Eating Disorders - fieldi

44 Recovery Through Nutritional Counseling
than they had ever been before. She realized that her self-esteem
had plummeted so much that she was incapable of helping herself.
What triggered her to speak up was that her cousin—a social
worker—had figured out what was going on and showed her scary
pictures of a relative who had been anorexic and bulimic since she
was fifteen.
Feeling totally out of control, she realized she needed help and
agreed to meet with Dr. Diane Mickley, the internist and director of
the Wilkins Center, who recommended individual therapy and nutritional
counseling.
Sue was ready for treatment, and after our first nutritional meeting
she stopped purging (vomiting). She wanted to believe that if she
ate a balanced diet she could be healthy and active and wouldn’t
have to end up obese. She knew she had a lot to learn and that this
was how she was going to help herself get better—by her own choice.
It meant a lot for Sue to find a role model in me, her dietitian.
She liked me to show her that this was all possible, but she needed
to be frequently reassured and remotivated. Sue’s eating patterns
were messed up; she didn’t know what a portion was and needed
redefinition of normal serving sizes. By learning how many calories
her body needed daily, and why, and what would happen if it didn’t
get these calories, she began to accept eating as a way of getting
better. Like other patients, Sue needed help dealing with the weight
she gained back. She had lost 35 pounds, which caused her to stop
menstruating and to grow fine hair on her face and body. She had
lost some hair on her head, and her skin was pale and extremely
dry. She looked unhealthy and emaciated but still thought she
looked fat—she also felt fat, although she could count her ribs.
In initiating normal eating Sue had a choice: to begin immediately
eating three normal meals a day (a full-fledged normal eating
pattern) or, if that was too scary, to increase her food intake gradually.
Like most patients she chose the gradual route. The very slow
start prompted her parents to comment that “not even a mouse
could survive on that.” Everyone involved understood that eating
was Sue’s own responsibility. She was not going to eat for me, for
her parents, or for her teachers—only for herself and her own needs.
Therefore we had asked all those involved to leave it up to Sue and
not make it more difficult with comments or even looks.