When you work with a dietitian or nutritionist to overcome your eating disorder, you can expect to learn a great deal about the impact of both adequate and inadequate nutrition on your body. You’ll also learn to replace your inaccurate beliefs with the correct facts 168 The Beginner’s Guide to Eating Disorders Recovery and strategies to help you recover. The first few sessions will probably address the following questions:
1. What is a calorie and what are my caloric needs?
A “calorie” is a measurement of the energy released when your body breaks down food, including carbohydrates, proteins, and fats. Your body needs a certain number of calories in order to survive and thrive. The more calories in a food, the more energy that food can give to your body. Under normal circumstances, if you eat more calories than you need for daily activities, your body stores the extra calories as fat and you’ll gain weight; if you eat fewer calories than your body needs, you’ll lose weight.
Males and females have slightly different caloric needs at different times of their lives.
While there’s no such thing as a “perfect” weight for any one individual, a certain range of calories is needed to maintain health.
Caloric Intake Range
2. What are the differences between “ideal body weight,” “target weight,” and “critical weight”?
“Ideal body weight” refers to the weight (or weight range of about 5-10 pounds) of someone your age, gender, and body frame under “normal” circumstances (non-eating disordered). The term “target weight” refers to whatever weight is 95% of your ideal body weight; “critical weight” is 80% or less of your ideal body weight. Generally speaking, if you are at or below critical weight, you should be hospitalized because you are at risk for major, potentially irreversible, physical damage to your body. One of the goals of sustained recovery is to reach and maintain your target weight.
3. What is a setpoint?
Everyone’s body has a setpoint, which is the weight (again, this is more accurately a weight range) that your body tries to maintain no matter how many calories you add or subtract. This weight range is the one at which your body is working most efficiently and is therefore most healthy.
Your setpoint weight is determined by genetic factors which are not changeable, and by your metabolic rate, which is explained in #4 below. Any daily food intake below 1200 calories for two weeks or more lowers the setpoint, as does keeping your weight less than your setpoint range. When this happens, all chemical reactions in your body slow down; your muscle tone, body temperature, and blood sugar levels decrease; and the ability of your heart muscle to work declines to 50% of its previous rate per minute. The longer you diet/restrict, the longer it will take for your body to normalize and its setpoint to return to normal.
4. What is metabolism (metabolic rate)?
Metabolism is the rate at which your body burns calories. Partial or total starvation is a physiological stress, which the body reacts to by automatically slowing down its metabolic rate. Metabolism fluctuates on a regular, 24-hour cycle: it tends to be slowest upon awakening in the morning and gradually increases to a peak around dinner time. Then it slows gradually. When you sleep it reaches that lowest point. Metabolic rate increases during and after exercising and, ironically, after eating. Also, certain medical conditions or medications can affect your metabolism, but we’re not addressing these exceptions to the rule here.
5. What are Body Mass Index, BMI, and BMI-for-age?
Body mass index (BMI) is a measurement used by physicians and dietitians to determine if the amount of fat in your body is appropriate and adequate to sustain your physical health. BMI increases as you grow into adulthood. BMI is calculated by the following equation: weight (in pounds) divided by height (in inches) squared multiplied by 703. Many websites will do the math for you, one of which is www.cdc.gov/nccdphp/dnpa/bmi/bmi-adult-formula.htm.
This measurement applies differently to children and teens than it does to adults. In children and teens it is referred to as “BMI-forage” and assesses underweight, overweight, and risk for overweight. It is gender and age-specific. (You can read more about this online at www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm). The BMI for adults is usually used to assess obesity. However, your appropriate BMI-forage will be determined by your doctor and dietitian. It will then be one of the gauges used by your dietitian to adjust your food plan throughout your recovery.
6. What is involved in initial weight restoration?
Adequate body weight is essential for health—both lean and fat mass protect your vital organs, which is why weight is first regained in the areas of the stomach, buttocks, and back. Muscle weighs more than fat—75% of muscle is water—and in the early stages of recovery the weight gained is comprised of a higher proportion of water and muscle tissue. Since the body wants to rehydrate, and fluid retention will occur because of hormonal changes and the sodium in food, some of the weight you gain is probably due to a fluid shift.
