(lively piano music) - Welcome back. Again, today, I'm sitting with my friend, Kate Mashado, who is a registered dietician. And we're just going over some of the questions that you have posted on my website, I had a forum open for a while.
Don't be alarmed, it's not there anymore. If you go looking for it. But I had asked you to give me some feedback about what kinds of questions you want me to ask her and how working with a dietician works. If you haven't checked out the previous videos, please watch those first because we're kind of going in order. Most of my videos are not in any particular order, but these are for a particular reason. Now, today's topic, we're going to touch on a couple things, but the first being, and I know this is coming out of a lot of anxiety or working with a dietician and starting to eat again, but the question is how quickly do you increase calories with someone? Let's say we're eating our meal plan right, we're doing okay with what we've done, and how quickly do you make us gain weight? Because I know the fear is I'm going to see a dietician, she's going to make me so fat so fast. (laughs) - I think this is really one of the scariest parts of going into a treatment center.
Outpatient level, we've talked about it before, it's going to be a little bit more slow, and I'll come back to that. But in a treatment center level, where sometimes you're insurance may be covering it, there may be actual guidelines that they're saying what we want to see some actual progression made in the weight area. If that is an area of concern for you, because not everybody goes in needing to gain weight. Sometimes it more of we need to get back to a caloric level that is right for your body.
It may be getting your metabolism stable again. Everybody is going to have a different goal in terms of weight restoration, caloric level, metabolic level, based on where they're coming from. So that's going to be assessed first. Again, in the treatment center level, it will depend on how severe your case is and if you are extremely underweight, below ideal body weight or someone said you're really instable at your weight, then there will be a higher end goal for you based on where you're at, because we want to get you to a level where you are more stable. So that may be closer to an ideal body weight, but that isn't a special number based on your height. It's more based on you and how old you are, what your body frame is like, what your family history is like, any experiences you've had where you feel the best at. So we take into consideration everything, but it may be a theoretical number that we'll say and we'll try to get you there. So, depending on how long you that you are able to stay in the treatment center may help on how quick we have to get there.
Sometimes, it may be a little bit faster, sometimes, it may be a little bit slower. But no matter what the actual number is, it's more on just seeing a difference week to week because if you are getting more calories in, your weight should be going up in an appropriate level. Sometimes you may be really afraid that you're gaining too much weight too fast and at any treatment center that you're at, there's going to be a doctor and there's going to be a staff evaluating. We will check your weight weekly or biweekly and hopefully, it should be blind. That's how we do it at our treatment center, so you won't know the number, but we'll see, because there is usually no reason to be afraid, but it's more of just so we can tell you that yes, you're making progress in the right direction and to help, I will adjust your calories based on if it's going at an appropriate level, if it's going too slow.
And that's more of a sign that your metabolism is changing. Because if you're eating all of this food and you can't even believe it, oh my gosh, I'm going to get so fat, but you're not gaining any weight, it's because your metabolism is increasing because you've been starving for however long and your body just really needs those calories because it's been in a deficit for so long. It can be a little bit overwhelming, I know, that for somebody who's been really underweight starts eating and they're not even gaining weight, we have to increase their calories a lot, every week a good amount more. - Yeah, add on some. - Because your body can go into something called hypermetabolic syndrome where you're burning your calories so fast just to replace certain tissues in your body and to refuel your body that's been in a deficit for so long that that can take a significant amount of time, from a couple weeks to a couple months, but that's when you'll be followed really closely by a medical team. It's not that common, but if you are severely underweight or have been restricting for a long time, that is a real life thing. - Yeah.
- And there can be some medical consequences due to that like bloating, blood pressure problems where you stand up, you get really dizzy really quickly. So it has to be kind of closely monitored, and that's an extreme. - Yeah. - And then, someone coming into a treatment center who maybe has been getting help from an outpatient team for a while so they're a little bit more stable. There may be need to gain weight, depending on where you're coming in at and, again, whatever the goal is, it's just to get there gradually. It's not so much about the weight number.
It's more about eating at a more regular rate and at a more regular amount of food, amounts of time in between eating. - Yeah. - And however long it takes to get there, based on your eating, is what we work with. But there is nothing really to be afraid of.
