A Realistic Story of Eating Disorder Recovery

In a recent video on The Kahm Clinic’s YouTube channel, nutritionist Elaina Efird, RDN, CD, CEDRD, CSSD discusses a case study that looks at realistic eating disorder recovery. As you read through the post below, it’s important to note how long this process took for the client as well as the changes her body went through on the journey to recovery. 

Case Study: Eating Disorder Recovery

This individual is 5 feet, 8 inches tall and weighed 134.5 pounds when she came to The Kahm Clinic. For the year prior to her first appointment, she was consistently over-exercising and under-eating. In terms of physical activity, she was doing 90 to 120 minutes of cardio-based activity (primarily running and biking), seven days per week (with one rest day every three weeks or so).

Additionally, she was mentally tracking her calories and restricting her intake to no more than 1,000 calories per day. In fact, when she and Elaina reviewed her food history, she was eating as few as 600 calories some days. She very rarely ate carbohydrates and would even cook with water in order to avoid fats and oils. 

As you can see, she practiced some really strong eating disorder behaviors. “She had a very loud eating disorder voice telling her that she can’t eat over 1,000 calories, that she has to exercise every day,” Elaina explains. “She was able to notice that these choices were not good for her, which is what led her to come see us for that initial visit.”

To start, the patient’s metabolic rate was only 933 calories per day (compared to a predicted 1,541 calories). This number shows that her body was compensating to essentially keep her alive. It was not getting the fuel it needed from food, so instead, it slowed her metabolism and broke down more lean mass than usual.

Metabolic Testing Results After Treatment

In order to correct this issue, she had to increase her calorie intake and rewrite some of her “food rules” — something that she worked on with Elaina for nearly two years. From July 2019 to August 2020, they focused on taking in more food and specifically worked on eating carbohydrates and fats. “I did not have her log calories — I don’t encourage individuals to do that — but based on my calculations, we increased her intake to 2,400 calories per day during this 13-month time period,” Elaina shares. 

Here’s why the word realistic is so important to this case study: Yes, this patient gained weight during her treatment. In August 2020, she weighed 182.2 pounds. It’s important to note, though, that her lean mass also increased, from 88.1 pounds to 106.6 pounds. This significant rise was necessary for her internal healing. She gained some fat mass as well, which was also normal for this healing period. 

“She needed to restore her metabolism and restore that lean mass, which came with some subsequent fat gain — and that’s okay,” Elaina stresses in the video. “I know seeing these numbers can be really scary, but that’s part of recovery for some individuals.” In other words, this weight gain is what her body needed to heal. By August 2020, her metabolic rate had more than doubled to 1,981 calories per day, even exceeding the predicted rate. Thanks to an appropriate treatment plan, her body was actually functioning the way it should!

For the next 10 months, Elaina and the patient focused on food freedom (allowing the client to eat what she wanted to eat without falling into restrictive behaviors) and body acceptance. She decreased her time spent exercising, ultimately settling on a routine of one hour a day for five days per week. She also decreased her calorie intake to about 2,000 calories a day (again, based on Elaina’s estimations). 

The most important thing, however, was that her relationship with food was notably better. She no longer obsessed over calories and her body. As a result, her weight decreased to 156.7 pounds, and her lean mass stayed high (103.4 pounds) with her fat mass decreasing (53.3 pounds). Even better, her metabolism stayed above the predicted rate at 1,743 calories per day. Note that this slight metabolism fluctuation is within a normal and healthy range. Ultimately, this individual felt happy without that wasted mental energy spent battling her past eating disorder behaviors.

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To talk to a professional about eating disorder treatment, nutritional needs, and more, please reach out to our staff or schedule an appointment at The Kahm Clinic today.