Expert: Joanne - 8/8/2007

Question
I had anorexia for about 4 years (I am now 16, and 5'4''). I've been to two outpatient programs, and one inmpatient program. After I went to the inpatient program, I got out and immediately lost 10 lbs (from 106 to 96). And from there, I fell to 74. I actually ate about 1400 calories during that time, but only at night, after 11:00pm. I ate only 200 calories during the day, and then spent 3 hours eating at night. I didn't really exercise, either. After about a year of this, I began to gain weight rapidly. I immediately cut down my calorie intake and ate only 900 calories a day, but still gained weight. So I started doing cardio workouts that burn 3-400 calories, and still gained weight. My nutritionist is at a loss, and all of my doctors say "well, obviously you're getting it in somewhere." It makes me feel helpless. No one can give me an answer. I am now 130 lbs, and although it is "within the range", it is not where I want to be. I have to be strict with myself and only eat about 8-900 calories a day, and only this keeps me from gaining weight. None of my medications cause weight gain. Can you help me?

Answer
The swing from starving yourself, to binging at night, then starving yourself again will be playing havoc with your metabolism.  Your body will be trying to store everything that you eat so that it has something to work with during time of starvation.

Your body will have become used to using as few calories as possible to carry out its essential functions, so when extra calories are introduced, it has nothing to do with them but store them!

In order for your metabolism to recover, you need to eat about 1500-1800 calories a day for a period of time, until your body is sure that it will no longer be starved, and will begin to burn what you eat as fuel rather than storing it all.  This will take time, however. Your body will also be repairing itself, and rebuilding muscle and fat (some is essential for normal body function!) and glycogen stores.

You also need to think about your exercise habits.  As you have begun exercising, you will be building muscle as well, and muscle actually weighs more than fat!

I think that you need to increase your calorie intake, and try that for a while and after a couple of months see if your weight has stabilised.  This may mean some weight gain initially.

Please do not fret about weight gain when you first increase your calorie intake - this will be normal.  But once your metabolism has recovered eating about 1800 calories a day, you may notice a natural fall in weight again as your body begins to sort itself out, finding a good weight for itself.

Many people end up yoyo dieting due to this!  They diet, and then return to eating 'normally'.  They will have switched their body into starvation mode, so when they eat again, their body stores it = weight gain.  The person will then diet again and so on and so on, constantly putting their body into starvation mode, and not giving it the chance to sort itself out.  Many will end up  heavier in the future that they were initially - they don't realise that their body and metabolism would have stabilised and maybe even lose some weight if they had eaten a well-balanced diet containing enough calories for a longer period of time.  Please don't become one of these people!

Do you still have a support team?  If you do, I think you need to be completely honest with them about how much you are eating now, along with exercise habits, and continue to stick to their plan.  These people will have a lot of experience in this area, and have plans that are known to work!  If you don't still have a team, I think you should ask about being referred back to them!

Please feel free to come back with anything else that you would like to ask or discuss!

All the best
Holly