[RisuNeko]

So about 3 months ago when I started at my new clinic my doctor weighed me and my weight was more than I knew, which scared the living daylights out of me. Being that much is a huge fear of mine. So he prescribed me metformin for metabolic syndrome (I do not have diabetes) caused by all of the antipsychotics I've been on in the last 3 years. I gained a lot of weight on meds in 2 years, which to me is just unacceptable and so shameful but my old nurse practitioner didn't care to do anything about it. He just kept piling med after med and promising they were weight neutral when they weren't (like risperidone, and zyprexa and seroquel).

Now I've lost weight or maybe more I haven't weighed myself in a week in the past two months and my doctor called me because he found out from my pdoc how much weight I've lost and he said that I couldn't possibly have lost it from the metformin and that you're only supposed to lose so much on metformin over the course of several years. So now he's obviously worried that something is wrong especially because I've told him I've been having a side effect of vomiting pretty frequenty unless I eat a whole lot when I take the metformin, but I have no appetite so my meals are very low calories, twice a day, and I usually can't keep one or the other down. I feel fine, not feint or anything. And I'm' really happy about the weightloss, except I feel like a whale still, I'm dtill more than I want to be (I'm 6 feet tall or so, but If I could keep going and be skinnier I would keep going

I'm just scared of what my doctor is going to say. i do have a history of bingeing and purging but my doctor doesn't know that and I haven't done it in forever. I've never been diagnosed with an eating disorder and I don't think I have one, just disordered eating. I don't know what to think.

[CANDC]

Risuneko sorry you are having challenges with your weight. Do you have a dietitian that helps you.

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[RisuNeko]

No I don't have a dietitian. It would be hard to have a dietitian because I have an extreme phobia of hot things so I don't cook, I just eat like dried fruit and nuts. I'm also paranoid of my roommates seeing me cook or even be in the kitchen. I don't use my own kitchen. So my dietitian would have to somehow come up with only foods that are unperishable and don't need to be cooked.

[finding_my_way]

have you considered seeing a therapist that specializes in eating disorders in conjunction with a dietitian? that might be a good idea so they can kind of work on those behaviors with you while also trying to challenge you to try new foods, like exposure therapy, etc.

have you ever been in eating disorder therapy of any kind or are you willing to if you have not?

i guess i have to also ask because of your rigid behaviors with food and eating and your fear of weight gain, do you feel like it is out of control, and would you like to change it?

[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.

[pinkflower17]

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.

[RisuNeko]

Thanks for your concern. It would be great to have some articles as I really like researching things and I'm the kind of person who doesn't believe what someone tells me until I read a well done scientific study on it. I told my new therapist about it but we made an agreement for him to not talk about it to my pdoc or my doctor yet because I'm not ready for that yet. But maybe he can help me. I don't know how much he knows about eating disorders because he's just a social worker who used to work with dual diagnosis people (which I am not). I didn't tell him about the past binging and purging because it was so long ago it wasn't really on my mind but I'll try to remember to bring it up next time.

Anyway thank you for your concern. I'll try to keep myself out of trouble. I was good yesterday and went out to lunch with a friend which I was nervous about because of the calories but I ate half of my meal at the restaurant and convinced myself to eat the other half later when I was home even though I knew the meal was about 900 calories. So i think I got at least a thousand calories yesterday. I felt so full and disgusted with myself afterward but at least I did it. Now it's just a matter of trying to eat that much on a regular basis. The bad thing though is I didn't eat for 2 days before going to the restaurant because I was so worried about it and because I hadn't lost any weight that week. I know that's a bad thing I just need to change my habits.