Eating disorder or not?

[sometimescharlotte]

Background: I went to the Urgent Treatment Centre on Friday because of severe stomach pain and vomiting. Had bloods and an ECG done. I am 30 (today!) and have one child (2) and have always been fairly slim.

The doctor who saw me was quite adamant that I must have an eating disorder (a lot of "you're not helping yourself and I think you know what I mean by that" comments to start with, but when pressed she was more specific). Apparently, in addition to my BMI being low, my bloods and ECG all showed things which would be consistent with an ED (low white cell count and "a little block" on the ECG). But I don't think I have one! I would admit that I don't particularly want to gain weight because I am now as I've always been, but I don't consciously restrict food or anything.

I've seen the discharge summary, which says "please follow up with this patient who seems to have an ED" and I'm now worried it is going to get messy... I'm also now questioning myself, like, do I have some kind of denial thing going on? I'm getting irrationally stressed about it, and perhaps that's because I suspect there subconsciously is something. Urgh...

OP:

If you went down to 40.3 kg last year, that is BMI 13.9
which is obviously concerning wrt your health

You mentioned that you wanted to eat more healthy food

• in your case that would be any food with more calories, so don't cut out "junky" foods you actually like but there are also healthy options like peanut butter on toast for breakfast, or cheese omelette if you eat eggs, to boost your intake

Train yourself never to skip meals, maybe add snacks if your stomach capacity is small

I hope the GP appt is helpful for you - they may suggest help with meal planning

This may come out a little blunt #sorrynotsorry but I have 2nd degree AV block from a BMI that for most of my adult life hovered around 16.5. After that first fateful ECG - no, heart didn't wait around to establish whether I received an ED diagnosis. Instead it just progressively deteriorated further, to the point at which I needed a pacemaker in my early 30s to save my life. I had young kids then too.

So IMHO, "do I have an ED?" is a pointless question to be asking. Whether or not you do, your weight is causing potentially life-threatening medical issues. When you speak to your GP, you'll need an urgent cardiology referral. And ED or not, you need to gain weight.

You may or may not be naturally thin.

But I was 160cm at college, and when I was very ill with IBS, my weight dropped to 50kg. That was still technically within the healthy range but I looked very thin. I was physically cold all the time. If I had been 4 inches taller and half a stone lighter I would have been incredibly thin. I would consider your weight in line with the fact that quite a few researchers think 18 is too low for a healthy BMI, and it should be 20. That would mean an increase to 58kg, and might give you an idea of why am "only a bit underweight" BMI is potentially impacting your health.

I've somehow had a big collection of friends with eating disorders over the years. One friend I used to talk to her and suggest maybe her portion sizes were a little out, but she used to genuinely believe they were reasonable. She also used to serve others that portion size, so yes, she ate the same as them, but they would also have pudding where she didn't, and they would snacks and she wouldn't. Breakfast would be half or a quarter of the size, and was porridge (notionally good) but made with water and with raisins on top (again notionally good), but in fact it can't have totaled more than 150 calories. The same would apply at lunch time. So something notionally reasonable - like say a ham and tomato sandwich. Except it would be one of those little loaves of bread, so around ,55 calories a slice (110 total) plus ham and tomato (no butter) at about 30 calories. (Total 140) She would then also have an apple (50) and a big glass of water.

So what she had if you described it was a perfectly reasonable "porridge with raisins and then a sandwich and an apple for lunch", but what she ate, when you examined the details, was a miniscule 340 calories.

Other friends used to cook dinners, and it would be the same dinner for everyone but it might be very likely to be say, a chicken breast salad, with butternut squash and salad leaves and lovely fresh herbs and maybe balsamic vinegar. No nuts, no fatty meat, no bread served with it (or maybe they do serve bread but they don't eat it, or its a baguette cut into small pieces and then have just one). It's a lively, vibrant, healthy meal . It's the sort of meal most of us feel we should be making regularly, and we should. But the cup of butternut squash is about 80 calories. Maybe 200 calories in a chicken breast. The salad will be negligible but let's say 100 calories of oil for cooking the butternut squash and for the balsamic. So the whole meal is 400 calories. Everyone who has a good amount of bread and butter with it then consumes another 300 on top. If you combine that calorie intake at dinner with a decent chunk of exercise and some not terribly high calorie breakfasts and lunches you soon get to a point where you "all ate the same at dinner" but you're actually eating unhealthily few calories.

I'm not saying this to tell you that you do or don't have an eating disorder. I'm more pointing out that calories can be deceiving.

I still haven't got the balance right myself. I don't enjoy calorie counting because all it does is make me think of all the friends I have watched, consumed by eating disorders. So I don't, and I'm a bit overweight. But I am healthy, I walk miles s day, swim miles a week, and my IBS is under control. I'll take that, for me.

