Transcription
Hello Mariam,
Hello, how are you?
Good, good. My name is Sad Shakley. I’m a nutrition student in the Introduction to Nutritional Counseling class at the University of Houston, practicing being a nutritional counselor.
Do you give me permission to videotape this assignment?
Yes, I give you permission.
Do you give me permission to show this videotape to the class? Three of my classmates and possibly one dietetic intern and my instructor might also see this for a grade. Is that permissible?
Yes, I give you permission.
Okay, thank you so much.
Thank you so much for agreeing today. Just to give you some background information, I’m really passionate about helping people live a healthier and happier lifestyle and achieving their goals. So there’s no judgment or anything; feel free to open up if you need to.
Okay, thank you.
We talked briefly on the phone, and you said you’re interested in improving your poor eating habits and your inconsistent sleep schedule. What are you looking to achieve after this session?
So, after this session, in terms of my inconsistent sleep schedule, what I’d like to achieve is, I guess, gradually building towards healthier sleep habits. Sleeping at normal times and not staying up too late and sleeping a decent amount because I usually tend to get less than six hours of sleep. So that’s something I’d like to work on.
In terms of my unhealthy eating habits, something I’d like to work on, or a few things I would like to work on, actually, would be just knowing when to eat, knowing how much to eat, and I guess specifically knowing what to eat. So like I guess just maintaining, or trying to maintain, healthier eating habits at healthier times throughout the day.
Okay, and have you seen a dietitian before?
Um, no, I have never seen a dietitian.
Okay, awesome. You said you’ve been struggling with maintaining your weight, correct?
Yes.
Tell me more about that.
So, I’ve been struggling with maintaining my weight because sometimes it just fluctuates up and down. Normally, I guess a lot of people don’t really have problems with that, but why it’s so personal to me is because growing up, I was always a skinny kid. I was always super lean; I was very active, and I had a fast metabolism growing up, so I was really skinny. I had really skinny arms, skinny legs, a very slim face, and whenever I hit puberty and gained all of my weight, I guess I just found myself not how I normally used to be.
I know that came with age—I guess, like, of course, you’re going to gain weight the bigger you get, the taller you get—but once it started changing for me was whenever COVID hit. I would just binge eat like crazy at night, and sometimes I would eat throughout the day; sometimes, I wouldn’t. I would just eat very unhealthy amounts of food and very unhealthy food in itself. I just gained a lot of weight outside of my healthy range.
So, after COVID ended, I went back down to my normal healthy weight range that I was content with—not just with my health, but how I physically looked and how I felt, content within my own body. But once my freshman year of college started—excuse me—once my freshman year of college started, I guess I had a lot of anxiety with starting college and everything with my classes. I’m sure that’s how it stemmed, but what I noticed is that in the span of about two months, I drastically dropped weight.
So, I went from about 135 to 115, and I’m a tall girl, so of course, that’s going to really show, especially because I was already at a healthy weight range. I considered myself skinny; a lot of people considered me skinny before losing those 20 lbs. Once I did lose that weight, I was diagnosed with anorexia. What I saw from that was my hair was falling out, my mood was very, very low. I felt very weak; I just didn’t feel, I guess—
Yourself?
Yeah, I just didn’t feel myself, basically.
What I also noticed was my pelvic bones were bulging out, my cheeks were sinking into my face, my cheekbones were very prominent, and my rib cage was out. That was just something I noticed about myself, or it was very obvious.
But it was just something that, once I lost all of that weight in the span of two months, very drastically, very quickly, from not eating a lot or not eating at all, because I didn’t have an appetite, then I would participate in a lot of physical activity, especially with the start of college, walking everywhere to and from classes and stuff.
So, that was just all the weight I lost. It took me about maybe six months to go back into my normal healthy weight range because I can’t just gain 20 lbs back in the same time I lost it in—like, two months was crazy to gain 20 lbs.
So, it took me about six months to get back to my normal healthy weight range. Since then, I would just maybe fluctuate—maybe lose five pounds or gain five pounds—and that’s just the range I always stayed at. Sometimes I do notice myself going above that range, and once I do, I try to cut back as quickly as possible. If I go below that range, I try to, I guess, put a little more food into my schedule and stay in that healthy weight range.
