Maria, a 17-year-old girl, was five feet tall and weighed 95 pounds. She was on the varsity crew team and practiced two hours every day for nationals. She had her first period when she was 14, and over the past three years she had had a total of 10 periods. She was eating 1400 calories a day and wanted to weigh 90 pounds. She weighed herself at least twice a day. If the scale was up one day, she made sure it was down the following day. Two years earlier, she had a stress fracture, but no bone density test had been done. Metabolic Testing showed she was severely hypometabolic, burning only 386 calories a day and therefore using her own lean tissue (organs, muscle, and bone) for fuel. Other medical tests revealed that she was anemic, deficient in vitamin D, and had osteoporosis (bone loss).
Initially, she reluctantly agreed to eat 2,000 calories a day. She was asked to stop exercising to correct the Relative Energy Deficit in Sports. After two months she got her period, and after four months of eating close to 2,200 calories a day, she reached 100 pounds. This frightened her. Her Metabolic Test and Body Composition Analysis showed major improvements, but her metabolism was still not corrected. She felt that she should be rewarded, and so her parents allowed and encouraged her to start exercising again. Three weeks later she was re-tested and her metabolic rate had plummeted from 1,000 calories to 437 calories a day. She had lost lean mass and her fat weight had increased. She had returned to being very hypometabolic and catabolic. It's as if her body was saying, "Don’t mess with me...I'll show you, you are hurting yourself!"
Maria and her parents were wrong in thinking that just because she had reached 100 pounds and had gotten her period that she was recovered. It took another three months, eating 2,500 calories per day, for her body to recover and to have a normal metabolic rate with a healthy amount of lean mass. She ended up weighing just over 100 pounds. Her percentage of body fat was lower than her first visit. She admitted that she had been in denial and would have continued being in denial if it wasn't for the Metabolic Testing and the Body Composition Analysis.