We're not going to get you to a weight that you're so uncomfortable with that immediately, once you leave the treatment center or leave our care, you're just going to do whatever you can to get it back down because that is defeating the purpose of the treatment. - Yeah. - And so we do take that into account.
And I think one thing, when we were talking about the re-feeding and the hypermetabolism, sometimes, if you're really, really, really sick, we will notice it by your weight and by the fluid changes in your body. And then it might be the time to go to the hospital. - Yeah.
- So we do notice that too. It's not very common and it's usually at the highest levels of care, but just wanted to let you know that anybody who is putting off getting treatment, the longer you put it off, the more severe it could get. - Yeah, and then the more help you'll need, and the more support because we can have either reactions. - Yeah. And then, I know, I think you've asked me this before, a lot of clients of mine and a lot of clients of Kati's have said, "Well, why, once I start eating, I gt really hungry all the time." and then that is one of the fears that well, I'm just hungry all the time and now I'm just going to have to eat all the time. Then I'm really going to get fat. Especially for somebody who's afraid of binging or has dealt with any type of binging in their eating disorder, that's a really strong trigger, is being hungry. - Yeah.
- Yeah, it's the most common, maybe, symptom of eating more regularly, is that your body adjusts to getting that food at a certain time and anticipates it by releasing our chemicals, your digestion chemicals, and getting your brain prepared to eat at a certain time and so you'll get really hungry. And it's nothing to be afraid of, it goes down, that big, intense feeling, it'll get less and less as you start to eat more and more consistently. It can be scary, but it goes away, and so does the gas. That's the other most common symptom.
- Yeah, usually the most embarrassing/uncomfortable. I think, a lot of times, on the therapy side of things, just having that feeling of hunger and knowing that you are going to eat and the anxiety that that causes, can sometimes push a regular hunger feeling into this bigger issue. I have a lot of clients that once they start eating again, then they know they're eating every three or four hours or whatever and even the thought of it turns, well, on my hunger and fullness scale, they're not down to a one or a two, but they feel, because it's just it's really stressful and it can be really hard and it's almost your eating disorder's lack of control. - Something else I wanted to bring up is that on the other end of things, if somebody comes in at, maybe at a weight, that they may technically be overweight compared to some charts, one of our goals isn't going to be for weight loss. I know some people come in at a level where they think well, if I can get my binging in control, then maybe this will be like a weight loss program for me because I think it's a really important reason and that's kind of the wrong reason to come into treatment. I know that naturally, if a body does consistently get less calories but is still getting adequate nutrition, maybe they'll start to lose weight, but that is not something that we're going to be looking for and that's not a goal of treatment, is weight loss for anybody, no matter what level you come in at.
Because that in itself is very triggering to have that in the back of your mind and can really inhibit embracing the program and and treatment philosophy. - And the rest of the work that you're trying to do. - Yeah. - Because the food issue, I mean, I always tell everybody it's not really about the food. I mean, yes, it is, we have to deal with it, but it's the emotional attachment to the food and the way that we form this connection of the two. To think that just by coming to a treatment center to get the nutrients I need and I will be watched so I can't purge then I should lose the weight that I've been wanting to lose but we're forgetting that connection and the reason that we were binging and purging or binging and whatever our behavior is of any sort. - Yeah.
- It's definitely something to keep in mind and know that that's never the goal of treatment. - With any registered dietician that you're working with, who has experience in eating disorders, they can help you, guide you to a caloric level, weight level that you feel comfortable, that you feel safe, and that you can reach longterm recovery. - Yeah, exactly, and that's the hope is that we're all working together towards recovery, right? Healthy mind, healthy body. We're trying to put that all together because one can't happen without the other, okay? And, like always, don't forget to subscribe to my channel so that when we put out new videos, you can hear about it and you can check that our right away.
And leave your comments below, I'd love to get the feedback. I like to know what you're worried about or what you liked or didn't like and if there's any other questions or topics, if I can maybe hassle Kate again for another little session, then we'll do some of those, too, so just let me know and keep checking back because we're going to work together, like I said, towards a healthy mind and healthy body.
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