So, what my main focus is trying to do is just stay in that healthy weight range, and that’s something I’m lacking.
Okay, thank you for sharing that. So how did you overcome that?
So, how I overcame that was that 20 lb loss, which led to the overall diagnosis of my anorexia. Since school was starting and everything, I just didn’t have enough time to eat. I would just be going from class to class, being too stressed to even think about food or have an appetite.
Once school ended and I didn’t have those factors, I guess blurring my appetite, I entered into the break with more of an appetite and more of a will to eat and just more confidence in how I viewed food. Through the break, I just started eating—or gradually eating more and more and more—and that’s when I noticed myself gaining weight back to a healthier weight range, I guess, because I went from very, very, very skinny to just skinny to, later on, six months later, maybe about how I normally would like to see myself and feel about myself as well.
Okay, and is there a family history of weight issues, or anorexia, or insomnia in your family?
So, as for insomnia, only my uncle suffers from insomnia. He tends to stay up all the way until the morning, and that’s out of his choice. Usually, that’s what he tells me, and that’s something I also suffer from. I’m not sure if it’s actually insomnia, but it’s just very, very poor sleeping habits that reflect what insomnia or what I see insomnia to be.
I just noticed my uncle having those same exact habits that I have. In terms of weight issues in my family, on my dad’s side, all of my aunts, so all of his sisters, they suffer from, or I wouldn’t say they suffer, but they’re all considered overweight—they're all clinically, I guess, considered obese—all of the women in his family.
Then on my mom’s side, I wouldn’t say they’re all in the normal weight range; especially for their height, they are leaning towards the heavier side. One of my aunts on my mom’s side, I believe she is considered anorexic. In terms of my mom and dad, they are more towards the heavier side, but that doesn’t show with me and my sister, so we are both at a normal weight range.
So, I don’t think, yeah—that’s just all the family history that we have in terms of weight.
Okay, and you touched a little bit on this; I just want you to tell me a little bit more about your weight history, growing up through the present. I know you mentioned you were diagnosed with anorexia your freshman year of college, and you’re currently at a healthy weight range. So how was growing up like? How was your relationship with food or your weight?
My relationship with food has, or up until recently, I guess, was always good growing up. I had a fast metabolism, so I loved to eat, especially because I knew I would never gain weight growing up. Because anytime I noticed myself eating more than I should, I never noticed myself gaining weight. I obviously owe that to my fast metabolism, but once it started to slow down, I grew up a little bit. I saw that I would actually be affected by the foods that I would eat more than I was when I was little.
So, I just had that relationship with food. I guess I took a step back and would monitor my—I wouldn’t say weight because I knew I was still at a normal healthy weight range. I would monitor what I was eating because I knew some of the foods I was eating weren’t the best choices. Maybe they weren’t the healthiest. Maybe they just weren’t foods that I wouldn’t eat if I was on a diet because I did participate in three diets.
Okay, tell me more about that.
Yeah, so these three diets were, I believe they were all during COVID when I did have that weight scare where I was gaining a lot of weight outside of my current healthy weight range. So there were three diets that I did. One was cutting off sugar completely. The next was a caloric deficit, and then the third was water fasting. I didn’t notice changes in any of these three diets only because I wasn’t consistent, but in terms of the water fast—actually, the goal for all of these three diets was just so I could lose weight.
The water fast, I only did it for about three days, where I didn’t eat food at all; I was strictly just water. Ironically enough, I noticed that I actually gained weight. I guess maybe sodium was being stored in my cheeks, and then it made me look more bloated or more swollen, I guess.
In the caloric deficit, I tried to eat less than 1,000 calories a day or less than 1,500, I believe. It was very possible for me to do that; it’s just that I was never consistent with it, so I never saw results. As for cutting off sugar, that only lasted for about a few days because I just couldn’t do it. Everything that I was around, especially at home, had added sugars in it. I understand natural sugars like fruit and everything is okay, or it was for me in that specific diet, but in terms of added sugars, I just cut that off and just went back to my normal eating routine.
Okay, and did this ever come back, the anorexia and those habits?
