Alice,

In the last few months I have lost about ten pounds. I went from being 5'5" and 122 pounds to 112. I exercise in the afternoon and at night. I also eat two meals a day. I eat a hearty breakfast (two bagels and a bowl of oatmeal). I skip lunch or simply have an apple. For dinner I have a very large salad and a fruit salad and rice cakes. I put either egg whites or tuna in my salad for protein. Considering my two hour a day rigorous exercise routine, am I eating enough? I don't eat any fat because I fear that it will make me fat, although intellectually I know it won't, and as a result I no longer menstruate. Am I anorexic although I feel healthy, run six miles a day, lift weights, eat seemingly large portions (perhaps large portions are insignificant when they are vegetables and fruits?), and look muscular and healthy (although I often think I am too fat)? What is wrong with me? My friends and family tell me I have an eating disorder. Do I?

— Anyone who goes to the gym knows me

Dear Anyone who goes to the gym knows me,

It's critical to be curious about bigger changes, like notable weight loss, that happen in your body, particularly when they happen over a short amount of time. Taking a cue from your own concern, and perhaps some from those who care about you, about your body and reflecting on your eating and physical activity patterns can certainly help lead you to learning more about what you might be experiencing. Only a health care provider or mental health professional can diagnose an eating disorder. In any case, talking with a professional may help you identify ways to feel strong, both physically and emotionally, while giving your body the fuel it needs to be nourished. Balance is the key to healthy eating and physical activity. A nutritious diet includes a variety of foods from all the major food groups, including a small amount of fat each day. Fats are critical to the body, as they help it absorb nutrients, protect organs, and produce hormones, among other functions. It also adds to the experience of eating, providing flavor and texture. Since your daily meals consist mostly of carbs, fruits, and veggies, you may be missing out on critical nutrients found in other food groups. Also, losing weight and skipping meals are signs that you may not be getting enough calories for your activity level. Speaking with a registered dietitian could help you learn more about the dietary needs for your level of activity. 

Sometimes, certain eating or physical activity patterns may develop into a more serious concern. You mention anorexia in your question. Anorexia is a form of disordered eating characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight. According to Mayo Clinic, some physical signs of anorexia include:

  • Extreme weight loss
  • Thin appearance
  • Abnormal blood counts
  • Fatigue, dizziness or fainting
  • Dry skin, hair, or nails
  • Soft, downy hair covering the body
  • Absence of menstruation
  • Constipation
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Osteoporosis

Despite the outward emphasis on food, the root causes of anorexia often have more to do with self-esteem or control over emotional issues completely unrelated to diet or physical activity. Anorexia is one form of eating disorder; many patterns of eating that are irregular may not be categorized as a diagnosable eating disorder, but they’d still be considered disordered behaviors.

You may find it helpful to reflect on a few questions in order to determine your course of action. You mentioned that you've lost ten pounds in the span of a few months; has anything else changed for you during this time period? Is this eating pattern and physical activity routine new during this time, or were you maintaining this routine before the weight loss? Is there a reason you're maintaining this level of activitity? If you're an athlete, do you have access to support to inform both athletic and dietary needs? How do you feel when you're being active? Does your food provide the energy you need? Have you explored your feelings about your body with a professional before?Thinking through the answers to these questions may help you figure out what's motivating your behaviors and how to best get support. If you're most concerned around weight loss and eating patterns, you may find it helpful to speak with a mental health professional. If you're concerned about athletic training, you may find meeting with a trainer or registered dietitian helpful to make sure you're getting what the body needs to sustain prolonged athletic activity. 

You've already taken a brave first step just by considering the fact that your eating and physical activity habits might not be supporting your body. By reaching out for support regarding your concerns, you can gather the support you need to engage with food and physical activity in ways that nourish your mind and body. 

Alice!

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