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Bulimia Eating Disorder

  1. Where can I find a dietitian who works with bulimia? Answers
  2. I am actually bulimic and a cutter because I feel so badly about myself as it is. Answers
  3. You said that vomiting does not work for weight control then why do I always gain weight during "recovery" even on the prescribed diets? Answers
  4. I am quite active so if I can begin eating at a calorie level that is closer to normal I may be able to lose weight slowly and realistically without being stuck in "diet" mode. Answers
  5. I am curious to know how the appropriate calorie level is calculated. How can I eat so many calories and still lose weight? Answers
  6. My beloved girlfriend is bulimic. I do not know how to approach this problem and things are getting worse all the time. Answers
  7. I do not have a question, but rather a personal story to share. I myself have dealt with bulimia for several years. Answers
  8. I just recently told my parents about my bulimia. What can I do to make them understand my situation? Answers
  9. In the last month or so I have been exercising, taking pills, laxatives, throwing up and doing all kinds of crazy things that slowly are driving me crazy. Could you please give me some advice? Answers

  10. I have a freind who never eats in school. How can I convince her she is not fat? Answers
  11. How can I speed up my metabolism without a lot of weight gain? Answers
  12. I am a vegetarian and binge on vegetables. I feel too sick! Answers
  13. I am a recovering bulimic. I am perpetually in fear of how my diet affects my life. Can you please help? Answers
  14. I have a friend who is bulimic and I am looking for some advice. The girl is very skinny, but not to thin yet. Answers
  15. Do you know of any specialists who work with bulimics? Who could she see or contact? My girlfriend has problems with constipation. Answers
  16. I have an employee who exercises at lunch and after work. She eats constantly and her work is failing. What do I do? Answers
  17. What is bulimia? Is it the same as anorexia? Can a person have both? Answers
  18. I have a roommate that gets sick a lot. The bathroom smells of throw-up. How can she be sick that often? Answers
  19. Large pieces of cake, whole packages of cheese or a quart of ice cream are gone overnight. Should I confront my daughter about the missing food? Answers

Where can I find a dietitian who works with bulimia?

The Behavioral Health Nutrition dietetic practice group of the Academy of Nutrition and Dietetics specializes in working with patients who have eating disorders. You can find a dietitian at the Academy of Nutrition and Dietetics. Include your zip code or city / state and the type of service you want (individual consultation) with eating disorders as the area of expertise.

I think that your calculator is messed up. People feel bad about themselves as it is and I don't think that it makes them feel any better. I am really only 15 years old, but I tried the calculator saying I was 18. I am actually bulimic and a cutter because I feel so badly about myself as it is. This pretty much screamed out "you are a fat ass"! My friend also took this and she is definitely not fat she is only a size 7 and it said she was at an unhealthy weight. Sorry for writing this I just thought it was necessary.

As gently as I can, I would encourage you to see a psychologist who specializes in eating disorders about your bulimia and self mutilation. You need to talk to someone about how you feel about yourself and find a healthier path in life. Food is not the issue and I would really hope that you find a therapist to talk to about your issues.

The text I used in the Healthy Body Calculator are rather gentle and don't even use the words obese and definitely not "fat ass". The calculator is designed for adults, not teens. If you want to send me your height, weight and age, I will give you some feedback using the Healthy Kid Calculator if you are receptive. Also ask your friend to send me the data she entered so I can duplicate her results.

Hi, I'm a 22 year old bulimic. I appreciate your site and have read a lot of the info on eating disorders. I've alternated between anorexia and bulimia (mostly bulimia) for 6 years.

My questions are regarding recovery. You said that vomiting does not work for weight control, then why do I always gain weight during "recovery", even on the prescribed diets?

Also, I had some successes with the new high protein diet, but became exhausted, unable to exercise and lost control again. It seemed effective in reducing sugar cravings and keeping water retention down. What's the deal?

You also answered one of the bulimics by saying that her metabolism probably was not destroyed after years of abuse. Why then do we all gain weight so quickly, eating normally and what can be done to prevent this?

