While in the process of refeeding and recovering from an eating disorder, the body is basically going into repair and maintenance mode. Much like how lifting weights damages a muscle and the rest thereafter allows the muscle to grow stronger and bigger, recovering from anorexia or bulimia is giving one’s physiology the space to internally heal. Tissues are being repaired, the metabolism is speeding up (which causes night sweats and just sweating in general), muscles are being made stronger (think of the heart–it’s a muscle that has not been getting the fuel it needs), electrolytes are being balanced–there are numerous internal changes taking place, and so much of the initial calories needed are for these very purposes. Some of these internal changes, in fact, are actually the body’s thwarted and inefficient method of converting ingested calories–some individuals in recovery will have hot flashes and increased body temperatures after eating. Those are symptoms that something in the digestive realm is amiss, and food that should be going towards repair is actually being exuded by the body as heat. So once again, the great amounts of calories taken in by patients are not morphing into fat. They are morphing into HELP FOR THE BODY or in some instances, NOT EVEN BEING USED TO THEIR FULL RECOVERY POTENTIAL.
Although a rational mind will understand this concept, the eating disorder mind does not and immediately equates scale weight to fat weight. This is where a dietitian is necessary. Yes, it is true that one can just eat whatever she wants whenever she feels like it and that will help weight gain. That is very true and something I tried as well. But what happens when said individual has a momentary lapse in rational thought and judgement and freaks out that she ate three cookies instead of one? Now three cookies in the grand scheme of it all is not horrible and bad, but she may think so. And so she may start to feel guilty and gross and fat and then restrict some rice at her next meal because she ate more carbs than expected from the cookies and then now she can’t eat more carbs after the meal with the rice because she can’t go over her allotted idea of what amount is the “right” amount of grains…
It’s a slippery slope. A dangerous, slippery slope.
That is why a dietitian is so important to work with. I know I said it once, twice, multiple times, but it is so true. A professional who knows about nutrition and an eating disorder can provide guidance so that one undergoing treatment WILL NOT HAVE TO THINK. Please remember, eating disorders are considered a mental illness, not just a diet gone awry. Think about it: if a person is diagnosed with depression and on Zoloft to help remedy the illness, you wouldn’t just tell him, “Eh, snap out of it. Don’t take the meds. Just think happy thoughts.” That would NEVER work. Same with recovering from an eating disorder. Merely saying, “Eh, snap out of it. Just eat food.” will never suffice. The indecision of what to eat, if one should eat, when one should eat, the macronutrients in the food, the effect said food will have on one’s thighs…the number of thoughts running through the mind of one recovering from an eating disorder is great and overwhelming. Having a professional tell a patient what to eat and when to eat it is a helpful step towards recovery.
Most dietitians will construct a meal plan to meet each individual’s needs, and when I was at my lowest weight, I liked to think of that plan as the bare minimum. Those meals and snacks were what I need to just get by, and my goal would be to eat beyond that. Researchers like Marzola et al. (2013), found that increases of up to 100 calories per day for restoring weight was necessary for weight gain to continue, and a high calorie load would still be essential even after weight restoration:
After achieving a healthy weight, individuals recovering from anorexia nervosa still typically need to eat more calories to maintain their new healthy weight — more than healthy individuals of the same weight who do not have eating disorder histories — usually at least 50 to 60 calories per kilogram per day (e.g., about 2500-3000 calories for an individual weighing 50 kg (110 lb). This hypermetabolic periods tends to last between 3 – 6 months after weight restoration.
How troubling, how psychologically taxing and stressful must it be for an individual who is at a seemingly healthy weight and is no longer visually “sick” to continue eating a meal plan given to her when she was in the midst of low bodyweight numbers? Once again, the role of the dietitian is vital in helping said patient keep on top of her nutrition. Without the guidance of this kind of professional, relapse would be looming on the horizon, and in fact, the chances of relapse rates are between twenty-two to sixty-three percent.
That is a big number.
Seeking the help of a nutrition expert to construct a meal plan and keep one accountable to it is vital. It is important. It is one of the many reasons why I am deciding to go back to school to become a registered dietitian. I understand the importance nutrition and food play in recovery, but moreover, I want people to understand that even AFTER weight restoration is complete, inwardly, there is still much work to be done for full physiological, mental, and emotional healing.
What has your experience been with meal plans and the recovery process? I’d love to hear your thoughts!