Ask the Expert - Week 2

Each Friday, I will post a question answered by Dr. Kathryn J. Zerbe. The questions are part of an on-going coversation with Dr. Zerbe from the New York Times.

NY Times Bio
Dr. Zerbe is the author of “The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment” (Gurze Books, 1993) and “Integrated Treatment of Eating Disorders: Beyond the Body Betrayed” (Norton, 2008). She has had 25 years of experience working with individuals with eating disorders and directed the Eating Disorder Unit at the Menninger Clinic for five years. She also served on the American Psychiatric Association’s Work Group on Eating Disorders in 2000 and 2006.


Week Two
I recently began running (in March) and since then have had no menstrual cycle. After seeing my gynecologist, she suggested that my amenorrhea, vegetarian diet, and increased fitness program meant that I could be struggling with an eating disorder. However, I eat very healthily and my weight is well within the suggested weight for my height (I am age 18, 140 and 5′11).

It’s true that I do not like to eat fattening foods, preferring to eat healthy, nutritional alternatives (toast with cottage cheese instead of cookies as a snack, for example) but does this mean that I am anorexic? I feel that my gyn. is not seeing the bigger picture here.

From Dr. Zerbe:
It sounds to me as if your gynecologist could be onto something, although I cannot be sure because I have not met with you in person, of course. Here is how I think about a situation such as yours.

Loss of one’s menstrual cycle and eating such a low-fat diet might be signs of an eating disorder. Be aware that we all need essential fat and soluble vitamins for healthy functioning of our brains, our metabolism and our entire bodies. Because many patients with an eating disorder begin with the desire to be trim and fit, it is often hard to know, without consulting a specialist in the field, when running and a particular diet begin to shade into a full or even subclinical form of anorexia or bulimia.

The exact weight of a person is less important than the emphasis one places on looking or feeling a particular way and the amount of time and attention placed on exercise. This is why we in the field say that the first step in recovery is being very honest with oneself about how much time and attention the focus on weight, diet and exercise is taking. We also ask, “Are you really satisfied in your life with respect to your work, your relationships and your overall self image? If you gained 10 pounds, would you feel your world was falling apart?” This helps one know if one is thinking too much about the body and hinging self worth on it.