right now as I know how daunting the task of recovering and giving up one's eating disorder can be.  Its really good that you are working with a counselor and a nutritionist-and that you are willing to work hard to beat this.  Trust me, that can be the biggest stumbling block for a lot of people and you sound quite motivated to get healthier and get rid of your eating disorder.  

Boy, I remember feeling that ambiguity and I really feel for you as it can sometimes seem like everything that you are "supposed" to do to recover feels quite wrong.  I promise you that as you get healthier, it will get a lot easier so I think the trick is hanging in there for the time being and continuing to take baby steps back to being healthy and free of this.  

You are correct in knowing that muscle weighs more than fat and that its possible to be at a somewhat healthy (though a bit below average) BMI and still be in physical danger.  And, as you are not getting your periods and are losing your hair, it is very good that you are working on getting better.  

In terms of your meal plan-it sounds like your nutritionist has put you at a fairly low calorie plan but this may be due to your previous restriction.  It can be quite difficult on the body to jump from very few calories to enough to significantly gain in a short period of time and often requires medical supervision.  So, my guess is that your nutritionist is slowly upping your calories. I would definitely check with him/her about this though as you may ultimately need to consume a bit more to gain back your weight.  It does definitely depend on your body and the extent of the damage done, so work with your nutritionist or doctor to figure out what is  best for you.  

You mentioned that you are eating all day and still not getting all your calories in.  One thing that might help is to look at the sources of your calories and perhaps switch some to lower density calorie sources so that you can get the nutrients you need without getting too full.  A good example of this might be peanut butter rather than jam on toast, nuts, cheese, energy bars.  I would check with your dietician and let her know that you are full on your current plan and that it might need some amending.  Another idea is to pre-plan your meals (even with your dietician) so that you already know what you will have and when and it won't be a struggle to fit in your calories.  You might also try to have 5 or 6 smaller meals throughout the day to help you not get as full.  

I also found that as you get healthier, you might need to move away from counting calories as stingently.  Now, obviously for the time being, it is important for you to do this so that you know that you are eating enough.  However, some dieticians are able to work out plans with you so that you don't have to count calories but have more of an exchange plan (meaning, a certain amount of servings of protein, carbs, fruits, veggies, fats, etc).  If you are one of those rather compulsive calories counters (I know that I sure was) this can help a lot.  So, that is another thing to bring up in your next nutritionist meeting :)

In terms of the exercising, this is probably a little more than I would recommend initially, however I suppose if you were used to doing a lot more then it is a step in the right direction.  Ultimately, it is probably a healthy amount but you want to be careful right now so that you can regain your necessary weight.  

I know that it can be hard to trust anyone who is telling you to eat more and break some of these patterns so I can see why you might be having a bit of trouble trusting your nutritionist.  I'm sure that she knows what she is doing, however you can always ask her as many questions as you want/need and if you find that you still are too unsure you can find someone else.  As long as she has some experience dealing with eating disorders and you feel comfortable talking with her, then she is probably okay.  I know its hard to take that leap of faith though.  

I think that everyone who has had an eating disoder has the huge fear of losing control when they start to give it up.  I know that I sure did and it was very hard to believe that I wouldn't morph into an elephant overnight without my ed, but I can assure you that even if it might feel like this is possible, it will not happen.  Its good that you are working with a dietician who can help reassure you as well, but normal eating will not make you fat and especially if you are athletic, you really can move forward knowing that its going to be okay and you won't be out of control-even if it sometimes feels this way.  This is also something to talk about with your counselor as quite often, ed's are about control and so there can certainly be an emotional componant to that too.

I hope that this helped at least a bit and that you can continue to fight this.  As I said, you sound quite intelligent and focussed and I promise you that as you can get rid of this obsession and get your life back-there will be a lot of great things ahead and all of them more fufilling than staying stick and making yourself disappear.  Please let me know how you're doing and feel free to write again if there is anything that was not clear enough in this response or anything more that I can answer for you.

Take care, okay?
Meg