I was bulimic for about four or five months and went from five-foot-six-and-a-half inches at 115 pounds to 95 pounds. I have not told anyone, and will not, so please don't ask me to, but I am back up to 110-112 pounds and pretty much graze throughout the day so I don't throw up. I mostly snack on white bread, fruit, potatoes, and cereal in large portions, but want to stop and eat a healthy, more balanced diet. The problem is, I am not sure what a healthy weight should be. Charts say I am too skinny, but I don't believe it because I know girls in the media are thinner than me and they seem fine. I want to be as small a weight as possible without being unhealthy. I skipped my period for three months but did get it in January. I have not lost any weight since then though, and I should have gotten my period about a week ago but didn't. I don't understand, it is so confusing, can you help me?
It is courageous of you to write in about your situation, an important first step in getting to a healthy weight (and body image, for that matter). For most women, a healthy weight is one that allows regular menstruation and is sustainable when following a healthy, balanced eating plan. If the only way to attain a certain weight is by severely restricting your eating, that weight is not the healthiest, most natural weight for your body.
As far as a healthy weight for you is concerned, pinpointing a number, or even a range, without having a thorough medical assessment would be difficult, because different people can be healthy even if they have vastly different body weights. Unfortunately, media images and celebrities often aren't great role models when it comes to having a healthy weight. Some celebrities may be thinner than you, as you note, however they may achieve their weight through unhealthy means, such as over exercising, using drugs or diet supplements, or severely restricting their diets. In reality, they may owe their good looks more to teams of stylists and make-up artists than to good health.
It sounds as though you still have concerns about your health, even though the purging has stopped. You're right to realize that not getting your period is a huge red flag indicating something is not right with your body. Amenorrhea (loss of your period) can happen if your weight is very low, especially if your body fat is too low, or if your diet is too low in fat. Other factors, such as excessive exercise, may also play a role in amenorrhea. Your reluctance to see a health care provider is natural and understandable, many people who have disordered eating feel the same way, however amenorrhea is a condition that needs medical attention. If you are a student at Columbia, you can meet with a member of the Eating Disorders Team (Morningside) or with any provider at Medical Services (Morningside) or the Student Health Service (CUMC).
As for your diet, based on the plan you describe, your body is probably lacking many nutrients, including calcium, vitamins D, K, B-6, and B-12. In addition, you may be getting too little zinc, magnesium, iron, essential fatty acids, and protein. Some vitamin and mineral deficiencies take time to develop, but you are starting to see the effects of inadequate nutrition by not getting your period. Many people make the mistake of severely limit their dietary fat; however, our bodies must have some fat to absorb vitamins A, D, E and K, assimilate calcium into our bones, and manufacture sex hormones such as estrogen. Women need estrogen to keep their bones strong and get their period. The amenorrhea is a clue that your body isn't making sufficient estrogen, which, if continued, can put you at risk for developing osteoporosis — even as a young person.
When you're thinking about improving your diet, remember that your body needs healthy forms of carbohydrates, fats, and protein to function well and stay healthy. Balancing these "macronutrients" may sound like a daunting process, but if you break it down to small, manageable goals, even small bites, you could have a better chance for success. You can check out ChooseMyPlate.gov to find more information about balanced eating. Here are some tips to get started:
- Try adding one new food at a time to your daily regimen.
- You might start with a good source of protein: tofu, fish, poultry, meat, or eggs.
- Next, you can add milk (soy or dairy) or yogurt to your cereal. It will help to satisfy your hunger, and provide much needed calcium in your eating plan.
- Add in some vegetables, one at a time.
- Finally, try switching to some whole grains; for example, whole wheat bread or brown rice (instead of the white varieties of each).
- If you feel more comfortable snacking or having several small meals during the day instead of having full meals, that's fine, as long as you have well-balanced food choices.
Although you don't want to tell anyone about your situation, it might just help you feel better about your situation. Perhaps there is a parent, religious leader, guidance counselor, teacher, doctor, nurse, friend, or relative with whom you could speak to help put your body image in perspective. Maybe starting the conversation seems like the most difficult part. If you are nervous about how to start, you can simply write down your symptoms and show someone, like you have here. You may find that talking to someone is less difficult than you expect, and also worthwhile.Alice!