My Support Forums - View Single Post - Worried about upcoming doctor appointment

pinkflower17 · 11:53 AM

Quote:

Originally Posted by RisuNeko

I don't think i get a choice of which therapist I get at my clinic. My old therapist just quit and I'm seeing some new guy tomorrow that they assigned me. I have no idea what his specialties are but I'll ask.

I don't know if my insurance would cover a dietitian but I can try to find out.

I've never been in eating disorder therapy or treatment as I haven't been diagnosed with an eating disorder. My pdoc doesn't seem concerned that I average 300 calories a day and walk 4 miles a day. He's just happy for my weight loss. Same thing with my pcp.

As far as whether or not I want to change my behavior I guess my first issue is that I don't want to push the issue with my treatment team if they already think I'm fine. Part of me wants to just keep getting away with not eating but there's a rational part of me that knows I should want to be more healthy. I don't know if it's totally out of control because I can say things to myself like I need more protein so I'm going to eat a protein bar even though they have a lot of calories. But I'm finding my mood is tied up with whether or not I'm losing weight like so far this week I haven't lost any weight and it's really upsetting me. So that part feels out of control. I guess I'm mostly ambivalent about whether I want to change. All I know is I want to lose weight and I really really don't want to gain weight.

It's really unlikely you're insurance will cover a dietician unless you're diabetic, and then usually only for diabetic education. You can occasionally get them to cover it under Medicare or Medicaid (I think you have one or the other), if your doc codes it as "hypoglycemia", but that's hit or miss, state by state.

I think the issue is "disordered eating can quickly turn the corner to an "eating disorder" really quickly. And although it doesn't appear to be the case, this area happens to be an interest of mine and I've done tons of reading on it and someone who has lost X number of lbs and is X number of lbs underweight is in the same boat as an individual who is overweight, but has lost the same amount of weight in the same amount of time. The loss of heart muscle mass is the same, the loss of organ mass is the same, the electrolyte abnormalities are often the same. It's called nutritional insufficiency. I'd be happy to send you some articles about it.

It sounds like you're well aware that eating 300 calories a day while walking 4 miles a day isn't normal, you just need to decide if you want to do something about it. There are a lot healthier ways to lose weight, if you need to do so to be at a healthy weight

I'm sure it's a lot harder to bring up something like this to a therapist of your doctor when you're not obviously underweight, but I think it's really important to let them know...I think whichever doc was concerned at the rate you were losing rate is concerned is correct, metformin usually results in weight loss anywhere from 3-10 kilos over a six month period, plus with your history of binging and purging...I'd be uncomfortable as a physician even prescribing metformin, knowing it's GI side effects.

Most docs are, unfortunately, really uniformed when it comes to eating disorders, they may need some education, you may need to seek out a specialist.

In med school and residency combined, I think I got maybe one full day total spent on eating disorders, and I did several months extra months in psych. The education just isn't there. You may have to really push the issue, but, at the end of the day, they need to know how little you're eating, coupled with how much you're exercising. My dad used to always say, well he used to say a lot of things, but one of them was, "you're cruising for a bruising". I think you're looking for trouble continuing down the road you're going down, and I mean that with all the concern and care in the world. As someone who's been through eating disorder hell most of her life, I'd hate to see you go any further down this road. So, please, tell your doc what's going on. Try at least.
Take care of yourself. Let me know if I can do anything to help.