It is very much like a tornado that just drags you around in circles. Just when you think you've found a way out, it whirls you faster than ever. Please help! I know you must have to answer an endless number of emails, and I really appreciate your time. Please email me at your convenience Thank you so much!

If you experience weight gain during bulimia recovery, it may be due to changes in how your stomach empties (your body gets to keep food to nourish your body) and changes to the mucosal barrier in your intestines where food is absorbed. A dietitian can help you with learning how to balance your food intake with normal amounts of exercise to achieve a healthy weight for your height without binging and purging.

High protein eating plans may not be effective at helping to control binges because they may not provide you with the energy you need for your daily activities. When you don't eat enough carbohydrate, your body may develop ketosis which is a state where there isn't enough carbohydrate refueling your blood glucose which in turn provides energy for your brain and muscles during physical exercise. Reaching a healthy weight is achieved by balancing food intake with physical activity.

Protein is a large molecule in your blood and does exert influence over fluid balance in your body, but high protein eating plans do not prevent water retention. Not eating enough protein like in anorexia can cause fluid imbalance in the body.

When you restrict food intake by not letting your body keep the food you eat by purging, your metabolic rate may go down because your body is trying to conserve energy. When you start to eat normally again, your body should readjust your metabolic rate back to normal. Be patient through your recovery and follow the nutrition therapy prescribed for you in terms of calories and number of meals.

Thanks Joanne for a quick and helpful answer. I did check again without estimating activity levels. This seems to be what other answers have been based on. I didn't realize that activity made such a difference. I am quite active, so if I can begin eating at a calorie level that is closer to normal, I may be able to lose weight slowly and realistically without being stuck in "diet" mode. I also appreciate the encouragement. I know I can beat this!!! Thanks again.

Thanks and you can do this. Just focus on short one month goals and try your best every day. No one expects you to be perfect.

I am curious to know how the appropriate calorie level is calculated. I have been struggling with bulimia for nearly 2 years and feel like I am gradually getting a hold of it. I want to try eating normally, but still aim for some weight loss as I am over fat (BMI) and in an unhealthy weight range. Your calculator suggests about 500 more calories than others (2,150 per day). I am very afraid of gaining weight. How can I eat so many calories and still lose weight? Thanks in advance.

The formulas used in the Healthy Body Calculator are proprietary, but I can tell you that they are based on current nutrition practice. Your current body weight is one factor that determines calorie needs. The more a person weighs, the more calories they need to maintain that weight. So it is possible that even on 2,150 calories per day, you may lose weight.

The only subjective data you enter into my calculator is your activities. Did you overestimate your activity? Do my calculator again and don't put in any activity hours. That calorie level result would be your BMR (basal metabolic rate) which is the amount of calories you need just to keep your body running, laying awake in bed. So when you get up and do whatever you do in a typical day is your activity calories which need to be added on top of your BMR. So do it again and now add in your activities. What is the difference in the calories you need to keep your body running and how many more calories do you need for your activities?

I do understand your fear of gaining weight. Isn't that why you started bulimic behaviors? You don't want it to control your life anymore. Congrats for dealing with a very difficult issue.

Bottom line is start with the calorie level in Your Nutrition Facts with your activity hours included. If after 2 weeks, you have gained more than 3 pounds, then you would need to lower your calorie intake no more than 500 calories. Definitely don't eat less than 1,200 calories per day.

You see, if you try to eat a very low calorie eating plan, skip regular meals, you may increase your bulimic behaviors. You need to eat a reasonable amount of calories and eat 3 regular meals even if you aren't hungry. If you wait until you are hungry, you may lose control again.

Perhaps now is not the time to stress yourself further with a weight loss goal. Would it be acceptable for you to just maintain your weight until you get your bulimia under control? That would be a reasonable, healthy goal. Then once your bulimia is under your control, set a moderate 1 - 2 pound weight loss goal. You can do it!

Hi. My beloved girlfriend is bulimic. Although I am studying to be a clinical psychologist, I am unable to assist her with her problem. I do not know how to approach this problem and things are getting worse all the time. She can barely eat now and she is already shows signs of kidney problems. Please help me. I have to help her out before it is too late. She is 22 and has been like that for the past three years.

