Underweight and diet
Underweight along with general malnutrition are among basic symptoms of anorexia nervosa (there is a type of anorexia nervosa without underweight and on the other hand, underweight may be due to another severe disease). Body weight can be estimated by orientation BMI that tells us whether our weight is within norms, i.e. optimal (see more).
Long-term underweight associates with numerous physical and mental consequences, some of which may be directly life-threatening (more here). It has been proven that maintaining body weight under a normal level is markedly affected by distorted body image (disorder of body scheme), thus increasing anxiety of gaining weight and significantly deepening anorectic troubles.
Achieving weight gain is rather difficult for the patients as it brings a host of anxiety, reproaches and feelings of failure. Yet is is necessary! Food is a major medicine against anorexia nervosa.
1. Sufficient daily income It is necessary to repeat that if I want to recover, I must gain weight. In order to do this I must eat more than until now. The orientation value of daily energetic intake during treatment of anorexia nervosa is ca 3500 kCal. This means eating 6 times per day – main courses, snacks, second supper. It is also necessary to reduce active movement (sports, exercise) to a minimum. Then it is possible to achieve the weight gain of 0,5-1 kg per week. A concrete example of diet can be found here. The increase of food intake can be gradual but it should not last longer than a week. Feelings of fullness, loss of appetite, anxiety before eating and reproaches afterwards are rather normal at the start and they must be overcome. An expert and family or partner support may help significantly. Precise calory counting is harmful, it usually raises anxiety and need of control over food intake. Consuming low-fat and low-energy products is unsuitable as they only fill up the stomach but do not provide sufficient energetic and nutritional value. Exercise after meals to push off remorses is absolutely inapt. It brings about a bad habit and thus it slows down and prolongs the time necessary to achieve optimal weight.
2. Regular eating Based on our experience, we know that before eating becomes a part and parcel of everyday life, it is helpful to draw a time plan when I will eat breakfast, snack, lunch etc. It may help relieving anxiety before eating as the unpleasant decision-making whether to eat know or later (and skip the meal completely) is gone. It may also markedly help in communication with others (family, partner) on food and their support. A daily plan needs to respect such a plan, on the other hand we have to be realistic when making it and consider work or school rhythms, home habits etc. The patients who have already planned their timing and diet, should not be forced to eat anything more. They have enough trouble to cope with this and we would ask them more than they can manage at this time.
3. Gradual widening of food selection The diet of anorectic patients is often very poor and stereotypical. The aim is to enrich their diet so that is becomes varied and balanced. It is helpful to list meals or foods that the patient has forbidden herself and that she avoids, and order them by difficulty. Then we choose meals that are suitable for including on the diet again and we start with the easier ones. It is not necessary to start eating food one has never eaten before. Everybody is entitled to personal taste preferences and to not eating some stuff, but such a thing should be exceptional.
4. Meat on the diet? Meat provides the body with many important nutrients, some of which cannot be gained otherwise in adequate quality. Moreover, it is energetically rich. So we recommend its inclusion on the diet, but it needs not be everyday (at least five times a week). It is suitable to alternate kinds of meat (fish, poultry, beef, pork, venison) and their preparation. If the person with anorexia nervosa doesn´t eat meat (refuses on various grounds), we shall find out when she stopped eating it. If it was at the outbreak of disease, we can perceive this decision rather as a manner of reducing food intake and an effort to control body weight. If there is a vegetarian tradition in the patient´s family or the decision was made long before the outbreak of anorexia, we shall respect it. Leaving meat off the diet means increasing portions of main meals (lunch, dinner) so that the meal is sufficiently substantial.