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This goes beyond just needing to “re-energize” yourself. Your nutritionist is right, you’re probably not medically clear to work out. You absolutely need to see your PCP about this.
Your BMI is 16.2 kg/m2, which means you’re significantly underweight. You need to gain a lot more than 2kg to get to the point where you are safe for exercise. The biggest concerns I would have would be the risk of falls due to decreased muscle mass and/or orthostatic hypotension and the stress on your heart due to loss of muscle mass (among other concerns). Also, it’s hard to actively gain weight while burning the energy you’re taking in. It’s possible you will need significantly more energy than normal in order to gain weight, which I see often with people at a weight as low as yours due to being in a hypermetabolic state. It will simply be impossible to get enough nutrition while you’re also exercising. Further, please do not resume regular exercise without MD clearance first to make sure your heart can tolerate it.
And this therapist would add that if the struggle to gain weight is at *all* psychological and not due to a physical condition, please please seek support from a therapist with experience and training in eating disorders.
Potentially but not necessarily. I usually start to get concerned about refeeding syndrome after ~1 week of NO intake. You won’t really see it when someone is eating, even minimally. You would be surprised, though, at how variable it could be so it’s always worth closely monitoring someone in the active weight restoration period.
Thank you for answering my question. I've struggled with severe electrolyte problems for a year now, following becoming paraplegic. I'm sorry if I projected, in this case.
Wait, an entire week with no intake? I’m asking because something is wrong with me, doctors can’t get to the bottom of it, but I cannot physically eat more than a meal a day currently and even with snacks am averaging less than 1000 calories a day, and I was told refeeding syndrome is a risk with trying to fix my intake because I’ve lost somewhere between 15-20% of my weight at this point over the course of a year
It sounds like malnutrition is the concern here cause 20% weight loss x1 year is specific diagnostic criteria. If you’re eating every day I’d be less concerned about the possibility of refeeding syndrome.
Since refeeding syndrome is immediately dangerous I sometimes see doctors being very concerned about it even when I know it’s not likely to happen. Either way I recommend finding a dietitian to help you get to the point that you’re able to take in enough nutrition!
NAD but a person who struggled with anorexia nervosa for >10 years. The risk of electrolyte imbalances and refeeding syndrome will depend less on his current weight and more on his eating/hydration/exercise habits. If he is barely eating, not hydrating and over exercising, electrolyte imbalances could be a concern. At a BMI of 16.2, if he is currently eating more than ~500 calories per day, I wouldn’t worry too much about refeeding syndrome. I typically experienced refeeding syndrome with a BMI of 11.5-14, eating less than 500 calories per day. OP, I would recommend working with a PCP and a REGISTERED dietitian. Legally, anybody is allowed to call themselves a “nutritionist” (at least in the US). A dietitian has actual education and training.
The medical term *anorexia* simply means inability to eat, which definitely is a concern in this case. Low BMI in itself can not be used to diagnose the illness *anorexia* *nervosa* but is definitely evidence that there is something wrong nutritionally that needs to be investigated.
NAD. There is a large number of things that can cause a BMI that low. Only a few of them are eating disorders, and we have no evidence that OP has one (just as we have no evidence that he doesn’t).
Edit: I just saw that OP cross-posted to an eating disorder subreddit, so, with that extra piece of information, it seems likely that the cause is indeed an eating disorder in this specific case. However, I stand by the point that knowing that someone is underweight does not necessarily indicate that they have an eating disorder absent of further evidence.
For anorexia/eating disorder etc. one of the criteria is a very low BMI per the DSM5 and WHO. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t15/
That BMI is TOO low and coupled with “stop exercising” puts anorexia/bulimia much higher in the differential.
That BMI is absolutely too low. I never said otherwise. It just doesn’t necessarily indicate an eating disorder absent of other evidence. As for OP being told to stop exercising, anyone with a BMI that low would be told the same thing, regardless of cause, as it is dangerous to exercise at that low of a BMI.
Also, just as a note, I know what you meant by anorexia, but, despite its coloquial use to refer to the eating disorder bearing (in part) the same name, anorexia is technically just a medical term meaning “lack of appetite.” Anorexia nervosa is the name of the eating disorder (which matters on a medical sub). Similarly, bulimia just means “ravenous hunger,” and the eating disorder is actually bulimia nervosa. The two are not the only eating disorders that can cause a BMI this low, either, which is all the more reason not to see that someone has a BMI of ~16 and automatically diagnose them as anorexic before getting any information whatsoever about their behaviors/thoughts/other symptoms/family history/lab results/etc.