I understand that you are having a difficult time understanding your girlfriend's behavior, even though you are studying to be a clinical psychologist. This is understandable since eating disorders are very complex and something in which psychologists specialize. If you have never experienced a person with an eating disorder or studied them, your girlfriend is feeling pain, both physically and mentally. It will take a lot of work by her to overcome bulimia during treatment.

It sounds to me that she knows you recognize her symptoms. You should not ignore her behavior, but try to talk about it to her in a supportive manner while expressing your concern about her health. Mentioning her weight will only provide a point to argue about. If she will talk to you, listen carefully and try to make her aware of counseling available in your area. Show your concern and offer to accompany her to treatment. Understanding how much you support her may motivate her to get help.

You say that your girlfriend is experiencing kidney problems. You don't say if that is reduced urine flow, pain on urination or that she is retaining fluid in her tissues due to reduced kidney function. She should be under the care of a medical doctor and perhaps that will open the door to getting psychological help.

If your girlfriend is bingeing and purging, then she has bulimia. If she is also having difficulty eating, then she probably has anorexia. Eating disorders requires a team approach. The treatment protocol is a two-fold approach. Psychotherapy is necessary to help her deal with the underlying issues. Nutrition counseling will help her understand she needs to nourish her body and help her develop more normal eating patterns. With both of these treatments working together and the earlier treatment is sought, the more likely she will reduce bulimic behavior.

I do understand that you have a background in psychology, but it may be better if she seeks the help of a psychologist or psychiatrist with experience in treating eating disorders, as well as a registered dietitian. Your emotional connection to her may interfere with your ability to work with her on a professional level. She will definitely need your support and understanding during her recovery.

I do not have a question but rather a personal story to share. I myself have dealt with bulimia for several years. I want to let your visitors know they are not alone! For me, my eating disorder began when I was approximately 15 years old. I am now 23. I want to let those who are struggling with an eating disorder know that it is possible to over come bulimia and/or anorexia. I myself have not entirely beaten this disease, but I'm more than half way there. There is an end to all the craziness, trust me, but it takes a lot of time, work, effort and the will to get better. You have to take each day at a time and you have to keep focused.

I had to quit the university, the year I was to graduate and believe me it was the toughest decision for me to make. I chose to delay my graduation in order to join group therapy in my hometown.

I think back to this day how grateful I am that I made that decision and how grateful I am to have had such supportive friends and family members. When it comes down to it, people are very caring and understanding when you come to them for help.

I would like to offer my help in any way possible in order to help others beat their eating disorders. I found that one of the best solutions is talking. Many people with bulimia out there feel like there is nowhere to turn or maybe they feel like they will be looked down upon. I'm still glad to see that there is somewhere to find help. Having an eating disorder is not a very easy thing to admit and I'm very glad to see that there are individuals strong enough to come forth with their problem. I know in my case that if it was not for my five roommates God knows where I would be now.

Congratulations. Yes, family and friends are the glue that holds life together when we can't. Sometimes the most difficult times in our lives become the times we learn the most and on looking back think; it was the best thing that could have happened because difficulty caused change in us. I believe that some day, you will return to the university with more focus and determination than even you thought possible. You may even find your career working with persons with eating disorders.

Support from others with similar issues can make the difference in gaining the understanding that you are not alone and learning the skills to change your life. People also need professional help and encouragement to see a psychologist and a registered dietitian. It takes support from others and professional counseling.

I am 18 and I have been bulimic for the past two years. I just recently told my parents about my condition. They seemed concerned and said they would try to find me help. Lately, anytime I bring the subject up my parents ignore me or act like I am a hypochondriac. I know I need help because I feel like I am loosing control. I have been bingeing and purging off and on for the whole two years, sometimes 3-5 times a day. I feel helpless. I can't do this without my parent's support. I can't stop by myself. What can I do to make them understand my situation?

Perhaps your parents don't know what to do or say? I would suggest that you ask your doctor for a referral to a psychologist who treats people with eating disorders. You could also ask your school counselor or school health service to refer you to someone. Then ask one or both of your parents to go with you to the appointment. If they don't go with you, ask a friend who knows your situation. It would be good if you had your parent's support, but if they are unable to help, ask a friend for support. You can do this.

