Eating Disorders - fieldi

Lesson 1: Daily Caloric Need and Metabolic Rate
Recovery Through Nutritional Counseling 21
At the initial office visit, a personal, family, and nutritional history is
taken during which I get to know the patient, her problems, and her
goals. The next question is: How can we solve her problems, at least
the food-related ones? She is mostly eager to listen and hopeful that
I can help her. I explain that, without exercise, the normal average
person needs about 1,650 calories per day for metabolism, growth
and repair, and maintenance of body temperature and heart and lung
function (Satter 1984). With this information, she starts to realize
that the body has specific needs and that it does not just store every
calorie as fat. The knowledge that the body actually needs about
1,200 calories a day just for metabolism is good news that reassures
her when she is ready to resume normal eating again. If the body is
underfed—either because of self-starvation or cycles of bingeing/
restricting or bingeing/purging—its survival response is to lower its
metabolic rate (Keys et al. 1950). How much it will drop depends on
the restriction. The patient can recognize this stage because, as the
metabolic rate falls, she will experience a decrease in body temperature,
muscle tone, and blood-sugar level (Reiff and Reiff 1992). This
will make her feel cold, weak, and less able to concentrate. She will
get hungry and become preoccupied with food—the body’s effort to
restore a “normal food intake.”
By comparing the effects of different diets, we know that the
strictest of them all—starvation—causes weight loss mostly from
muscle tissues and very little from fat. Not until one eats a balanced
diet of about 1,200 calories per day (1,500 calories for teenagers) and
combines it with moderate exercise will one save muscle tissue and
lose the weight mostly from fat (Connor and Connor 1986).
After this discussion, the patient has usually grasped what has
happened to her. She understands that her metabolism is down and
that she cannot eat more—not even normal amounts like her
friends—without first gaining weight. She feels stuck. The next questions
usually come from her: “How can I get my metabolism back up
again? Have I ruined it? Is it possible to get it up again?” Luckily the
answer is yes, you can get it up again, but there is a painful price: weight
gain! To better understand the effects of undereating, I often refer to