Eating Disorders - fieldi

Recovery Through Nutritional Counseling 39
Lesson 9. Realistic Body Weight and Body Image
There is a difference between ideal body weight and preferred body
weight, and this can only be discussed when the patient is ready to
do so. Most likely, discussion can only occur when she has accepted
her weight gain from rehydration.
Initially the patient’s preferred body weight resembles that of her
thin role models who are about 5 feet, 10 inches, and weigh about
110 pounds. In order to remain so thin, most of us would have to
deny our hunger, deprive ourselves of what our bodies need, and
probably obsess about food day and night. One would think that no
one would choose to suffer through something like that. But because
being thin today is frequently associated with being successful, living
a better life, and being in control, it is not surprising that so
many are willing to pay this price to get thin.
Today, depending on which survey one looks at, 70 percent to
nearly 90 percent of women report dissatisfaction with their bodies
and a desire to lose weight. In fact, body hatred is not about our bodies
at all, but about self-doubt and feelings of inadequacy. Focusing
on perceived body faults and not dealing with our real struggles and
unpleasant feelings becomes a convenient scapegoat. This is why it is
so difficult for the anorexic patient to gain weight. She focuses on
feeling fat—her distorted body image—when in reality she is emaciated.
I generally guide any patient who says “I feel fat” to change her
focus by rephrasing her feeling to “I feel inadequate, because . . .”
By regaining weight, her disturbed body image will not totally
change but it will improve. But how much must she gain? A realistic
body weight refers to a genetically determined amount of body fat that
the body actively defends. This is frequently referred to as the set-point
weight (Reiff and Reiff 1992). The body acts in such a way as to maintain
this weight range and, if it is challenged, will defend it vigorously
by altering metabolic rate and intensity of hunger. The following sums
it up succinctly: set-point weight is the weight a person’s body maintains
within a few pounds (3–5) when the individual is not thinking
about it. A patient who is maintaining a weight below her genetically
or biologically predetermined set-point will know it because of an
increased obsession with food, weight, and hunger. Recovery should