I’m 14 years old, and I am very underweight. Over the past two years, I have suffered a great deal of stress, and as a result I have anorexia. I recently had an appointment with a social worker who specializes in eating disorders. She told me that I needed to restore weight and put myself at around *** lbs. I am extremely uncomfortable with this but am very afraid of what might happen if I refuse to gain weight. Please help me. Also I have attempted to gain weight over the past few days but have been having trouble due to ED thoughts causing panic. Today I feel incredibly guilty because I ate food that is not considered healthy. I feel horribly fat, and I am wondering if I am bloated, just feeling guilty, or if I have already gained weight.
Dear Anonymous,
I’m really glad you wrote in asking for advice. Weight issues are some of the hardest to tackle in an eating disorder. You are already taking a very brave first step by going to see a social worker. Good job. Since I have no idea what your usual body weight was before the eating disorder started, nor do we know exactly what it would be if you had never started the eating disorder, a beginning recommendation such as the target weight your social worker set for you is a very reasonable place to start. However, obsessing about this or any other number will absolutely drive you mad in the eating disorder. The best advice I could give is to try as hard as you can to hand over “the number” to the treatment team you are working with. The most important job you have today is simply not doing anorexic behaviors and following everything that your team (social worker and others) is suggesting for you. Follow your meal plan, take it easy with exercise (or do no exercise right now), and let the weight restore naturally and slowly on its own. This is so much easier said than done, but you are so right when you say that you are afraid of what might happen if you don’t restore your body weight…it is very scary. Usually, what this means is years of struggling in an eating disorder; this means losing friendships, freedoms, your health and more. It is so important and essential to get that weight back. Do the very best you can with that. Each day is the chance for a little bit of forward progress.
As far as eating the unhealthy food item, I’m sure you know by now that sometimes the thoughts can turn completely crazy in an eating disorder. In fact, distorted thinking is one of the most common features that people with eating disorders share. You are not alone, and you are not crazy. This doesn’t make it right however. Work with your therapist (or social worker) on catching these distorted thoughts (for example, “I’m instantly fat after eating ice cream cake”), challenging these thoughts to see if they are actually true or not, and then changing them to the TRUTH. You may indeed be feeling some bloating and constipation as you refeed your body and restore weight; this is perfectly normal. Yet this is so uncomfortable because even though the bloating is literally gas (air) or fluid, it makes you feel fat. Keep reminding yourself, “This is only temporary; I will get back to a healthy relationship with food, and I can tolerate feeling uncomfortable sometimes after eating. I don’t have to use eating disorder behaviors to not feel uncomfortable; I can ride it out.”
Keep talking to qualified professionals (social worker, dietitian, psychologist) about these panicky, scary thoughts that you have. The thoughts will lose power the more you get them out of your head and put things in perspective. You are absolutely doing the right thing by getting help for your eating disorder. Keep asking for support and making smart recovery choices. You can do this!
Juliet N. Zuercher, RD