The nerd in me wants to understand more about the science of eating disorders so I am going to start reading and summarizing eating disorder research articles as part of my blog. Let’s see how long this lasts 😉
The first article, “Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment“, is a review. Later I will start looking at primary articles, but it is always good to start with reviews for a big picture sense of the field. Coincidentally, the corresponding author of this review, Walter Kaye, is one of the research directors for the UCSD Eating Disorder treatment program where I received my intensive outpatient care.
The following is a list of the some of the interesting key points and my reactions to each:
(1) People with eating disorders typically have unusual eating behaviors like slow and irregular eating, vegetarianism, and consuming a narrow range of foods, which often start before the onset of illness. This is interesting to me because I had default disordered eating behaviors years before I developed my eating disordered thoughts.
(2) Healthy women without eating disorders require ~30 kcal/kg/day to maintain their weight, while anorexic patients require up to 60 – 100 kcal/kg/day for sustained weight gain. When I was in treatment, my meal plan was increased substantially 1 – 2x/week, and I usually felt like the nutritionist was recommending way too much food for me. However, my meal plan kept increasing because it takes a lot of food to restore weight in someone with anorexia. A “normal” amount of food is insufficient for the early stages of recovery.
(3) People with anorexia often become hypermetabolic wherein they easily lose weight and need an even larger amount of food to gain weight. A reason for this is that anorexic patients are less efficient at converting caloric intake to body mass. This is related to #2 and definitely contributed to my constant meal plan increases during treatment.
(4) A significant portion of the calories for refeeding are converted into heat instead of building body mass. Ben often commented that I felt like a furnace, especially at nighttime, when I was on a refeeding diet. Anorexic patients spend 30% of their energy on heat versus only 14 – 16% in healthy controls, which contributes the need for more calories during recovery.
(5) Although anorexic patients require high-calorie diets to gain weight, they are at a risk of refeeding syndrome if caloric intake is increased too quickly. Refeeding syndrome can result in heart failure, low blood pressure, breathing problems, muscle breakdown and weakness, coma, and seizures, among other health conditions. For this reason, my treatment team increased my caloric intake slowly at first and then much faster once I was free from developing refeeding syndrome.
(6) Even after anorexic patients reach a healthy body weight, our bodies are inefficient. While, as mentioned in #2, healthy women require ~30 kcal/kg/day for weight maintenance, recovering anorexic patients require 50 – 60 kcal/kg/day for maintenance. This part has definitely not been fun for me because eating more than the “normal” healthy woman during weight restoration has made me continue to feel like I am on a weight gain diet. However, if I do not maintain this higher caloric intake, I am at risk of relapse (reported to be up to 50%) from rapid weight loss. This is particularly scary given that a significant number of anorexic patients regress back to being underweight within a year after hospitalization. It reportedly takes 3 – 6 months for the metabolisms of recovering anorexics to stabilize after weight restoration.
(7) Fat intake is critical to anorexia refeeding. My mind and body still cringe at the thought of needing to consume fats after all those years of restricting fats. However, all of our cells contain fats, and our neurons especially require fat to pass along signals. I may not always want fats accumulating on my thighs or hips, but I definitely want my brain functioning optimally.