No, so it didn’t specifically come back, but for the past maybe year, it’s been about two years since my freshman year; two years since that happened with the diagnosis. But in a little over a year and a half after, I fully overcame it. It didn’t come back as of late, but those tendencies where I would feel the need to gain more weight like I did before would come back. So if I lost a little more weight than I’m normally used to now, then I would immediately notice it, and I’d try to instantly get myself back to eating or get back on track into trying to go back into that normal weight range.
I guess I wouldn’t call it a trauma response, but I would just quickly snap back into it and not let myself want to be back into how I normally was. It was a pretty dark time for me just because that’s not how I was normally—how I looked like; that’s not how I felt. I didn’t feel like myself.
Whenever I noticed myself gaining weight, yeah, whenever I noticed myself gaining weight, then I’d instantly cut back. I’d probably starve myself, or I’d eat one meal a day, and sometimes that happens on accident. Sometimes it happens on purpose, where I’m purposely not letting myself eat, or I just don’t feel the need to eat anymore just because I know if I eat more, I’m going to feel guilty.
I always have that sense of guilt that if I’m above that weight range and I eat more than I know I probably should, I know that’s just a personal factor. But then I’ll just snap back into it and say, “Okay, we need to fall below this line.” That line typically ranges from, so 135 or 130 is my base. When I gain weight, it’s usually 135; if I go above that, then I know I gained more weight. If I go underneath 125, then I know I’m losing more weight than I should be losing, and it’s going to be maybe—I guess I have a fear of going back into that anorexic habits and being diagnosed again as anorexic.
I see.
Okay, so you’re seeing that when you gain a few pounds or whether you gain or lose a few pounds, you start to—
You’re taken back by just like—is this? You mentioned it was 1 to 5 pounds above or below your normal weight, your average weight.
Okay, so you are at the age—you’re 20 years old, correct?
Yes, I’m 20 years old.
Okay, so you are at the age where your weight is going to fluctuate a lot. It’s going to go up; it’s going to go down, and it’s very normal, especially for your age.
So just—it’s important to try and keep that in mind. I know it’s hard, of course, dealing with a past with anorexia, but just to reassure you, it’s very, very normal. You are at that age, and it happens. Whether you gain a few pounds or lose a few pounds doesn’t necessarily mean that you’re falling back into that or you’re becoming overweight; it’s just actually healthy, if anything, of course to a certain degree.
So try NOT to focus too much outside of that weight range.
Yes, okay, sounds good.
And do you exercise?
Very—um, so yeah, I actually do, or I actually—I used to exercise regularly in terms of, you know, going out of my way to exercise. Now it’s more so I just find myself within physical activities such as walking from class to class. But at the beginning of the year, when I still had my membership activated at the gym, I would go maybe three to four times a week, and those gym visits would lean towards—I guess the goal would be lean towards muscle mass.
I would just try to focus more on gaining muscle versus trying to lose fat because I just wanted to have that lean body, I guess. Arguably more importantly, have that healthy body that I just felt healthy in. Because once I started working out, I noticed that my eating habits would be better.
So that’s why I would exercise more regularly, maybe three to four times a week. Then I guess that slowly declined— that schedule habit I guess slowly declined after summer started when I traveled, so I didn’t go to the gym at all. Then once school started back up again, I didn’t go to the gym at all because my membership got put on hold. The only physical activity I would participate in would just be walking long distances from class to class almost every day that I’m on campus.
So yeah, when I was exercising at the gym, I would go home; that would make me I guess hungrier.
So, it didn’t feel like it was me trying to eat more because it wouldn’t feel like I was gaining weight in a bad way—like gaining fat—because sometimes I do have that guilt where if I’m hungry and I do eat more, I’m going to feel guiltier for eating. Just because I guess I associate food with gaining weight.
But when I was back in the gym, I just noticed—or I would guess I would associate eating more with gaining more muscle mass, which was my ultimate goal at the gym.
So from what you shared, it sounds like you’re in a healthy weight range now, but there’s still some anxiety about the possibility of gaining weight. I can see how that might be challenging, especially given your past with anorexia and your experiences of always being naturally skinny growing up. It makes sense that you’d be especially mindful of your weight.
I know you’ve been through a lot with managing your health and weight. So what are your biggest priorities at the moment? Are there any specific things you’d like to focus on in relation to feeling more confident with your health?