You could also ask your parents to read this bulimia topic to give them some background information.

Hi, I'm a 16-year-old student in Guatemala. I need to tell someone about my eating disorder and I spotted your site in my research. Well, I have been bulimic for a time now. Sometimes I used to throw up, but that was a long time ago. Then I started to exercise compulsively etc. In the last month or so I have been exercising, taking pills, laxatives, throwing up and doing all kinds of crazy things that slowly are driving me crazy. Could you please give me some advice on how to stop this? Thanks.

Bulimia's symptoms are food related, but the problem has its roots in your head, not your stomach. You are not crazy. I would suggest you go see a psychologist that specializes in eating disorders. Your behaviors aren't going to go away on their own. I'm sure you feel panicky with the thought of giving up these unhealthy behaviors because how else are you going to control your weight? Well, a healthy eating plan and a reasonable exercise routine do work to control weight.

The combination of compulsive exercise, taking laxatives and throwing up are unhealthy. You are going to get your body out of chemical (electrolyte) balance and end up in a hospital. Go get some help now. Ask a trusted friend who knows your situation to go with you. Start with a school counselor or your family doctor that can refer you to a psychologist.

You will need to daily document what you eat, pills you take and how often you vomit. Don't beat yourself up with an "all or nothing" attitude. If you reduce these unhealthy behaviors each week to eventually stopping, you will succeed. It starts with asking for help. Now go do it.

I need your advice. I have a friend who is stressed out a lot and she doesn't throw up. But when she is in school, she never eats. When she is at home, she eats and eats and eats, but she won't throw it up. Then she says she is gaining so much weight. I tell her she's not, but she insists. So I told her maybe if she didn't eat so much at night she wouldn't make herself feel this way. She says she doesn't think she's fat, just overweight and chunky. How can I convince her she is not fat? Or is it more than that? Does she need help? Please answer soon.

Sounds like your friend may have the start of an eating disorder. Not eating in front of other people and then eating lots in private are symptoms along with a preoccupation with her weight and how she looks. Perhaps the best support you could provide is to tell your friend that what she is doing with food is not healthy and she should talk to a professional about it. Depending on her age, she could talk to her doctor or school counselor who could refer her to a psychologist who works with eating disorders before your friend starts throwing up. Keep encouraging her to go see someone and you could offer to go with her for support.

You could also suggest she try the Healthy Kid Calculator® which will calculate her healthy weight based on her age, gender and height. You can use her results to show her what a healthy weight is for her height.

I am a 28 year old woman who has anorexia and bulimia. I started these behaviors when I was 16 years old and was recovered until last year. Last December I fell into the terrible anorexic trap again and lost 30 pounds, which only put me at 100 pounds (I'm 5 feet 5 inches). Luckily I was able to stop the weight loss in time, but have not been able to eat properly.

I switch back and forth between lots of bingeing and purging (all day of eating and vomiting, unable to stop) and back to days of little or no eating. I really do want to eat normally again (and am under a counselor's care), but my metabolism is so ruined now if I eat normally I gain weight immediately. I wouldn't mind being 110 pounds (well sounds scary, but I know that is a healthy weight for me), but am afraid it will take at least a 20 pounds or more weight gain to get my metabolism working again.

Friends tell me that the temporary weight gain will be OK then I can start to work it off in the healthy way, but that idea scares me to death. How can I speed up my metabolism without a lot of weight gain?

I already have a diet very low in fat as you probably know and have tried eating a normal healthy diet for a period of one or two weeks at a time, but the weight gain is just too unbearable and I always retreat back to my old ways of vomiting after meals. Please advise me on the best steps to go from here. Thank you.

You deserve credit for recognizing that you need to gain control of your eating disorders. The issue is not food; food is only a symptom. Some incident may have happened to trigger a re-occurrence. So until you get through your issues with your counselor, make an appointment with registered dietitian to plan a healthy eating pattern for you.

Metabolism is the rate at which you burn calories for energy you use for daily activities and build body tissue like muscles and organs. Your metabolism is probably not screwed up because you are alive and breathing with enough energy to move around. You don't need to speed up your metabolism.

