Eating Disorders - fieldi

Recovery Through Nutritional Counseling 23
office visit because she had lost 40 pounds in three months. She had
had her last period four months earlier. A vegetarian since fourth
grade, she was exercising compulsively, consuming no more than
200 calories per day, and was still losing weight. Two weeks later her
weight was down to 109 pounds, and she was then hospitalized. Her
refeeding was observed by the hospital staff and gradually increased:
1,200 calories, 1,500 calories, 1,800 calories, 2,100 calories, 2,400
calories, and finally 3,600 calories.
The explanation for this refeeding plan is as follows: By consuming
1,200 calories per day she started to gain weight. But after gaining
6 pounds, her metabolism came back up and she maintained her
weight. The 1,200 caloric plan then caused her to lose weight and
calories had to be increased to 1,500 per day. Since she still lost
weight, her intake increased to 1,800 calories per day. She was now
able to maintain her weight but had to gain some more in order to
qualify for being discharged. Calories were increased to 2,100 per
day but her weight was still stable. At 2,400 calories per day she
slowly gained weight, but she herself decided to add nutritional fluid
supplements to a total of 3,600 calories per day in order to gain
enough weight to be discharged. After two months of hospitalization,
she was discharged at 126 pounds. To maintain that weight she
had to eat 1,800–2,400 calories per day.
When a patient can be treated without hospitalization, a similar
but varied program is planned. Patients frequently ask: How long
will this take? My answer is always the same: I don’t know. We can
only guess, but the longer the patient has been trapped with a lowered
metabolism, the longer it will likely take to get the metabolism
back to normal again. Further, the quicker she gets her calories up
to a normal intake, the faster the metabolism will rise. Because we
are talking about weeks or maybe a few months, patience is essential.
The patient will actually be able to tell me when her metabolism is
up because she will experience an increase in energy, a higher body
temperature, and a better sleeping pattern, and she will be more
physically fit.
By now the patient—although not happy—has an explanation as
to why she will need to gain weight. She is now usually eager to work
out a food plan. We discuss her short-term goal of eating a minimum
of 1,200 calories per day, and her long-term goals of being able to