Dear Alice,

I was bulimic for about four or five months and went from 5'6.5" 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 to 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?

Confused

Dear Confused,

It’s courageous of you to write about your situation and ask for help — and it’s a key step in helping you get to a healthy weight. While it’s easy to compare your body to those portrayed in the media, remember that each person’s body is different and that there are a number of factors that play into what may be a healthy weight for you specifically. To develop your own picture of health, it’s wise to focus on your individual needs and concerns, rather than looking through the lens of what or who is seen in movies, television, and glossy advertisements. And, though it may be challenging, there are resources and sources of support that can be helpful for you moving forward.

Pinpointing a healthy weight, or even a range, for you without a thorough medical assessment and history can be challenging, as there are a number of contributing factors that go into that determination. Individuals can be healthy at many different weights and it all depends on several variables, including their environment, family history, genetics, lifestyle behaviors, and habits, among others — all of which are often under-represented or unseen in media images. Those images may not be realistic representations when it comes to healthy weight. Some people who are featured may have achieved their weight or body shape by unhealthy means. What’s more, photo editing programs may have been used to alter the images to make their bodies appear in a way that is not truly representative of their actual body weight or shape. It’s definitely challenging, but recognizing that these types of images are likely unrealistic is both a worthy pursuit and a first step towards body acceptance. Practicing this and reminding yourself what you like about your own body might help you start to feel better about your own body and weight.

When it comes to wanting to change up your diet, all the foods you mention have a place in a healthy eating plan. Moving forward, you might consider focusing on getting some variety in your diet. For instance, try making half your plate fruits and vegetables, but vary them when possible. To ensure you get other necessary nutrients, try incorporating different forms of protein such as poultry or seafood, and if you’re vegetarian or vegan you might try beans, nuts, or tofu as a protein source. Though working towards a balanced diet is your goal, you don’t have to do it all at once. The newest nutrition guidelines, released by the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services, recommends making small changes toward a healthy eating style and maintaining that style over time. As you continue to learn what nutritious foods you’d like to incorporate, you’ll likely find that there’s a lot of information out there about nutrition. One reliable source (that’s also full of useful tools for healthy dietary decision-making) is ChooseMyPlate.gov. You might also consider talking to a registered dietician about adopting a healthier eating plan that works for you.

Lastly, you mentioned experiencing some irregular or skipped periods. While not experiencing menstrual periods may be related to low body weight, a late or missed period could also be due to other health-related variables. Menstrual cycles can vary in length, so missing or having a late period could be associated with your typical cycle. On the other hand, factors such as stress, certain medications, or a hormonal imbalance may also be culprits. If you continue to miss periods, it’s a good idea to talk with a health care provider so you can pin down and address what might be causing this issue.

Confused, although you say you aren’t ready to tell anyone about your situation, it might just help you feel better and help you make progress toward your health goals. If speaking to someone close to you (like a family member, a friend, a teacher, or a religious leader) seems uncomfortable, is it because you’re concerned that what you share about yourself could be shared with others? If that’s the case, rest assured that you can still access confidential resources and receive support. Any of the health professionals mentioned — a health care provider, a registered dietician, and even a mental health professional — are considered confidential and are trained to help you. Not sure who to speak with? The National Eating Disorders Association (NEDA) has an information and referral helpline you can utilize to find out more and locate resources where you live. If starting the conversation seems to be a daunting, you might just try to write down your concerns and symptoms and show them to someone, like you have here. In any case, you may find that talking to someone is less difficult that you expect, and also worthwhile.

Alice!

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