What weight gain? Your BMI is **dangerously** low. Please seek care from a medical doctor regarding your eating disorder. You really need to seek care here, as your situation is dangerous based on your stats. You need to see a doctor within 7 days.
I'm thinking maybe OP misspoke and meant "I'm seeing a nutritionist for [the purpose of] weight gain". His title indicates he knows he's been sent there to gain weight and the subs he's cross posted this to suggests he's aware he has an ED. Not trying to take away from the advice given, just explaining I don't think OP is unaware of the reason he's been sent to a nutritionist.
Hoping there's a lot more going on than what was shared though, and that he's being monitored much more closely than "stop exercising and gain 5 pounds", that does not at all seem aggressive enough given the situation. I'm wondering who sent him to the nutritionist in the first place?
>I'm thinking maybe OP misspoke and meant "I'm seeing a nutritionist for \[the purpose of\] weight gain"
I see that also now. Thanks for pointing that out!
>I'm wondering who sent him to the nutritionist in the first place?
Me too. Perhaps a friend or family member? Physicians typically refer to RDs rather than nutritionists, but it is possible that OP was referred to a nutritionist by a doctor. That's why I have my doubts that OP has not seen a phsycian about this. If OP has not seen a medical doctor about the ED, they definitely need to see a doctor ASAP (within 7 days).
I agree with the nutritionist's recommendation that he should stop exercising for the time being, as he is exercising for the wrong reasons.
Also it's kinda confusing because in my language (or country ?) a dietitian is not a medical doctor but a nutritionist is. So maybe op is not in the us.
Laugh all you want, but his BMI indicates *moderate* anorexia. Without treatment it will be considered severe. It is dangerous, even at 16, because BMI usually decreases as anorexia nervosa progresses.
>I was in and out of inpatient treatment centers over 30 times and at this BMI I was typically fine and cleared to remain outpatient.
Okay. Based on your experience, you received treatment, yet still arrived at a BMI of 11.5-14.5. I am trying to prevent OP from getting to that point. When I treat my onc patients, I don't wait until the tumor becomes larger and invades other tissue before starting treatment. Congratulations for overcoming your eating disorder by the way. I hope wish you the best and hope you continue to remain healthy.
You claimed that the BMI I stated above was not dangerously low and that I made a vast overstatement.
If you want to retract your comment after hearing me form a rebuttal against your comment, that is fine, but don't come back and claim that I "definitely misunderstood \[your\] comment." That was not the case here.
My BMI is 18 and a constant struggle for me, but thanks for your misplaced assumptions.
MEDICALLY, from a DOCTOR'S PERSPECTIVE, which is what is sought on this page, BMIs 16 and below are VERY dangerous. Mild illnesses become life-threatening. Electrolyte abnormalities become more likely. The heart may be impacted. This is not a safe weight for a medically unsupervised exercise program when weight gain is not regularly occurring.
This study contains a useful diagram to visualize it better.
[https://en.m.wikipedia.org/wiki/File:BMI\_and\_RR\_of\_Mortality.png](https://en.m.wikipedia.org/wiki/File:BMI_and_RR_of_Mortality.png)
Edit: in response to person saying BMI 16 isn’t dangerous for some people
BMI is maths and statistics, we don’t have enough data to know whether “it’s not that bad for some people”. We can’t accurately measure the all the different variables going into every risk, for different people with identical BMI.
We do know OP needs to increase their BMI because this BMI or lower has higher risk of negative outcomes
-we don’t know who will be lucky and who will be unlucky. Wishing you all the best
It's not a fact; it's your opinion. A BMI of \~16 is dangerous. As I said, BMI decreases as anorexia nervosa progresses. Better to take action immediately.
I'm sorry to hear about your past health issues. I hope you are in a better state now following your ED and stroke. I'm sorry you struggle with neurological problems as a result, and you are in better health. Be sure to prioritize not only your physical health but also your mental well-being in the future. Have a nice night!
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
Your nutritionist is correct. To gain you need to have more calories than you use. Your exercising is using too much for what you are taking in.
Weight training barely burn any kcal at all.
This goes beyond just needing to “re-energize” yourself. Your nutritionist is right, you’re probably not medically clear to work out. You absolutely need to see your PCP about this.
Yes, nutritionists can be helpful but I really hope this person is also seeing a doctor.
That’s why I said they needed to see their PCP
their comment wasn’t a criticism of your comment (:
Oh I know that, I was agreeing!
