Eating disorder recovery
The road to eating disorder recovery starts with admitting you have a problem. This
admission can be tough, especially if you’re still clinging to the belief–even in the
back of your mind–that weight loss is the key to happiness, confidence, and success. Even
when you finally understand that thinness isn’t the Holy Grail you thought it was, old habits are hard
The good news is that the eating disorder
behaviors you’ve learned can be unlearned. That doesn’t mean the process is smooth,
quick, or easy, but you can do it if you’re motivated to change and willing to
ask for help. However, eating disorder recovery is about more than giving up unhealthy eating
behaviors. Overcoming an eating disorder is also about rediscovering who you are beyond your eating habits,
weight, and body image.
True recovery from anorexia and bulimia involves:
- Learning to listen to your body
- Learning to listen to your feelings
- Learning to trust yourself
- Learning to accept yourself
to love yourself
This may seem like a lot to
tackle, but just remember that you’re not alone. Help for eating disorders is out there;
all you have to do is ask!
weight can be a very frustrating process for persons with anorexia nervosa.
Often what looks like weight gain turns out to be fluid retention, or edema. (Edema
is swelling of any part of the body due to collection of fluid in the spaces between the cells.)
We talked with Dr. Wayne Callaway, a well-known endocrinologist and eating disorders
expert in Washington, DC, to see what one can do about regaining weight safely and comfortably.
Disorders Today: Why is the process of regaining weight so frustrating
for some patients?
can be difficult because many factors are involved, including the unseen physiologic processes
that can work against the patient. The more a person understands about what is happening, the more
independent he or she can become, and the more successful weight regain will be.
What does happen when a patient
First, it's important to remember that day-to-day measurements on the scale nearly always
reflect water weight, and the number on a scale should not be used as the only guide.
Generally, when people have severely cut back on their food intake and/or have been
exercising excessively, their resting metabolic rates will fall. They can do nothing about this; it
is programmed in the genes to allow one to survive famine or lack of food. When food is restricted,
less thyroid hormone is converted into the active form, triiodothyronine, or T3, and the
sympathetic nervous system slows down; this involves norepinephrine (a hormone secreted by
the adrenal glands) and dopamine (a neurotransmitter essential for normal nerve activity).
Then metabolism slows. This is very helpful for survival, but also causes blood pressure and pulse
rate to fall. As a result, the small blood vessels don't constrict as well when one
sits or stands. This is one of the reasons that some people faint when they are restricting
there any way to predict who will have problems with edema when they start refeeding?
If a person has a pulse rate
of 60 or less or her blood pressure is under 100/60, or even 110/70, if her hands are
cold, and she has slowed reflexes, these are all pretty good signs that she will retain fluid
as she begins to eat more, particularly if she eats more carbohydrates. With increased carbohydrates,
the body is forced to produce more insulin, which causes the kidneys to retain salt and water.
It also increases the permeability, or "leakiness," of the capillaries. Patients
will still have low blood pressure when they sit or stand. The heart pumps harder because
it is pushing more fluid out, too.
What do you do in your practice?
First the patient and I discuss what is happening
physiologically, and during the physical exam I show her that she has edema or slow reflexes.
Often these persons will have bluish fingertips and slowed deep tendon reflexes. I explain that
since her metabolic rate is low, the best and healthiest way for her to regain weight
is to first identify the underlying physiologic things that are going on. I explain
the biology of what is happening behind the scenes. It may be a little scary at first to talk
about these things, but most patients can stay with the program if they know that the water weight
gain will pass. If a person has a very low metabolic rate, I work with a nutritionist try
to increase food in small increments. Sometimes this is as little as 100 calories a
week, then we go to 200-calorie per week, until the level gets back up to something that is
midway between what a person should be burning at rest and with activity.
What can a person do about
We suggest that patients try to keep the amount of fat in their diets at the
daily amounts recommended in standard dietary guidelines, or up to about 30% of daily
intake. When fluid retention is a problem during the recovery phase, it doesn't hurt
for a patient to get 35% or even more of their calories as fat. Most anorexic patients don't want
to eat fat, but if they try to bring their metabolic rate up with carbohydrates, the
carbohydrates will cause increased insulin secretion, which will only exaggerate the edema.
I also suggest trying to limit simple sugars; they are high in carbohydrates, which
can be every easily absorbed and require a surge in insulin, which makes the whole problem of fluid
retention worse. One type of complex carbohydrates, those that contain beta-glucan insoluble
fiber, slows the absorption of sugar. Also, there is nothing wrong with eating eggs.
It's also important to try to establish an eating pattern where you get enough food at each meal and
thus don't crave food between meals.
Some patients complain about regaining weight right in the
abdomen. What can they do?
If they are getting lots of calories during refeeding, most of the calories are going to
end up right in the abdomen because there is also a large release of steroids, which
makes the insulin level go up, and this gets stored as fat in the abdomen. My goal for
patients like these is to allow them to build back their muscle tissue, and to some extent
their fat storage as well, while bringing their metabolic rate up.
How can family members help?
The most important thing family members
can do is not to be policemen. Sometimes fathers are worse than mothers in this regard.
The goal of therapy should be to rewrite the story for that person. I deal with the
physiological part, and tell patients that their therapy will be much more successful if
they can focus on the areas that are really important in terms of understanding behavior and
dealing with individual issues. But I also tell them that it is going to be very difficult
if there is a biological part that can sabotage efforts to regain weight.
And what if the patient skips or
delays a meal?
My patients know that if something happens and they delay a meal or under-eat a meal or skip
a meal, it is a one-time event. The mistake gives them a roadmap to go by, to get back on
track. It is like this in business, sports, and politics as well. The person who learns
from the experience, not the person who blames the experience for his or her failure
the rest of her or his life, is much more likely to succeed over the long term.