I'd echo what others say, regardless of whether this is an ED, your weight is too low for you to maintain good health.

Your meal plan sounds ok ish on the face of it (although lower in fat and protein than ideal), but the portion sizes could be tiny, and they must be.

I am 175cm tall, only a little taller than you, and have been naturally slim my entire life. Like you, I was called anorexic at school, despite eating well, and like you I have a slim frame.

I recently put on weight due to a stressful year where I wasnt able to exercise as usual, but the weight at which I feel healthiest is 63 - 64kg. Below 62kg and people start to ask if I'm ok. To hear that you are only 47kg at 170cm tall rings alarm bells.

Obviously the doctor will recommend a treatment plan, but I would start now by adding eggs, cheese, oil and seeds to your meals where you can. I'm also veggie, and I have to consciously keep my protein and fat intake up, as it's easy to slip into just having veg + pasta.

Also, I could say that I eat the same meal as my DH every night, and I wouldn't be lying, but he east roughly double the calories I do. He has a very fast metabolism and needs a LOT of food just to maintain a steady weight.

If you look at the people you eat with regularly, and assess your intake honestly against theirs, I would get their meals are much more calorific than yours. Larger quantities, plus bread, oily dressings, grated cheese, puddings etc would boost the calories quite a lot.

^ bet, not get

Whether you’re in the grips of an ED or not your are underweight and it is seriously affecting your health. You need medical support to get your weight back under control and it may need to to take a hard honest look at your intake. It is very very easy to deceive yourself on the realities of what is actually going on

I’m your height and would look dangerous underweight at your current weight. I’m my 20s I danced dangerously close to disordered eating. I was fairly obsessive over exercising and controlling my intake. At my lowest weight my BMI was 18.5 but I was starting to look think enough for those close enough to comment. Fortunately, for me it didn’t spiral into a full blown ED but I do shudder looking back on what it might have turned into. Please try to be honest with yourself and the doctors about what your intake is really like

You clearly have concerns about your health.

Your doctors have concerns about your health.

Yes, you've described some on this thread, but as some PPs have said - you have described other concerns on other threads, too.

I think your situation is far too complex for any of us to know what to say, other than "you need to see a doctor again"

In fact, I think any advice that isn't "you need to see a doctor again" shouldn't be taken seriously. You know it shouldn't. You know you're ill. See a doctor and take their advice. Follow their treatment. Stop looking for labels - you need help, with or without the label of 'Eating Disordered'

You know you're ill. See a doctor and take their advice. Follow their treatment. Stop looking for labels - you need help, with or without the label of 'Eating Disordered'

Absolutely - @Huggybear16 speaks the truth.

I'm glad you're going to follow up and get help with the doctor. What matters most is that you get help for the sake of your health. You can explore what's really going on with your doctors.

We can't say if you have an eating disorder, but here's my two pennies' worth: I was diagnosed at uni with an eating disorder "not otherwise specified" (I don't know if this term is still used). The thing was, I didn't understand it. I wasn't trying to be thin, I was the same weight I had always been (I never weighed myself), I didn't think about food, I didn't purposefully not eat. I ate cakes and pizza a lot. I thought I ate like anyone else. I didn't know that my eating was disordered as I had never eaten any other way. Over the years and with help, I eventually noticed the things I do that are different to other people. I could only eat food in a certain order, many foods couldn't be touching, certain textures would be make me vomit. I would take so long to eat food that it would seem like I had eaten as much as everyone else. If I went on a night out, I'd often not have eaten and the only calories I would have that day would be from alcohol. I had never really felt hungry at breakfast, often eating a tiny amount or skipping breakfast. Not eating lunch some days. Doing lots of exercise. Not eating enough protein or veg. I didn't see myself as thin, I thought my thighs were huge. I would over and daydream about operating on my thighs to scoop out "all the fat".

I could go on but it was essentially just lots of things that now I know are not normal, but I had no idea at the time. It stemmed from anxiety and depression and because I wasn't thinking about food at all really, it didn't seem to me to be possible that I had an eating disorder. Years later I read a novel about addiction and could see so many of my thought patterns and behaviours reflected, I couldn't believe it.

ED in my family.
GP appointment is first step. Well done for that. Maybe focus on your heart and bloods and don’t worry about ED label. You have a small child who needs their mom around.
Putting on weight can be as hard as loosing it. But with the right mindset you will get there. You really can do this, and it gets easier after a while. Also you will be surprised about much better you will feel.

Wishing you the very very best of luck.

Like PP have said I think you know you have an ED or at least complex issues around food. If I was under weight and had an ECG which showed signs of malnutrition I would immediately be upping my food intake. I absolutely would not be worried about putting on weight. It's completely normal to have put on weight since you were a young teenager. I would seek professional help ASAP.

How did your telephone appointment go @sometimescharlotte?