So maybe some things I would like to—are you talking about in terms of maybe our next visit or just in general?
Just in general right now.
Okay, so in general, some things I’d like to focus on would probably be—I think my main priority would be just eating. I wouldn’t necessarily worry about sleep too much now because I know that is a very gradual process, right? I know it’s going to take time since it is a habit that I need to build up.
But in terms of eating, that’s something I would really like to work on and more so prioritize just because eating is very easy. Your eating habits are very easy to change, or not your habits, but it’s very easy to get to that point.
So I guess implementing healthier options for my food—maybe low-calorie stuff. For example, maybe my coffee, if I choose a low-fat creamer or a healthier creamer or maybe an organic creamer—anything healthier, honestly. So that would be something I’d like to work on. Maybe implementing more greens.
And this isn’t just in terms of losing weight or gaining weight; it’s just in terms of, like I said, specifically with what I eat. I just want to be healthier. So I guess choosing more organic or choosing lower-calorie food options is just something that I would like to work on.
Okay, um, so let’s go over what you ate yesterday just to get a snapshot of where you’re at with your eating patterns. This will just help us identify areas that are working well and any spots where you might feel uncertain. So what did you eat yesterday at breakfast?
So yesterday, my eating habits usually fluctuate just like my weight. Sometimes I wouldn’t eat as much as I normally would. Some days I would eat a lot; some days I wouldn’t eat at all. So specifically yesterday, I ate—I did eat breakfast only because I had to work, and usually on days that I have work, I hold myself accountable and try to eat breakfast because I know I’m going to get really hungry throughout the day. I know I’m going to need that energy to work through my shift.
For breakfast, I had overnight oats. For lunch, I believe maybe six hours later, so at 3 p.m.—because I work early in the morning—I had Slim Chickens, which were just a few chicken strips, fries, and a drink. I didn’t really snack throughout the day just because I had a lack of snacks. If I did have snacks, I definitely would have probably gone through all the snacks just to keep myself busy or to keep myself, like, snacking throughout the day.
At night, I went home and ate dinner, but I ate dinner very late just because I got home late. Usually, I don’t like to eat the second I get home, so I had a very late dinner. Then I stayed up—like I said, with the sleeping problems—I stayed up very much later after that and still ate during that time.
But usually on days that I’m not working, it’s completely different.
Okay, you mentioned that it differs from day to day. So take me through a day in the life of Mariam from when you wake up to before bed.
Okay, so like you mentioned, it does differ from day to day. Usually, my two options—well, not my two options, but the two differences in how my days would go would be if I had school or if I didn’t have school.
To start off with, when I do have school, I usually wake up in a hurry because I tend to leave my house for campus very early in the day. Sometimes I wake up late because, like I said, I don’t really sleep often, and I noticed myself having to rush a lot in the morning. If I’m lucky, I’ll make myself a coffee to go on the way. I’ll drink it on the way to campus, and if I'm in a complete rush and I don’t get that coffee, then I’ll try to find the time to stop at a coffee shop before class, maybe at the campus coffee shop, and just try to buy a pastry if I’m really hungry.
And if I do, then nine times out of ten, I will not finish that pastry because it just won’t be, I guess, a part of my appetite. Throughout the day, I would not snack just because I wouldn’t have snacks and I wouldn’t even feel the need to eat because I'm not hungry. But most times when I’m on campus, when I do have school, I eat maybe at around 8:00 p.m., which tends to be very, very late.
Once I get home very late, then I’ll go a few hours, and I’ll probably eat throughout the night—maybe, because I’m so deprived of that food throughout the day. I’m just trying to, I guess, catch up because I know I didn't eat enough in the morning and throughout the day at all. At 8:00 p.m. when I left campus, I may have had fries or a small snack—just something to keep me going, I guess.
So at night, I would start to binge, and that would just be due to the fact that I didn’t eat all day and maybe have a tiny meal throughout the day.
On days that I don’t have school and I’m at home all day, I’ll wake up, stay in bed, and whenever I have that sense of hunger or that sensation where I need to eat, I’ll go make myself breakfast. That usually consists of mostly coffee or orange juice alongside—I’ll make myself eggs and spinach and tomatoes with a hash brown, or I’ll make myself avocado toast. Those are usually my two most made options that I tend to lean towards.