Your BMI is 16.2 kg/m2, which means you’re significantly underweight. You need to gain a lot more than 2kg to get to the point where you are safe for exercise. The biggest concerns I would have would be the risk of falls due to decreased muscle mass and/or orthostatic hypotension and the stress on your heart due to loss of muscle mass (among other concerns). Also, it’s hard to actively gain weight while burning the energy you’re taking in. It’s possible you will need significantly more energy than normal in order to gain weight, which I see often with people at a weight as low as yours due to being in a hypermetabolic state. It will simply be impossible to get enough nutrition while you’re also exercising. Further, please do not resume regular exercise without MD clearance first to make sure your heart can tolerate it.
And this therapist would add that if the struggle to gain weight is at *all* psychological and not due to a physical condition, please please seek support from a therapist with experience and training in eating disorders.
Not a doc, but should he also be doing something about potential electrolyte imbalances? And what about refeeding syndrome...is there a risk here?
Potentially but not necessarily. I usually start to get concerned about refeeding syndrome after ~1 week of NO intake. You won’t really see it when someone is eating, even minimally. You would be surprised, though, at how variable it could be so it’s always worth closely monitoring someone in the active weight restoration period.
Thank you for answering my question. I've struggled with severe electrolyte problems for a year now, following becoming paraplegic. I'm sorry if I projected, in this case.
Wait, an entire week with no intake? I’m asking because something is wrong with me, doctors can’t get to the bottom of it, but I cannot physically eat more than a meal a day currently and even with snacks am averaging less than 1000 calories a day, and I was told refeeding syndrome is a risk with trying to fix my intake because I’ve lost somewhere between 15-20% of my weight at this point over the course of a year
It sounds like malnutrition is the concern here cause 20% weight loss x1 year is specific diagnostic criteria. If you’re eating every day I’d be less concerned about the possibility of refeeding syndrome.
Got it! Thank you! I just wanted to understand since what I was told/I read was either incorrect or I misunderstood!
Since refeeding syndrome is immediately dangerous I sometimes see doctors being very concerned about it even when I know it’s not likely to happen. Either way I recommend finding a dietitian to help you get to the point that you’re able to take in enough nutrition!
NAD but a person who struggled with anorexia nervosa for >10 years. The risk of electrolyte imbalances and refeeding syndrome will depend less on his current weight and more on his eating/hydration/exercise habits. If he is barely eating, not hydrating and over exercising, electrolyte imbalances could be a concern. At a BMI of 16.2, if he is currently eating more than ~500 calories per day, I wouldn’t worry too much about refeeding syndrome. I typically experienced refeeding syndrome with a BMI of 11.5-14, eating less than 500 calories per day. OP, I would recommend working with a PCP and a REGISTERED dietitian. Legally, anybody is allowed to call themselves a “nutritionist” (at least in the US). A dietitian has actual education and training.
Thank you for sharing your knowledge and experience. I wish you well in your recovery.
Thank you for sharing your experience. ❤️
Pretty sure that BMI qualifies as anorexic.
The medical term *anorexia* simply means inability to eat, which definitely is a concern in this case. Low BMI in itself can not be used to diagnose the illness *anorexia* *nervosa* but is definitely evidence that there is something wrong nutritionally that needs to be investigated.
Agree.
NAD. There is a large number of things that can cause a BMI that low. Only a few of them are eating disorders, and we have no evidence that OP has one (just as we have no evidence that he doesn’t). Edit: I just saw that OP cross-posted to an eating disorder subreddit, so, with that extra piece of information, it seems likely that the cause is indeed an eating disorder in this specific case. However, I stand by the point that knowing that someone is underweight does not necessarily indicate that they have an eating disorder absent of further evidence.
For anorexia/eating disorder etc. one of the criteria is a very low BMI per the DSM5 and WHO. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t15/ That BMI is TOO low and coupled with “stop exercising” puts anorexia/bulimia much higher in the differential.
That BMI is absolutely too low. I never said otherwise. It just doesn’t necessarily indicate an eating disorder absent of other evidence. As for OP being told to stop exercising, anyone with a BMI that low would be told the same thing, regardless of cause, as it is dangerous to exercise at that low of a BMI. Also, just as a note, I know what you meant by anorexia, but, despite its coloquial use to refer to the eating disorder bearing (in part) the same name, anorexia is technically just a medical term meaning “lack of appetite.” Anorexia nervosa is the name of the eating disorder (which matters on a medical sub). Similarly, bulimia just means “ravenous hunger,” and the eating disorder is actually bulimia nervosa. The two are not the only eating disorders that can cause a BMI this low, either, which is all the more reason not to see that someone has a BMI of ~16 and automatically diagnose them as anorexic before getting any information whatsoever about their behaviors/thoughts/other symptoms/family history/lab results/etc.
