Recovering from anorexia – It’s not just about the weight

by Insook Jeon, M.S., R.D.

Patients entering treatment for anorexia sometimes resist getting help from what they perceive as various authority figures such as doctors, psychiatrists, and nutritionists trying to make them fat and gain weight. This is partly in response to some of the screening and evaluation methods used with eating disorder patients, especially the widely used height and weight charts from MetLife or the USDA.

For example, a 20 year old woman might enter treatment at 5′ 5″ and weighing 80 pounds, which corresponds to a Body Mass Index (BMI) of 13.3. The standard BMI chart range for this age is between 19 and 26, or between 114 to 159 pounds, with a 50th percentile target of 130 pounds. It would be difficult for most anorexic patients to contemplate gaining 34 pounds, not to mention 50 pounds at the outset of their treatment program.

One response to the perception of “unrealistic” goals set by treatment programs can be that patients will actually work diligently at gaining weight as quickly as possible, in order to be declared “cured” and thus “escape” from their treatment program, free to resume their old behavior. It is not uncommon to see some women who have gone in and out of treatment facilities with this pattern.

Rather than trying to force a struggle with an overwhelming increase in weight, I often ask new clients, “What weight do you think you manage without hating yourself?” This helps us set a “safe” goal that we can work towards together, and allowing a focus on recovery through changes in nutrition, behavior, and attitudes, rather than a focus on weight gain. By the time the initial goal is achieved, we are ready to set a secondary goal, building on the improved health and behaviors, and progressing toward levels that seemed unattainable at the beginning.

Link: Interactive age-adjusted BMI calculator (Baylor University)

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Ross’ Story

Ross, one of Insook’s patients, shares some thoughts about his experience with developing and recovering from an eating disorder:

Words to Inspire
by Ross F.

Regardless of what side of the spectrum those who suffer from eating disorders fall on, the battle to get better is truly epic. Many of those who are lucky enough to find, afford, and receive quality treatment do not always make it out alive. With eating disorders becoming as mainstream as low-rider jeans or The O.C., the people who have devoted their lives to curing this epidemic seem to be fighting a losing battle

It has become the crusade of the twenty first century to eradicate eating disorders, in all of its forms, and it could not have come at a more crucial time. Both sides of the “eating disorder spectrum” have been swarmed with and it seems as if anorexia has become socially acceptable. Our culture is infatuated by those who live lives the general population can only dream about and it is feeding the fires of this growing epidemic.

I, personally, have spent more than half my life not only consumed by anorexia and bulimia, but hiding it from my family and friends. My eating disorder was born from chaos. My life, it seemed was presented to me and enforced for my own good. When you live a life that is not yours, control becomes the focal point of your existence. That was my curse, control. In a world I didn’t belong, in a life I did not choose, the only thing I could control was what I put, or in this case, what I didn’t put in my mouth.

It started innocently enough, a way to get back at the one who ruled my life with an iron fist, however, it began to consume every aspect of my early life. A year or so in, I started believing that I didn’t deserve food, that if I wasn’t who everyone thought I should be, I stumbled, if I found life to be difficult, I was something less than human. These thoughts, these feelings might not be uncommon to an eleven year old, but my desperation grew exponentially until my depression peaked at thirteen.

There was no where else to go. I found myself carefully compiling my final thoughts on this earth, apologizing to those I had failed, wishing my peers luck, praying and hoping that there was some other way, but at that age, options are few and far between. And as I sat on the foot of my bed with a .357 magnum in my hand, tears pouring from my eyes, I knew this would be the tragedy of Ross Edward Farley III.

My only saving grace was the thought of leaving my mother and my sister to grieve, and the guilt I felt for the potential mess I was about to make for my father to clean up. I put the gun back where it belonged, and spent six more years tormented by my disease.

I have been in treatment for two years with one of the most brilliant nutritionists I have ever met. She has truly saved my life, and I will never be able to thank her enough for taking my case, no matter how risky it was.

To those who continue to suffer, please do not give up hope. Life is precious. Every pound I gain is the most I’ve ever weighed, and I couldn’t be happier.

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Common Symptoms of Eating Disorders

Anorexia Nervosa* Bulimia Nervosa* Binge Eating Disorder
Excessive weight loss in relatively short period of time X
Continuation of dieting although bone-thin X
Dissatisfaction with appearance; belief that body is fat, even though severely underweight
Loss of monthly menstrual periods X
Unusual interest in food and development of strange eating rituals X
Eating in secret X
Obsession with exercise X
Serious depression X
Binging–consumption of large amounts of food  
Vomiting or use of drugs to stimulate vomiting, bowel movements, and urination  
Binging but no noticeable weight gain  
Disappearance into bathroom for long periods of time to induce vomiting  
Abuse of drugs or alcohol  
* Some individuals suffer from anorexia and bulimia and have symptoms of both disorders.

(source: NIH Publication No. 94-3477, 1994)

What is Anorexia?

People with Anorexia Nervosa see themselves as overweight even
though they are dangerously thin. The process of eating becomes an
obsession. Unusual eating habits develop, such as avoiding food and
meals, picking out a few foods and eating these in small quantities,
or carefully weighing and portioning food. People with anorexia may
repeatedly check their body weight, and many engage in other
techniques to control their weight, such as intense and compulsive
exercise, or purging by means of vomiting and abuse of laxatives,
enemas, and diuretics. Girls with anorexia often experience a
delayed onset of their first menstrual period.

The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode; some have a
fluctuating pattern of weight gain and relapse; and others experience a chronically deteriorating course of illness over many years.
The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.

The most common causes of death are complications of the
disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

An estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime. Symptoms of anorexia nervosa include:

  • Resistance to maintaining body weight at or above a minimally normal weight for age and height
  • Intense fear of gaining weight or becoming fat, even though underweight
  • Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight
  • Infrequent or absent menstrual periods (in females who have reached puberty)

(source: NIH Publication 01-4901, 2001)

What is an Eating Disorder?

Eating Disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe
overeating, as well as feelings of distress or extreme concern about body shape or weight.

Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain
maladaptive patterns of eating take on a life of their own. The main types of eating disorders are anorexia nervosa and bulimia nervosa.

A third type, binge-eating disorder, has been suggested but has not yet been approved as a formal psychiatric diagnosis. Eating
disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood.

Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance abuse, and anxiety
disorders. In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including
serious heart conditions and kidney failure which may lead to death. Recognition of eating disorders as real and treatable diseases,
therefore, is critically important.

Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia
or bulimia and an estimated 35 percent of those with binge-eating disorder are male.

(source: NIH Publication 01-4901, 2001)