By: Debbie Andersen, MS, RD, CEDRD
Monday, June 20, 2016
From the ACUTE team: To offer our readers a more comprehensive look into the various aspects of eating disorders and treatment, Medical Mondays will periodically be penned by team physicians at the ACUTE Center for Eating Disorder.
This week’s Medical Monday is written by Debbie Andersen, MS, RD, CEDRD.
“Is she going to increase my meal plan today?”
“How can I convince her I don’t need more calories?”
“How much more does she think my body can take?”
These are all common thoughts many patients have before having a session with their dietitian. It is no wonder most of my patients tend to have a love/hate relationship with me. On the one hand, my role as a dietitian challenges the very thing that they are afraid of. On the other hand, I am the person who can provide understanding, encouragement and support where it is best understood.
The predicament individuals find themselves in is their desire to get better and recover. However, in the same breath, they do not want to gain weight or increase calories to reach their recovery goals. In reality, weight restoration, nutrition and eating disorder recovery go hand in hand.
At ACUTE Center for Eating Disorders, patients typically see calorie increases in their meal plan at least twice a week. Understanding why your body needs calories or energy can help in getting through the anxiety. Nutrition is necessary to maintain our energy and strength. It is needed to prevent nutrient deficiencies, and is vital in supporting basic daily activities and basic cognitive processes. To simplify it, our bodies are like automobiles – you need to put gas in the tank in order for it to “run”. When you are severely malnourished, your body will find it difficult to function both physically and cognitively. Essential cells and muscles are broken down when you do not receive enough energy over time. Some individuals will often find it hard to perform basic human activities such as opening their eyes, lifting their head, and standing up. When energy is not provided to the human body, it continues in this catabolic state. An adequate amount of calories is crucial in order to rebuild essential cells and muscle protein.
Weight restoration and nutrition truly are the medicine for recovery. Individuals need a certain amount of calories to maintain a healthy weight. If you are not receiving enough energy to maintain a healthy weight, you will lose weight. If enough weight is lost, your body’s metabolism will slow down in an effort to spare every calorie that it can. In the setting of severe malnutrition and the need for weight restoration, the human body tends to need an increased amount of calories since the body is playing catch-up in rebuilding cells for basic organ and body function for recovery. This increased amount of calories also helps to bring your body out of “hibernation mode” and turn your metabolism back on. While an increased amount of calories is necessary during medical stabilization and treatment, once you are in recovery, the amount of calories decreases in order to maintain a healthy weight.
We recognize the process of taking in calories is easier said than done. This is the very reason why we provide our patients with gradual amounts of calories over time during the refeeding process. With some flexibility, your dietitian can support you and give you guidance in individualizing your meal plan. Providing balanced meals that include calorie dense foods will offer a bigger bang for your nutrition buck without making you feel too full. Calorie increases and sessions with your dietitian don’t have to be awful and full of anxiety! Being open to reintroducing challenging foods and trusting of treatment will help on your road to recovery. Keep calm and talk to your dietitian! At ACUTE we strive to provide a safe environment to help you overcome barriers that may prevent you from the treatment and recovery you deserve.
Here’s to your good health!
Debbie Andersen, MS, RD, CEDRD