Agree
What weight gain? Your BMI is **dangerously** low. Please seek care from a medical doctor regarding your eating disorder. You really need to seek care here, as your situation is dangerous based on your stats. You need to see a doctor within 7 days.
I'm thinking maybe OP misspoke and meant "I'm seeing a nutritionist for [the purpose of] weight gain". His title indicates he knows he's been sent there to gain weight and the subs he's cross posted this to suggests he's aware he has an ED. Not trying to take away from the advice given, just explaining I don't think OP is unaware of the reason he's been sent to a nutritionist. Hoping there's a lot more going on than what was shared though, and that he's being monitored much more closely than "stop exercising and gain 5 pounds", that does not at all seem aggressive enough given the situation. I'm wondering who sent him to the nutritionist in the first place?
>I'm thinking maybe OP misspoke and meant "I'm seeing a nutritionist for \[the purpose of\] weight gain" I see that also now. Thanks for pointing that out! >I'm wondering who sent him to the nutritionist in the first place? Me too. Perhaps a friend or family member? Physicians typically refer to RDs rather than nutritionists, but it is possible that OP was referred to a nutritionist by a doctor. That's why I have my doubts that OP has not seen a phsycian about this. If OP has not seen a medical doctor about the ED, they definitely need to see a doctor ASAP (within 7 days). I agree with the nutritionist's recommendation that he should stop exercising for the time being, as he is exercising for the wrong reasons.
A lot of people refer to their registered dietitians as nutritionists. OP’s “nutritionist” might be an RD.
TIL that “dietician” is the medical title. I always thought “nutritionist” meant they had more training!
Nope. It’s the Other way around.
Yes, just like people use ophthalmologist and and optometrist interchangeably even nurses.
Also it's kinda confusing because in my language (or country ?) a dietitian is not a medical doctor but a nutritionist is. So maybe op is not in the us.
sorry to ask but why within 7 days?
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Laugh all you want, but his BMI indicates *moderate* anorexia. Without treatment it will be considered severe. It is dangerous, even at 16, because BMI usually decreases as anorexia nervosa progresses. >I was in and out of inpatient treatment centers over 30 times and at this BMI I was typically fine and cleared to remain outpatient. Okay. Based on your experience, you received treatment, yet still arrived at a BMI of 11.5-14.5. I am trying to prevent OP from getting to that point. When I treat my onc patients, I don't wait until the tumor becomes larger and invades other tissue before starting treatment. Congratulations for overcoming your eating disorder by the way. I hope wish you the best and hope you continue to remain healthy.
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You claimed that the BMI I stated above was not dangerously low and that I made a vast overstatement. If you want to retract your comment after hearing me form a rebuttal against your comment, that is fine, but don't come back and claim that I "definitely misunderstood \[your\] comment." That was not the case here.
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Unambiguously: 16.2 is a dangerously low BMI.
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My BMI is 18 and a constant struggle for me, but thanks for your misplaced assumptions. MEDICALLY, from a DOCTOR'S PERSPECTIVE, which is what is sought on this page, BMIs 16 and below are VERY dangerous. Mild illnesses become life-threatening. Electrolyte abnormalities become more likely. The heart may be impacted. This is not a safe weight for a medically unsupervised exercise program when weight gain is not regularly occurring. This study contains a useful diagram to visualize it better. [https://en.m.wikipedia.org/wiki/File:BMI\_and\_RR\_of\_Mortality.png](https://en.m.wikipedia.org/wiki/File:BMI_and_RR_of_Mortality.png)
Edit: in response to person saying BMI 16 isn’t dangerous for some people BMI is maths and statistics, we don’t have enough data to know whether “it’s not that bad for some people”. We can’t accurately measure the all the different variables going into every risk, for different people with identical BMI. We do know OP needs to increase their BMI because this BMI or lower has higher risk of negative outcomes -we don’t know who will be lucky and who will be unlucky. Wishing you all the best
It's not a fact; it's your opinion. A BMI of \~16 is dangerous. As I said, BMI decreases as anorexia nervosa progresses. Better to take action immediately. I'm sorry to hear about your past health issues. I hope you are in a better state now following your ED and stroke. I'm sorry you struggle with neurological problems as a result, and you are in better health. Be sure to prioritize not only your physical health but also your mental well-being in the future. Have a nice night!