The Art of the Meal Plan

While I haven't been formally diagnosed with an eating disorder until my recent acquisition of anorexia nervosa, I've experienced every diagnosis on the eating disorder spectrum. I strongly suspect my core diagnosis is and has been bulimia. It seems I've just gotten so good at it, I'm able to stay at a BMI that qualifies me as AN.

In all honesty, I wear my anorexia badge with pride, a reflection of my success at eating disorders lately. This is a statement I will surely regret in the future, but for now, I am happy that I am so malnourished, so thin and so bedraggled, that I have achieved this gold star of approval. What I fail to consider is that in recovery, we with anorexia must Eat A Lot.

Breakfast

2 starch

1 dairy

1 fruit

1 fat

Lunch

3 protein

2 starch

1 dairy

1 vegetable

1 fruit

1 fat

Dinner
3 protein
2 starch
1 dairy
1 vegetable
2 fats

And
2-3 snacks throughout the day

Each patient has a plan tailored to her needs with snacks and supplements (Boosts or Ensure) as needed. Snacks and supplements are added or subtracted to meet weight gain or maintenance goals during treatment. Everyone must meet the basic, minimum food group exchanges.

Physiologically speaking, high calorie meals are required to ensure calories in exceed calories out, especially with the 6 10 miles I'm allotted doing every day, necessary for weight gain. The contract I signed when bumped up to day treatment listed 2-4 pounds per week as a weight gain goal. There are 3500 calories in 1 pound, so to achieve a 2 pound gain, an excess of 7000 calories per week is required (1000 per day). 4 pounds per week? That's an extra 2000 calories per day.

The average 26 year-old female of my height and weight burns approximately 1290 calories per day doing nothing. These calories are expended through basic metabolic processes like breathing, muscle turnover, and heart contractions. If you're ambulatory, up and moving through daily life, with no additional physical activity, this number jumps to 1548. If you're me, running 10 miles every single day, this number jumps to 2225 to maintain weight. Add the 1000-2000 extra calories per day to gain 2-4 pounds per week, and you're looking at a daily caloric intake of 3225-4225, also known as a bulimic nightmare.

To me, consuming and holding down 4225 calories is more physically and emotionally difficult than any 15 mile run. Meals of cheese, pasta, sandwiches, milk, and dessert served at the treatment center are ridiculously triggering to all of us. As a professional bulimic (prolimic we'll say), it is overwhelmingly difficult. The internal struggle to eat the meal is the first challenge. The physical and mental challenge to hold the food in my stomach immediately after eating is the second challenge. But the third is the worst challenge.

Treatment concludes a mere hour after the horrific lunch meal and I am sent home with a snack. This has ended the same way every day, except a few. I drive away, clutching the snack, and devour it within a mile of the center, still painfully stuffed from lunch. I stop at the nearest gas station, purchase a diet coke in size bulimia, chug, and purge on the side of the road. It's 2:45 pm at this point. I see snack, lunch, and even the string cheese from 11:00 am emerge, clearly undigested.

Relief. Temporarily. Hungry Again. Binge. Purge. Repeat.

I have learned it is unclear how to refeed a prolimic. I do not know how many calories I retain or if my weight fluctuation from day to day sets off red flags to the treatment team, but I fear residential... babysitting treatment... may be the only way. 

I welcome any comments or suggestions from readers on how to conquer the process of weight gain and refeeding in those who are prone to purging. I'm afraid of this vicious cycle and must stop in order to make any sort of progress through recovery.