Woman with anorexia makes public appeal to help save her life
Anorexia NHS
When I was struggling with my anorexia, I had a limited number of foods I would “allow” myself to eat. Can nutritional counseling help me learn to expand my food choices?
Yes! Both nutritional counseling and psychotherapy can be helpful tools for enabling you to expand the types of foods you eat, the range of food you purchase at the grocery store, and the variety of meals you prepare at home. A nutrition expert can also help you learn new skills for meal preparation and provide sample meal plans. (For sample meal plan suggestions, you can also visit http://www.cnpp.usda.gov/mypyramid.) Many patients avoid certain “feared foods” or may be used to eating pre-packaged “diet foods,” leaving them with a limited range of natural, healthy foods to choose from. It can be a challenge to find variety for the three meals and two snacks per day that your doctor may recommend for you. (Note: Some prefer to eat 5-6 smaller meals throughout the day; you can discuss your preferences with your treatment team.) You also may be so used to reading nutrition labels and counting calories that the task of grocery shopping has become cumbersome. For practical help, I have offered some general recommendations for grocery shopping that may help you to expand your food choices while encouraging a healthy variety of nutrients in your regular diet.
Sample Grocery List
Fruit
Apples, oranges, bananas, grapes, grapefruit, melon, strawberries, blueberries (fresh or canned)
Fruit juice
Vegetables
Potatoes, tomatoes, onions, green/red/yellow peppers, mushrooms, carrots, celery, cucumber, squash, zucchini, broccoli, cabbage (frozen, fresh, or canned)
Garden burgers
Meats/proteins
Hamburger, other lean beef, chicken breasts, turkey, fish
Eggs
Beans: pinto, white, navy, black (canned or dry versions)
Grains
Whole grain bread for sandwiches and toast
Hot or cold cereal, oatmeal, grits, waffles, pancake mix
Brown rice, wild rice, pasta (assorted varieties)
Bagels
Tortillas
Crackers
Muffins or muffin mix
Dairy (good sources of calcium)
Milk
Yogurt (plain or flavored)
Cottage cheese, cheese
Frozen yogurt
Carnation Instant Breakfast
Fats
Peanut butter
Margarine
Nuts
Mayonnaise
Cream cheese
Desserts and snacks
Cookies
Brownies
Cakes
Ice cream
Puddings
Chips, pretzels, popcorn
Granola
Other entrées
Macaroni and cheese
Spaghetti
Pizza
Chili
Risotto
Deli foods
Sarah shares:
I don’t know if my eating disordered voices will ever disappear completely, or if I will ever look at food the way a “normal” person does. I’ve memorized the nutrition labels of every food in the grocery store, and that knowledge is hard to forget, especially now that the nutrition information is printed on foods even in restaurants.
But one of the most empowering feelings in the world knows exactly what is in the food I am eating, knowing that I once would have never let it get within 10 feet of my mouth, and eating it anyway, just because it tastes good. I can choose what I eat for entirely different reasons now.
How will my treatment team determine my healthy weight range?
Your therapist, physician, and nutrition counselor will gather information and use medical tests to evaluate an appropriate goal weight for your body type. Information that may be gathered includes: your eating disorder history and symptoms, highest and lowest past weights, alcohol and drug use, food preferences, food allergies, exercise habits, food associated with binge episodes, current eating patterns, and, in females, age at onset of menses and history of amenorrhea. Your doctor may take blood tests and measure your blood pressure, body temperature, and heart rate. Your healthy weight range will also take into account your height, age, body type, and activity level. An appropriate food plan will be determined based on all of these factors.
While it will be important to consume an adequate amount of food for weight restoration, many dietitians advice that patients in recovery avoid counting calories. Instead, they may recommend an approach that uses a food exchange system rather than calories as a guideline for weight restoration. Your treatment team can help you sort through the options and provide information to your family for informed decision making.
What changes should I expect in my body as I start to return to a healthy weight?
It may take some time to get used to healthy eating again, however, your therapist and/or nutrition counselor will help you to feel increasingly comfortable with the process of weight restoration. You should be aware that in the initial stages of weight restoration, fluid retention is common as the body rehydrates itself. Therefore, you may notice some temporary swelling in your abdomen, face, thighs, and/or buttocks. Delayed gastric emptying is a frequent side effect of anorexia. Thus, you may feel bloated or experience abdominal pain after ingesting even small amounts of food. You should let your doctor know if these symptoms occur, as bloating may also be a sign of food allergies or food intolerance. Occasionally, patients in recovery report nighttime sweating or sweating after meals. This can result from changes to your metabolic rate due to increased food consumption. You will be encouraged to eat at regular time intervals to help stabilize your metabolism and interoceptive cues. It may not be what you are used to, thus you may feel like you are eating “mechanically” at first. However, changes to your diet and food choices will take place gradually rather than all-at once. Discuss your experiences, feelings, and thoughts with your treatment team. These caring professionals can help you work through any discomfort you may experience. It will be especially important to inform someone on your treatment team should you have the urge to binge, purge, or restrict your food intake. Remember that weight restoration is just one part of the recovery process. Continue to work with your treatment team to ensure a complete recovery.
What is the Maudsley approach to weight restoration?
The Maudsley approach to weight recovery is based on a treatment method developed by two British researchers, Christopher Dare and Ivan Eisler, during the 1980s at the Maudsley Hospital in London. In the U.S., the approach has grown in popularity with the help of the book How to Help Your Teenager Beat an Eating Disorder. Long-term treatment outcomes appear to be promising. Studies show that children treated with the Maudsley approach recover faster and relapse less often. However, the approach is considered less effective for patients over the age of 18, or those who have prominent binge/purge symptoms, chronic illness, or families in which there is a high degree of interpersonal conflict. In essence, the first priority of the Maudsley approach is regaining physical health and stability through refeeding. Unique to this approach is that it is the parents of an anorexia patient who lead the refeeding and healing process; a family therapist assists the parents in their efforts. After physical health is restored, emotional and social issues are addressed. According to the Maudsley Parents Web site (http://maudsleyparents.org), there are three phases to treatment. First, parents are encouraged to normalize their child’s eating while providing compassionate, non-judgmental support. A key intervention used during this phase includes the “coached family meal,” a family-based meal that focuses on regaining control of a child’s disordered eating, assisting with weight restoration, setting appropriate boundaries, and starting a patient on the road to recovery. In the second phase, once a patient’s physical health is restored; the family works with a therapist to return control of eating to the recovering child. In the final phase of treatment, the focus shifts to helping the child establish a healthy adolescent identity. In this method, psychotherapy is not introduced into treatment until initial weight restoration is complete.
Terms:
Delayed gastric emptying – A decreased rate of emptying of the content in the stomach; also called gastroparesis.
Delayed gastric – emptying can cause nausea, vomiting, feeling full after a small meal, bloating, abdominal pain, and heartburn.
Interoceptive cues – Sensitivity to sensations that occur inside the body (e.g., gastrointestinal sensations, cardiac sensations).
Weight restoration is just one part of the recovery process.
It may take some time to get used to healthy eating again.
