Expert: Leigh-Anne Persing, PA-C - 2/9/2007

Question
Hi. MY friend is suffering from anorexia. She wont go see anyone ecause she is too shy and I am the only person she feels she can talk to.

She really wants to get better and try eat properly again but is to scared to because she says her metabolism is messed up and she will gain weight is she eats again.

She said that she plans to try and eat properly for 5 days in a row (1200 calories) of the week and then not eat much (400 calories) for the remaining 2 days. She said that this might get her metabolism going but then not put on weight beacsue of the 2 fasting days? Will her body still be in starvation mode if she does this or will this help her metabolism to get better?

I know that its not healthy way to do things but it is the only compromise that she will try to start with and I'm hopng that once she does this, she will get used to eating again and not have to do the 2 days of almost fasting. Do you think that she will put on weight is she does this because that will also freak her out!

Answer
Generally when a person suffering from anorexia starts to eat again they will gain a significant amount of weight in a short period of time. The body holds on to the nutrients it's given because it is afraid that the person will starve the body again. However, once a normal eating pattern is established the metabolism does normalize somewhat and the body will begin using calories efficiently rather than storing them all. I suggest that she start her calorie intake at a low level, and slowly increase it to a more normal range. That way her body has time to adjust to the changes and hopefully minimize the rapid weight gain. Start at 800 calories a day and then increase by 200 calories every week, with a goal of getting to at least 1400 calories per day depending on activity level.