Throughout the day, I won’t eat at all, and maybe I’ll snack a little bit if I find something in the pantry or if I’m craving something. It usually doesn’t come out of a place of hunger because if it came out of a place of hunger, I would just resort to a meal instantly. But the snacking throughout the day would just be out of—a sense of boredom, but just to keep me going throughout the day.
That would be very rare, though. I wouldn’t really eat throughout the day. I’d just maybe have that small breakfast before noon. At night, maybe after 12:00 a.m., that’s when I would actually eat a real full meal. Anytime there was food at home, someone would make food at home, I wouldn’t eat it right away; I’d just wait until very late and then start eating.
Okay, thank you for sharing that. It sounds like having breakfast sometimes and not feeling hungry until much later in the day—one approach we could try is exploring some lighter balanced meals or snacks that you could have during the day to keep your energy up without feeling too full.
For example, maybe we could work together to find a few small snack options that feel manageable and don’t feel overwhelming.
Yes, that does sound good, just because I know that if I skip breakfast, then I probably wouldn’t eat throughout the whole day. Even though I might be hungry, I still wouldn’t eat; I’d wait until night. But those healthy snack options—healthily snacking throughout the day—I think that would be a smarter option in terms of my health and my weight fluctuations just because I know sometimes it does—
There is a difference in how I eat day to day, but if I stick to that consistency, yeah, what you’re saying is right. If I feel like I do stick—I do need to stick to that consistency you’re saying, then I probably wouldn’t have the same problems that I am currently going through now.
So I guess just snacking throughout the day, maybe having a snack that I like, or something that I enjoy eating or enjoy making—whether it’s a small snack or a big snack—or maybe even resorting to a meal—
That’s great!
That’s very good to hear.
Amazing!
So since you’ve been at a healthy weight, the most important thing is also helping you feel comfortable and balanced with your eating habits and body image.
We’ll focus on what’s medically necessary first and then build from there. Does that sound like a good plan?
Yes, that sounds okay.
So I know your journey can be challenging, so let’s go at your pace. How open do you feel? I know you mentioned you’re willing to start making a change and exploring small adjustments in your meals or routines as we work towards finding balance.
What’s the small-term goal that you feel comfortable setting for yourself until our next session?
And are you talking also about in terms of sleeping?
Yeah, just any goal that you have.
Okay, from everything you mentioned, I guess one of my primary goals that I would like to prioritize—in terms of like maybe waiting for our next session, or I guess like in between our sessions—would probably be holding myself accountable.
So, accountability is something that—I'll try to work on because I do need to hold myself accountable. I guess not force myself to eat, but remind myself to eat because I know if I remind myself to eat throughout the day and I tell myself, “Okay, if you eat, then your weight will not fluctuate, or you will be healthy, or you will feel better after you eat,” because it doesn’t necessarily come out of a place of “Oh, I feel guilty for eating too much.”
It just comes from a place, I guess, of what I ate specifically and when I ate it. So, I guess if I space out my meals throughout the day, and I have certain meals, and I do space them out like I said, then I’ll feel less guilty, and I’ll just try to implement more healthy eating habits—not necessarily because the goal for me right now isn’t really implementing healthier food options because that is a drastic change in my opinion.
I think that is something that has to happen gradually. But I guess just reminding myself to eat more, and spacing it throughout the day, and not just fully resorting to binging at night, and completely skipping breakfast.
So I guess snacking, and if I’m not snacking, then I’ll resort to spacing my meals out. I’ll have breakfast in the morning; lunch throughout the day, and dinner at night. I’ll try not to eat after a certain time, maybe three hours before I sleep, and trying to sleep earlier in that matter. So those would be things that I would like to change before our next session—just maintaining healthier eating habits, spacing the meals out, and sleeping earlier so that I don’t find myself binging at those times where I’m staying up too late.
Okay, perfect, sounds good.
So it is huge—you’re at a very good phase where you’re willing to make a change, and you recognize that you want to improve. You’re setting your own goals to work towards that, so that is very, very good to hear. A huge step already.
Thank you.
So thank you so much for being so open today. Do you have any questions or any concerns about the nutritional counseling session?
