My Daughter Is Very Underweight and Obsessed With ‘No Fat’

By November 19, 2012

My 20 year-old daughter is very underweight. She eats healthy balanced meals but very small portions. She is obsessed with the ‘no fat’ notion. She has not had her period for about one year. She has been to counselors, doctors and a dietitian but no one has given her real guidelines on what or how much to eat at a meal, or what is needed for healthy fat intake. She measures out her breakfast cereal & milk according to the serving size on the box. She started gaining but now works hard on the farm during her summer break from school so she has lost weight again. Do you know where I can find info that gives some specifics for gaining weight the healthy way? She doesn’t want to develop any bad habits that would cause her to become heavy later. She is very meticulous and would follow a plan if she knew it was healthy for her. She has also been on a Splenda kick. She has trouble with constipation even though she eats lots of fiber – whole grains, fruit, vegetables. Any help you can give us would be greatly appreciated. – Concerned Mom

Dear Concerned Mom:

Your daughter is fortunate to have a mother who cares enough to seek help and resources. It sounds like you have reason to be concerned; her weight loss, constipation and lack of menstrual periods are all red flags for an undernourished body.

Before discussing possible solutions, it’s important to understand exactly what is driving your daughter’s fear of eating fats or “unhealthy” foods. Does she think she weighs too much, even though she has become underweight? Is she afraid of gaining back any weight? If so, she may have developed anorexia nervosa. On the other hand, is her main problem not that she has been trying to become thin, but that she has become obsessed with eating healthfully and has unintentionally lost weight from being overly restrictive? If so, then she might fall into the category of “orthorexia nervosa.” (See the article at this site for more explanation.) Frankly, I find the fact that your daughter has not received much professional support puzzling, which is why I’m wondering if she is struggling with orthorexia—a much less recognized disorder.

I would love to be able to give you a specific plan to help your daughter attain a healthy weight, but that is really something that needs to be individualized, after a full nutritional assessment. Since the dietitian she previously consulted wasn’t very helpful, I would recommend that she try another one. See “Finding a Nutritionist” for some guidance. As a start, she probably needs to eat six small meals a day, since she tends to consume too little at each sitting. But depending on her medical status, calories have to be increased carefully and gently.

In the meantime, I have some resources that you might find helpful. First, there are many articles available in the “Eat Well, Live Well” section of this site, but “The Truth about Fats” would be the first one I would recommend for your daughter. In terms of books, I really like Intuitive Eating by Evelyn Tribole. Ultimately, all of us need to learn to honor our bodies’ internal cues of hunger and fullness, to fuel them healthfully. Since your daughter has been eating very restrictively for a while, however, she may have temporarily lost sensitivity to them (her constipation is probably a symptom of a slowed gastrointestinal tract). This book is packed with lots of wisdom and helpful information, which I think will give you both some insight. The author is a registered dietitian with years of experience counseling people struggling with disordered eating.

It is my hope and prayer that you will find the right professional help, combined with the information from these resources, to guide your daughter onto the path of recovery. Let us know how things turn out.