I am very frustrated and need your help. I left residential treatment one year and two months ago and have not had a good dietitian to help me since. I am currently 30 years old, 5’2″, and after meeting with a horrible dietitian today, I am TERRIFIED to discover I weigh ***lbs and am **% body fat. I thought I weighed ***. I struggled with anorexia for eight years and left residential treatment weighing *** after gaining ** pounds. My dietitian said to simply maintain that weight without exercise (*** pounds), I should be eating 1900-2100 a day. Since leaving, my habits have returned to previous habits, but my weight has not dropped. I am an athlete, completed my 1st triathlon two weeks ago and eat about 1600 calories a day w/ 90 minutes (minimum) of hard cardio a day, 6-7 days a week. My eating is not regular, eat like a bird during the day and eat a big meal at or during the night and I have gained weight! I am really upset and frustrated with this. I thought I was restricting but I am gaining. I finally found a dietitian and today she told me 3 times that what residential treatmen said about my maintenance calories was ‘completely ridiculous’ there was NO way I should be eating that many calories w/out exercise. But according to her calculations, what I am eating and my exercise I should weigh *** but I weigh ***! PLEASE HELP ME. I don’t know who or what to believe. Now I’m just afraid to eat completely. Am I gaining/retaining weight because my metabolism has slowed down? I have heard that when you have an ED, your body has a memory and that my body has slowed down again. Part of me thinks that I am gaining/retaining b/c I actually need to eat more to get it out of starvation mode, but I’m not anorexic looking and I didn’t think I was starving myself. Being 5’2″, 1900-2100 seems like ALOT to be eating. Please help me understand what you think maybe happening to my metabolism. How can I speed it up? Do I need more than what non-former anorexics need and that’s why she thought my intake was too high? PLEASE REPLY, PLEASE. – Sarah
Thanks for your excellent questions. I have many thoughts in response. It may be helpful just to list them to keep it clear:
- You say: “I am TERRIFIED to discover I weigh *** lbs”. TERRIFIED in all caps signals a continued strong emotional trigger to the number on the scale. I’m sure you’ve worked very hard on this-don’t give up-sound like more work is needed. Is this what determines your worth? Your value? Your uniqueness? Your strength? Your identity? The truth is, these numbers logically sound within normal limits. However, a truly healthy body fat/weight is one in which you can eat with balance, variety and moderation in freedom, weight is stable, exercise is moderate/pleasurable/ sustainable, menstruation is monthly/normal and the mind is not obsessing about eating/exercise. Nobody knows better about a truly healthy body weight for you than you.
- I completely support the recommendation from the residential treatment dietitian for maintenance calories at 1900-2100; this sounds perfectly reasonable. I’ve been a dietitian in this field for over 11 years and have had extensive experience in recommending calorie ranges for all ages, body types and eating disorder types…I assure you this recommendation is reasonable and sound. This does not mean however, that this calorie range remains the same for every phase of activity in life or stage of life; it will continue to slightly change. By saying that you “returned to previous habits” means that you returned to some restriction of calories but your weight didn’t drop, then so be it. You at least for a time were able to meet your body’s needs without measureable weight loss. Now, however, it sounds as though these restrictive patterns have caught up to your body. 1600 calories per day with that amount of activity sounds as though your body has gone back into conservation/ preserve metabolism mode. In all likelihood, your body is conserving every amount of nutrition (not only because of your total calorie level but the erratic time of eating) at the cost of other energy-saving systems in your body (i.e. menses, thermal regulation, adequate cell generation, adequate hormone levels and neurotransmitter activity, just to name a few). Judging by this dietitian’s response, I wonder if she is either unaware or uneducated in the area of eating disorders and its effect on the body and/or has eating issues/disordered eating herself?
- You are absolutely right about retarding metabolism by restriction. Your body (and your mind and spirit) would benefit tremendously by getting out of starvation mode. You may also have had a rebound fluid shift from dehydrating after the triathlon which resulted in a logical weight (fluid) increase. So, this begs the question, is it wise to be training/competing in triathlons at this possibly fragile stage of your recovery process? Only you can truly answer that. There are many ways to care for your mind-body-spirit without engaging in such triggering activities until recovery is more solid for you.
- Even though 1900-2100 sounds like a lot, it is a very reasonable place to start with resuming a maintenance calorie level. Furthermore, you likely have a higher than usual amount of muscle mass as a result of your athletic activity over the years and this requires a higher calorie level just to maintain regular metabolism. Restriction slows metabolism; eat more, rev up metabolism. Ironic, I know.
Finally, you are not broken. Your metabolism is completely fixable. Return to the basic facts that you first learned in recovery to make this journey successful. Keep talking to your treatment team members and share your concerns while thinking critically about choices you make in recovery. You can do this!
Juliet N. Zuercher, RD