Eating Disorders - fieldi

Recovery Through Nutritional Counseling 25
to assess a patient’s nutrition, but it is a valid guideline to learn how
her tissues have been affected by starvation.
Referring to these measurements, together we examine the
tables, determine her percentage of body fat and muscle tissue, and
then compare those figures with the normal expectations for her age
and height. When the anorexic patient sees her actual numbers in
the tables, more often than not she realizes that her body fat is well
below normal, falling in the range of patients who are labeled as
underweight or malnourished. She then understands why her periods
may no longer be regular. Realizing that her percentage of muscle
tissue is below normal disappoints her because now she sees that
her recent weight loss has been muscle, not fat. To her, muscle tissue
means thighs and arms; she hasn’t thought about her weight loss
also affecting and shrinking vital organs like her heart, ovaries, and
brain. Suddenly realizing how her body has been coping during starvation
can be a painful eye-opener. “I didn’t know I was hurting
myself” is a frequent comment, spoken with fear. In most cases the
anorexic patient is now ready to go home and try again, with new
food-intake sheets for another week.
The bulimic patient, too, is overwhelmed when she begins the
food plan, thinking that keeping all these calories in her system will
make her gain weight (i.e., fat). When her fear becomes too burdensome,
she is likely to return to her former habit of bingeing and
purging. Unlike the anorexic, however, the bulimic patient is less
likely to be remotivated by nutritional assessment. Usually she is
close to normal weight, but being normal is not good enough for
her. She wants to be thin—always thinner than what she is. So with
the bulimic patient, instead of nutritional assessment, we spend
more time on body image and prevention of binges, which is discussed
in a later chapter.
Helpful to both bulimic and anorexic patients is to learn about
pubertal development, namely, what happens to the body between
the ages of eight and eighteen. A seven-year-old boy and a sevenyear-old
girl, both nude and viewed from the back, look very much
alike. Their percentage of body fat is similar: approximately 18 percent
of their total body weight. When these prepubescent children
turn eighteen, however, they exhibit a marked difference: The male
has either maintained or decreased his body fat by approximately 15