Eating Disorders - fieldi

24 Recovery Through Nutritional Counseling
maintain weight on more than 1,700 calories per day. Usually
patients feel they want to do everything required in order to get this
over and done with, that is, eat 1,200 calories or more right away.
Some of them will do that, but some will start lower because they
know and feel that this is going to be hard when they get home to
their kitchen and try to do this all by themselves.
After having agreed on an acceptable food plan based on the American
Dietetic Association’s food groups exchange system, the young
woman again leaves my office with a handful of food-intake sheets and
a new sense of knowledge. She is supposed to use one sheet per day
and list when she eats, what she eats, how hungry she was before she
ate, and how full she felt after she stopped eating. The heading on the
last column reads “feelings.” Here she is to write down feelings associated
with her eating, either before, during, or after. I will not criticize
her for not being able to follow the food plan since most patients
cannot do that every day of the week. Instead, I always say that there
are no failures, only learning experiences—that is, we need to know
what was difficult, why it was difficult, and how we can make it less so.
Patients leave with the best intentions to try their hardest, and we try
to make the next appointment within the following week.
Lesson 2: Nutritional Assessment and Pubertal Development
Each session usually starts with a quick review of the previous session.
Any questions are answered, and we check how the week went
by looking at the food-intake sheet. Patients often mention how easy
it is to talk about eating while sitting in my office but how hard it is
to go home and try to follow the plan. Perhaps the anorexic is motivated
while she is in my office, may hear my voice for the first few
days after a session, but gradually the fear of gaining weight (or
rather fat) becomes overwhelming and she may return to her former
controlled way of eating, that is, starvation or semistarvation. If she
continues her former eating pattern, she needs to be motivated
again. She needs to hear that very few patients are able to begin eating
in a balanced way after only one session. To remotivate her, we
continue with nutritional assessment—a method where I measure
her frame size (small, medium, or large), her upper-arm fatfold and
circumference, and her waist fatfold. It is not the most accurate way