You are using vomiting to control your weight from the binge eating and it doesn't work. These behaviors reinforce each other so both must be stopped. Start by reducing the number of binges and vomiting each day. Eating normally is scary because you are afraid the weight gain will get out of control. It won't with a healthy eating plan created for your calorie needs and weight gain goals by a registered dietitian.

A healthy weight range for your height is 111 to 149 pounds, so a 110 pound goal is still underweight for your height. I used the Healthy Body Calculator to calculate your calorie needs based on your height and current weight of 100 pounds. If you eat 1690 calories a day, you will gain 1 pound a week, which is slow enough. Once you get to 110 pounds, you will need about 1730 calories a day to continue gaining 1 pound per week to get to a healthier weight of 125 pounds. I did not make any calorie adjustments for your activity or exercise habits which could add 275 to 290 calories more just for daily activities.

A very low fat eating plan can trigger binge eating. Fat helps you feel full or satisfied. If you don't eat enough fat, you are more likely to feel like you need to eat more food more often. Try increasing the fat in your eating plan to 25% to 30% of your total calories. If you eat 1730 calories, you can eat 48 to 58 grams of fat each day. Read food labels as the fat grams are listed so you can keep track of fat grams you eat, but don't obsess over getting the exact amount of fat each day. We average fat intake over a week so some days you might be a little over and some days a little under, but on average over a week, you need 48 to 58 grams of fat per day and 1730 calories.

To gain control of your bingeing, remove foods that you have binged on in your home. Usual binge foods are high carbohydrate, high fat foods. Don't buy any of these foods either until your eating pattern normalizes.

Give yourself credit as your bingeing and vomiting reduces in frequency each day. Don't expect perfection - all or nothing. You did it once, you can do it again.

I am a vegetarian and eat dairy products sparingly. I feel that my diet is generally healthy and I exercise 4-5 times a week for about 45 minutes. My problem is that I binge every 2 weeks or so. My binges don't seem to be triggered by emotions or cravings and when I have them I will eat anything-- whether it is something fattening like pizza or healthy like steamed vegetables. I will consume in one sitting more than I've eaten all day! I don't try to exercise it away or use laxatives, etc. I feel too sick!

Binge eating is characterized by a very large intake of food in a short period of time as you describe. Usually high sugar, high fat foods are eaten. People should stop eating when they feel full, but persons with bulimia continue eating even after feeling increased stomach discomfort due to distention. Vomiting may or may not occur after a binge. Excessive exercise or the use of laxatives are other behaviors that can be present. Your exercise program seems healthy and appropriate. Food is not the cause of a binge. I would suggest you see a psychologist to discuss what episodes trigger your binge eating.

In the meantime, plan 6 small meals per day. Choose mealtimes and stick to those structured times. Remove any high fat, high sugar foods from your house that you have binged on in the past. Steamed vegetables are healthy foods so don't eliminate them, but eat them in moderation. Ask your psychologist to see a registered dietitian with experience in working with eating disorders.

I was surfing the net trying to find all the info I could find on hypoglycemia.

I am a recovering bulimic. Both my parents are alcoholics. My father is a "rage aholic". I think this stems from a sugar disorder. I am also in recovery for money issues. I am debt free, but I still use shopping as a mood altering. I have recurrent Candida. I have many allergies (food) as well.

On the outside I appear very happy healthy and successful. Even my boyfriend who is a family practice doctor tells me I'm fine.

I am looking for support re: my hypoglycemia diet. I was completely off sugar for 6 weeks and began bingeing. I am worried about myself. I don't seem to be able to find the support I need in OA (Overeaters Anonymous). It is extremely hard to remain sugar free.

I take lots of chromium, but lately I've been out of control. Can you please help?

A support group and/or additional reading and a recommendation for a physician in my area would be very helpful.

My sister died of leukemia 2 years ago and my dad and grandparents had or have cancer. I know that all my illnesses are related.

I am also mildly depressed despite the fact that I am in a healthy relationship and my business is going well. I have childhood abuse issues, which have been dealt with in therapy. I am a beautiful loving intelligent woman with a lot to offer. But I am perpetually in fear of how my diet affects my life. I'm trying to better my odds. Can you please help? Thank you for giving me the opportunity to vent.