This is important to understand because it’s possible to misperceive the physical sensation of fluid retention as out-of-control weight gain, and escalate it into anxiety, obsessive thinking, even panic. You may insist you can “see” a weight gain of one or two pounds on your body, but that’s virtually impossible. Fluid retention is not an accurate reflection of how “fat” you are (even if “fat” is how you say you feel). Your dietitian will help you learn ways to address and challenge this misperception.
7. What is the Food Pyramid and how can it help me decide on a balanced diet?
The Food Pyramid is a guideline for healthful eating from the U.S. Department of Agriculture:
Source: U.S. Department of Agriculture/U.S. Department of Health and Human Services
A balanced diet has
• 60% – 70% carbohydrates
• 12% – 15% protein
• 25% – 30% fat, with no more than 10% saturated fat.
The food pyramid breaks the percentages down and gives you choices:
Milk, Yogurt, Cheese Group
One serving = 1 cup milk or yogurt; 11/2 ounces of natural cheese or 2 ounces of processed cheese
Meat, Poultry, Fish, Dry Beans, Eggs, Nuts Group
One serving = 2-3 ounces of cooked lean meat, poultry, fish. 1/ 2 cup of cooked dry beans, 1 egg, or 2 tablespoons of peanut butter count as one ounce of lean meat.
One serving = 1 cup of raw leafy vegetables, 1/2 cup of other veggies cooked or chopped raw, or 3/4 cup of vegetable juice.
One serving = 1 medium apple, banana, orange, or 1/2 cup of chopped, cooked or canned fruit, or 3/4 cup of juice.
Bread, Cereal, Rice, and Pasta Group
One serving = 1 slice of bread, 1 ounce of ready-to-eat cereal, or 1/2 cup of cooked cereal, rice, pasta.
You should try to eat at least the lowest number of servings from the five major food groups listed here. Eating the minimum supplies about 1600 calories; the midrange supplies about 2200; the upper range about 2800. You can find the entire pamphlet on the USDA website: www.usda.gov/cnpp/pyrabklt.pdf.
There are other food pyramids as well that focus on different cultural eating patterns. One is the Mediterranean pyramid, which emphasizes consumption of carbohydrates, fresh fruits and vegetables, beans, legumes, nuts, olive oil, cheese and yogurt. Ask your 173 Working with a Nutritionist dietitian about this strategy or read about it on the web at www.oldwayspt.org/pyramids/med/p_med.html.
8. What are “food exchanges” and why will they make it easier to stick with a food plan?
Food exchanges are just that: exchanges. Many items in your food plan can be substituted for others with similar nutritional and caloric values, so you can honor your food preferences without allowing the prior eating-disordered thinking and behaving to come into play. Since the goal is to normalize your eating patterns gradually and safely, these exchanges help you add variety to a food plan without losing nutritional punch. For instance, if you hate milk but are supposed to drink it, you can exchange it for soymilk. If you must eat bread but don’t like it, eat a taco or tortilla instead; if you can’t stand red meat, a serving of canned tuna or salmon would suffice, and so on. Your dietitian will teach you how to calculate food exchanges so you get the right proportion of nutrients and the appropriate number of calories. You’ll also learn “tricks” to help you determine what a serving of food looks like; for example, a medium size fruit is like a tennis ball or fist, a half cup serving is about the size of the palm of your hand, one ounce of cheese is the size of your thumb, an ounce of nuts is one handful, etc.
9. What is a nutritional supplement and how do I know if it’s safe?
A nutritional supplement is usually something specific that your dietitian or doctor tells you to include in your food plan to augment missing nutrients, such as a can of Ensure or Boost, a protein bar, a daily calcium chew, or a multivitamin.
Unfortunately, there are many unsafe items marketed as “supplements” that claim to enhance your mood and physical health. For example, kava (to relax you) and St. John’s Wort (an antidote for stress, the blues, and depression), popular herbal remedies in the last decade, have now been deemed harmful; kava has been taken off the market. Ephedra has been banned by the F.D.A. but it was recently used in a variety of herbal concoctions. Do not use anything that contains ephedra. And don’t take a supplement that hasn’t been suggested and/or approved by a member of your treatment team.
Nutrition and healthy eating are goals that seem elusive when you are in the throes of an eating disorder. But once you challenge your inaccurate beliefs about the relationship between your food intake and your body’s reactions to the foods you select, recovery becomes plausible and probable.
Excerpt reprinted with permission from Beginner’s Guide to ED Recovery
by Nancy Kolodny, MSW, LCSW
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