Dear Alice,

I am very concerned about my eating and exercise habits. I'm a first-year, and since I got here last fall, I've lost about 35 pounds. I've been exercising almost obsessively and eating a rigid, low-fat diet. I try to eat about 2000 calories a day, but still feel hungry a lot (especially in the morning) and still seem to be losing weight at the rate of about a pound a week. I'm 6'0" tall and weigh 133 lbs. right now; my family and friends are all worried and although I keep telling them I'm not sick, I wonder if I am. I've seen a nutritionist in Health Services; she gave me some advice about good nutrition and what I should be eating, and I've been trying to follow her guidelines, but it's gotten very hard for me to know what is a "normal" diet. Am I anorexic? If I am, what can I do to help myself? I know I could never go to counseling; I'm too independent. Can you give me any advice?

— Teetering on the Brink

Dear Teetering on the Brink,

It's common for people to notice changes in their physical and mental health or well-being as they adjust to a new setting or situation. In your case, it seems that beginning school has coincided with appetite shifts, weight loss, and increased physical activity. Given these physical changes, as well as your family and friends’ concerns, it makes sense that you’d want answers. While only a health care professional can tell you whether these physical changes are the result of an eating disorder (such as anorexia nervosa) or another medical condition, you’re taking a valuable step by educating yourself on anorexia nervosa, weight loss, balanced eating habits, and professionals who may be able to help. Read on to do just that!

Anorexia nervosa is an eating disorder and form of self-starvation that involves rapid weight loss, obsessive preoccupation with food, and the desire to lose weight. While many people without eating disorders experience dissatisfaction with their body shape or weight, those with anorexia nervosa diagnoses may respond to these perceptions by decreasing the variety and amount of food they eat, skipping meals, avoiding eating with others, or excessive physical activity. Anorexia nervosa is associated with other health issues, such as depressed mood, fractures, and heart problems, and typically results in significant weight loss of 15 percent or more of body weight that is appropriate for them. Treating anorexia nervosa usually involves behavioral monitoring, nutritional rehabilitation (in order to normalize weight), and psychotherapy (which attempts to change preoccupations with weight and body shape, and prevent relapse). As noted by Johns Hopkins Medicine, fear of weight gain and discontent with the body tend to decrease gradually over the course of several months if they maintain a weight that has been deemed appropriate for them through treatment. In these cases, the rate of recovery is between one-half and three-quarters of people. 

Eating disorders aren’t the only factors that contribute to significant loss of weight. In fact, even small changes in physical activity or eating habits may do so as well. You mentioned exercising obsessively. Are you active daily? How long are your workouts? You may consider taking a day off of vigorous physical activity once per week so that you’re not overexerting yourself. Another factor to consider is to make sure you’re not working out on an empty stomach. You also mentioned feeling hungry in the mornings. When you eat, do you do so until you feel full? Are you eating foods that help you feel full? Are you eating as soon as you feel hungry, or waiting until the feeling intensifies? Because you’ve already taken the proactive step of consulting with a nutritionist, these are questions you may have already answered. Your nutritionist may have also encouraged you to have breakfast every morning and to eat at the first indication of hunger (meaning that you don’t prolong eating, which may increase risk of overeating). They may have also encouraged you to choose foods that help you feel fuller longer, such as foods with protein, fat, and fiber. Consider being on the lookout for, and responding to, common cues for hunger such as:

  • Having an empty stomach or noticing it growling
  • Having a headache or feeling lightheaded
  • Feeling grumpy, anxious, or irritable
  • Not having energy
  • Feeling shaky or weak

Teetering on the Brink, it’s great that you’re independent, but it doesn’t mean that you can’t reach out for help and advice! The mental health professionals you may choose to consult with are equipped with training and skills needed to determine whether your health is at risk and to help you understand potential factors that may have led to the changes you’re experiencing. Health care professionals, particularly those in the field of mental health, use specific criteria to diagnose eating disorders and can provide additional support and resources tailored to your needs, whether or not you receive a diagnosis. While it may seem like a loss of independence to seek the advice of a professional, you may find that rather than being a loss of independence, it's an active choice you're making to strengthen and facilitate your health, and that it actually makes you feel more independent.

Sincerely,

Alice!

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