You are a survivor. You are on the right track. I do not believe that food or eating is your issue, only a symptom of the real issues.

Obviously, you don't agree with your doctor boyfriend that you are fine and perhaps his emotional closeness to you is blinding him. It doesn't feel fine from what you are describing.

I would recommend you see a psychologist who is trained in domestic abuse, depression and compulsive disorders. You have more work to do. There is a relationship between all your family issues including bulimia, alcohol, abuse, depression, death of a family member and compulsive shopping. Your father's rages of anger belong to him and are not caused by a sugar disorder. You need to keep yourself safe from his rages even if that means leaving when your father starts raging.

Hypoglycemia should be diagnosed by a doctor. Your eating plan does not have to be carbohydrate free, just sugar free with 6 small meals like a diabetic nutrition therapy using carbohydrate counting. Maybe you should see a registered dietitian who can help you with a healthy eating plan while you deal with the underlying issues. I don't know of any support groups for hypoglycemia, but you could ask the dietitian you see if there is one in your neighborhood.

While at the doctor's, get the Candida infection treated as it is due to a fungus often in the throat or vagina. Has an allergist tested you for specific allergies (food)? If so, what are they?

I wouldn't recommend chromium supplements for you. Chromium won't do anything for the symptoms you describe. Chromium is part of insulin, but if you do have hypoglycemia, then you are producing too much insulin. Excess chromium will not change how much insulin is secreted by your pancreas.

I have a friend who is bulimic and I am looking for some advice. The girl is very skinny, but not to thin yet. She has confided in only me that she is throwing up her meals around once a day to lose weight. She tells me that it's not out of control and she is going stop after loosing 20 pounds. I don't know if it is out of control yet or not but I am worried about her anyway. She just started doing this about a month and a half ago or so. I have done everything I know of to try and get her to stop, but nothing works. I have explained to her that even if her problem isn't out of control, it is still not a proper way to lose weight. I have told her that she looks fine and doesn't need to lose weight. I have even threatened to tell the proper authorities on her. (To be honest with you, I don't even know who the proper authorities are.) No matter what I say to her she tells me not to worry and she'll stop as soon as she loses her 20 pounds. I would appreciate any advice or information, you could give me.

You are pretty astute. The proper authority would be her family, doctor or psychologist. Depending on your and her relationship to her family, start with her family.

First, switch approaches and talk to her about how unhealthy throwing up is and that you want her to be healthy. She will not hear you say that she looks fine. Second, her weight is not the issue and throwing up even once a week is unhealthy. Besides, the body can't be fooled into losing weight and people with bulimia soon discover that throwing up doesn't help them lose weight. The problem comes when they cannot stop bingeing on food and alcohol. Food is not the issue. Your friend needs to see a psychologist to deal with issues that got her preoccupied with her weight. A registered dietitian can help her with a healthy eating plan to achieve a healthy weight goal.

You say that she is skinny. Is she also anorexic? This is a dangerous combination that can lead to depletion of electrolytes (sodium and potassium) in the body when starvation and vomiting are combined.

Use the Healthy Body Calculator to determine a healthy weight for your friend. Again, when referring to her weight, if she is too thin, tell her that she looks unhealthy.

My girlfriend was bulimic for several months. She used laxatives. It is now two or three years later and she is having stomach problems. She is lactose intolerant, which may complicate the matter. Last May she became severely constipated, which was extremely painful. After seeing a gastroenterologist for several months there was no solution to the problem. He prescribed several different "industrial strength" laxatives, which had no effect. Now, when things get bad she resorts to using regular laxatives (she's done this once or twice), although I am not concerned about her slipping back into bulimia (through counseling she's past that stage), but I do worry that this is going to be an on-going problem. Now for the question. Do you know of any specialists who work with bulimics, who she could see or contact?

Do you know of any solutions? It seems that this is a common problem, because two of her friends, also ex-bulimics, are in a similar, but not so serious situation. Any information that you can send me would be greatly appreciated.

