Recovering from bulimia and looking to gain weight

Dear Confused,

It’s courageous of you to reach out about your situation—and it’s a key step in helping you get to a weight that supports your body’s needs and daily functioning. Each person's body is unique, and what might be considered a “healthy weight" for you may be completely different for someone else. To develop your own picture of health, it’s wise to focus on your individual needs and concerns, rather than looking through the lens of what or who is seen on social media, movies, TV, and other media. Some things you may consider instead are what foods help you feel good, sleep well, give you energy throughout the day, and enjoy eating, among others. As you continue this journey there are resources and sources of support that can be helpful for you moving forward.

Pinpointing a healthy weight range for you without a thorough medical assessment and history is tricky. Individuals can be healthy at many different weights based on several variables, including their environment, family history, genetics, lifestyle behaviors, habits, and among others. You mentioned that your charts say you're too skinny—the next time you visit your health care provider, you may find it helpful to ask them to explain what they mean and ask if they can provide you with information about your body type as well as recommendations they have for a nutritious diet that would meet your specific needs.

These contexts are rarely provided in the media, and some people who are featured may have achieved their body shape by unhealthy means. What you may not see is how they feel or what they experience physically and emotionally in order to maintain their appearance. Photo editing programs have the capability of making people in the media appear thinner than they actually are or distorting their body shape in a way that isn't necessarily indicative of their exact body weight. While it may be challenging to distinguish these things just by looking at a picture, recognizing that these images are likely unrealistic and that it’s hard to connect them to a number on a scale can be a step toward body acceptance.

When it comes to wanting to eat a more balanced diet, there is a place  for all the foods you mentioned. A strategy for getting a good mix of nutrients is to eat a variety of foods and food groups. The MyPlate tool from the U.S. Department of Agriculture (USDA) offers recommendations for the proportion of each food group you should aim to consume to achieve a balanced diet. The tool also offers ideas on different foods you can eat to meet your nutritional needs. Learning about nutrition and re-vamping your eating habits can seem intimidating at first, but you don't have to make these decisions all at once. The USDA and Department of Health and Human Services' newest nutrition guidelines emphasize that long-term dietary habits, not just eating specific foods on occasion, have the greatest effect on your health. For more personalized support, you might consider meeting with a registered dietitian who can help you create a healthier eating plan that suits your needs.

You also mentioned experiencing some skipped periods. While this could be related to low body weight, there could be other reasons for this irregularity too. Menstrual cycles can vary in length, so for some people missing or having a late period could just be what's "normal" for them. On the other hand, factors such as stress, certain medications, or a hormonal imbalance could change your cycle too. If you continue to miss periods, it’s a good idea to talk with a health care provider so you can pin down and address what might be causing this.

It’s great that you’re working towards recovering from bulimia and sometimes doing it alone can be challenging. Although you say you aren’t ready to tell anyone about your situation, sharing this information with someone close to you or a confidential professional might help you feel better and make progress toward your health goals. Health care providers, registered dietitians, or mental health professionals are all great options and are trained to support you. The National Eating Disorders Association also has a confidential, toll-free helpline that can offer local referrals based on where you live. If you do decide to reach out for support, but you’re feeling uncomfortable about the conversation, you could write it out and share with them what you’ve written to Go Ask Alice!. In any case, you may find that talking to someone is less difficult than you expect, and also worthwhile compared to going through this alone.

Hope this clears up some of the confusion