5/28

Today I met with a 43 year-old woman who is 5'2", 75 pounds. She has a history of anorexia nervosa, along with a host of other problems. I spent about 40 minutes with her, listening to her and trying to offer helpful advice when I could get a word in. The first thing she said to me when I entered the room was that her recent 20 pound weight loss had nothing to do with a relapse- she blamed it on her gallbladder removal 1 year ago, persistent nausea from migraines, and the 13 pills she takes daily (for legitimate medical conditions). It was both a sad and frustrating experience. She said everything right- she's seen two dietitians, she eats 3000 calories per day, she cross-referenced her medications to make sure none of them cause weight loss, etc. Plus, she knows her stuff (counts calories, understands nutrition). She really made me feel like she honestly WANTED to gain weight, and she was doing all that she thought she could do. At the same time, it was hard not to doubt her. Scientifically, it's VERY hard to believe that if she was truly eating 3000 calories per day, and not exercising as she claims, that she can't get above 75#. I wanted to help her- refer her to a dietitian who specializes in eating disorders or at least give her some new suggestion she hadn't heard before. But to some extent I realize it may not matter how much she knows- she won't change her behavior. The problem is likely outside the realm of dietetics. So that's my naive and wide-eyed inexperienced dietetic intern story of the day...