Your girlfriend's lactose intolerance and constipation problems may have nothing to do with a past history of bulimia. She can limit foods high in lactose and substitute lactase reduced milk (Lactaid) or switch to calcium and vitamin D enriched soy milk.

Constipation can result from too little fiber or water in her eating plan. High power laxatives are a short term solution. I would suggest your girlfriend gradually increase the fiber content of her eating plan (1 gram of fiber per 100 calories or 25 grams of fiber per day) by switching to 100% whole grains in breads, cereals, rice and pasta, cooked dried beans or peas, fresh fruits and fresh vegetables. This would be preferable to resorting to laxatives again.

To determine if she is drinking enough water, suggest she look at the color of her urine. If a person is drinking enough water, urine should be colorless and odorless during the day. An exception to this is vitamin C supplements will turn urine yellow as excess is excreted in urine.

Does she get constipated more often just prior to menstruation? Just prior to menstruation, there is a physiologic reason to the constipation. Every month a woman's body prepares for pregnancy and starts resorbing fluid from the intestinal tract. This concentrates fecal material, makes it more hard and difficult to eliminate. I would suggest paying particular attention to increasing the fiber and fluid content of her eating plan during the week prior to menstruation.

Bulimia, anorexia and other eating disorders are best treated by psychologists. Suggest your girlfriend talk to her former therapist and ask that person to refer her to a gastroenterologist familiar with treating eating disorders.

I have an office manager who started working for me less than 3 months ago. Right off the bat she started taking 1 1/2 to 2 hour lunches so she could run. This is after she worked out in the morning for about 1 - 1 1/2 hours. Then she leaves promptly at 5:55 so she can do 90 minutes of aerobics.

She eats constantly and everything, rice crackers, candy, Chinese food, junk, junk. Her desk is a mess and I can't stand it. She doesn't finish projects on time, the quality is poor, lies about her work and she denies I tell her things (I have a great memory and write most everything down for her!). She is snappish, openly hostile in front of others and at 33 years of age claims no one has ever said these things about her work pattern before.

I researched her work pattern at other companies and she HAS had the same pattern AND they thought she was bulimic, too. I started adding up the facts.

What do I do - approach her first or just fire her. She has 2 weeks left on her probationary period.

She is driving me mad. I manage 3 departments and I spend more time working on her than any other person or group. She can not be trusted to do the work I assign her. Always asks for extensions, etc. etc.

Help, help, help!

Bulimia is an eating disorder that manifests with large amounts of food eaten in a short time, followed by vomiting. Anorexia is another eating disorder characterized by a preoccupation with thinness and often compulsive exercising. Some of both characteristics are present in your employee.

If she has a job performance that she is not completing in a timely manner, then you will have to make the decision to terminate her employment based on that. Seems like you have invested a lot of time documenting her performance as well as with previous employers. As her supervisor, you will have to decide whether to continue her employment or not. However, in the United States, you could not fire someone because of a medical or psychological problem as that would be discriminatory.

What is bulimia? Is it the same as anorexia? Can a person have both?

Bulimia is characterized by binge eating, which is eating a lot of food in a short period of time (usually less than two hours). Ninety percent of the time, a person with bulimia follows this with vomiting to rid herself/himself of the calories in the food. The vomiting does not result in expected weight loss. Yet, most people with bulimia are normal or slightly overweight.

Bulimia is not the same thing as anorexia which is self-imposed starvation. The person with anorexia is abnormally thin, has a distorted body image and has an intense fear of gaining weight.

Yes, a person can have both bulimia and anorexia. They starve and periodically binge/vomit. They are the most seriously ill, have the hardest time recovering and need the most help quickly before blood electrolytes (sodium, chloride and potassium) get dangerously low.

Some common foods a person with bulimia will binge on are popcorn, ice cream, doughnuts, candy, cookies, cake, etc. Binge foods are usually high calorie/carbohydrate foods that can be eaten quickly. They also usually don't eat food in front of other people, yet seem to maintain their weight. Again, as with people who have anorexia, food is not the problem, but a symptom of psychological issues.

A person with bulimia can usually remember when she or he started bingeing and vomiting. From my clinical experience, most patients remember their parents divorce or breaking up with a boyfriend as being the start of the binge / vomit cycle. They can remember overeating a "fattening" food followed by guilt from eating a "forbidden food".

In the beginning the vomiting becomes a way to rid oneself of excess calories. The person with bulimia then uses the vomiting as a means to control weight. Other diets have failed and vomiting becomes the weight control method. Vomiting becomes a life preserver that the person with bulimia can't let go of because they know they have lost control of their eating. If they let go of the vomiting, they fear their weight would drown them.

But vomiting does not control weight. What happens is that the body adapts. Food is retained longer in the stomach because the body doesn't think it will get all the nutrients out of the food. Digestion starts occurring higher in the gastrointestinal tract. People with bulimia have thrown up food they ate more than 24 hours before when the usually stomach empties in about two hours.

People with bulimia express guilt and shame about bingeing and vomiting. They usually have a limited number of trusted persons that they tell about their vomiting. In fact, most of the bingeing and vomiting happens in their own home when no one else is home. However, other family members notice missing food and the smell of vomit in the bathroom.

The typical person with bulimia is a white, single, female, high school or college student. The average age is 21 years. Athletes who participate in sports with weight restrictions, like gymnastics, wrestling, football and boxing, may practice periodic binging / vomiting to control their weight. Sports is no excuse to start vomiting to control weight.

It is not normal to force yourself to vomit after overeating. If this happens at least once a week, you have one of the symptoms of bulimia.

One health problem that people with bulimia have is that by vomiting, they are losing a lot of water, sodium and potassium. Your body gets out of electrolyte balance quickly and you can become seriously ill. Dehydration is serious for persons with bulimia.

Another health problem people with bulimia have is with their teeth. Because of repeated vomiting, the enamel on their teeth gets destroyed by the stomach acid vomited with the food.

How do you help a person with bulimia? First they need professional psychological help. Most can be treated in an outpatient clinic. Professional help is available at most mental health clinics. Also, eating disorder clinics usually advertise in phone books and newspapers. Most college campuses have support groups for persons with eating disorders. If the person is someone in your family, remove any foods they usually binge eat. If you are not sure eliminate sweets, desserts, snack chips and any food frequently found missing.

A person with bulimia needs to learn other, more healthy ways to control weight. They need to eat three regular meals a day and anticipate hunger. Persons with bulimia also need to learn what situations set them up to binge eat and vomit.

I have a roommate that gets sick a lot. The bathroom smells of throw-up. How can she be sick that often?

Persons with bulimia commonly use the phrase "I got sick" to describe vomiting after a binge episode. Vomiting for the person with bulimia is a means of ridding themselves of the guilt they feel by eating "forbidden foods". Vomiting for your friend is her means of controlling her weight.

Frequent and regular vomiting does not cause weight loss. Your body learns to adjust and starts digesting food higher in the gastrointestinal tract because it learns that it can't hold onto the food very long. Also, food stays in the stomach longer because of the frequent vomiting. Patients with bulimia have told me of vomiting food they ate almost 24 hours before.

It is not normal for persons to throw up on a regular basis, even as infrequently as once a week. The next time your roommate says she "got sick", tell her you think she vomits a lot and it is unhealthy. Ask her if she wants to talk. Express to her your concern and offer to help her seek professional help. Most communities offer psychological help and support groups for persons with eating disorders.

My 16 year-old daughter is really concerned about her weight, but she does not look fat. She and I live alone in an apartment. I have been worried about her because some food I buy disappears quickly. Large pieces of cake, whole packages of cheese or a quart of ice cream are gone overnight. Should I confront my daughter about the missing food?

Getting up at night and eating frequently during the night is not a usual eating pattern. Since only you and your daughter have access to the food in your apartment, it is obvious who is eating the "missing food". Hunger is probably not the problem.

I would suggest you and she sit down and discuss the missing food. Accusing her of taking the food or threatening her with restrictions will only cut off her communication to you. Express your concern and desire to help her. Be prepared though, she may not be able to overcome her shame and guilt to tell you. She needs psychological help dealing with the "why". The eating is only a symptom and not the real problem for her.

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