Yeah, so I just have one thing. I know, like I mentioned, with my anorexia, I said I have that fear of falling below that weight range that I’m just going to completely go back into how I was before my freshman year of college when I was anorexic. So, does that mean if I fall below that healthy weight range, does that mean I’m going to probably find myself slipping back into how I was before, into those anorexic habits in that physical build that I really don’t want to go back to?
Does that necessarily mean I’m going to completely fall into that, or what does it mean?
That’s a great question, by the way. Very good question.
No, so that you—losing, if again, with your age, is very normal for your weight to fluctuate—go up and down. So it’s not alarming; that doesn’t mean you’re necessarily back into anorexia unless, like you said yourself, it is a drastic change, and you’re experiencing the same habits and tendencies that you had when you were going through that.
But gaining or losing a few pounds, you know, trying not to focus too much on the number, but more so on how you feel.
Yes, and just making your mind and your body happy at the same time.
I definitely agree. Just because—I don’t know if I mentioned before, but my normal healthy weight range is, I guess, my base is 130. And like I said, gaining five pounds or losing five pounds, that’s usually within my normal range.
So when I gain more, you’re saying I shouldn’t feel bad if I gain more because it’s always fluctuating?
Right, exactly, yeah—as long as you maintain you’re within that healthy weight range, and you know, you’re attempting to exercise—you’re feeling good. You’re not going over a certain limit, then you’re okay.
So what do you recommend in terms of exercise aligning with my, I guess, my eating habits? Because like I said before, I realize that I eat more when I’m at the gym, and it’s not a type that makes me feel bad because I’m gaining weight—I know it automatically goes to my muscle gain, which is my ultimate goal at the end of the day.
It does increase my appetite; it makes me feel more hungry, but in a good way that doesn’t make me feel bad for being hungry.
So what do you recommend in terms of exercise?
Okay, so for exercise—just what are your goals with? Do you enjoy doing more cardio or weightlifting? Would you like to lose—I mean, put on muscle—or you said your goal was to maintain the weight?
Yeah, maintain the weight and also, I guess in the process, lose a little bit of fat just because I want to have a more lean build. So I guess more muscle gain.
So maybe, I don’t know if you’d recommend weightlifting.
Of course! Yes, weightlifting is actually a great start. So you mentioned that you’ve done that in the past before you canceled your membership.
So you can start small—weightlifting. You know, try to set a small goal to where you know that you can achieve it, and then from there, you can, you know, improve and build on that and start going more frequently.
Would you like to make a goal to start exercising as well along with the other?
Yeah, I think that would probably be my third goal. So not just fixing my sleeping habits or getting a—as having a healthier, I guess, eating routine—but also, I guess exercising more, just because I know all those three align.
I noticed that when I do exercise, not only do I have healthier eating habits because I do notice myself eating better, but I also find myself sleeping earlier because I’m tired throughout the day since I just worked out.
So I think exercise would be, I guess, a really good factor to implement into my schedule just because I know that would help with the other factors, possibly, like you said.
Yes, of course!
So for your exercise goals, you could start with weightlifting and then incorporate some form of cardio at the end of your workout—even if it’s 5 to 10 minutes, just making that a habit for your goals.
You said you wanted to build some muscle, but also stay on the leaner side; that doesn’t necessarily mean restricting yourself or starving yourself or anything. You just have to include more cardio if that is your physique goal.
So what about in terms of diet? Like, after your post-gym diet, I would recommend lots of protein as well as carbs and fiber.
I can make you a meal plan that would work for your goals to help you achieve what you’re looking for.
Okay, that sounds good!
Do you have any other questions or concerns?
No, I don’t think I do. Thank you so much.
Thank you so much for being so open today. I know it’s not always easy to talk about these things. I’m here to support you, and we’ll keep taking steps together toward a balanced approach to food and wellness.
How are you feeling about our session today?
I feel very good. I feel like I’m ready for change—I feel like I’m, or actually not just ready, but I’m also excited to implement that change—not just exercise, but also sleeping habits and eating habits and just bettering my eating routine. I know I’m going to be healthy no matter what as long as I stick to this schedule, and that was honestly my ultimate goal from the beginning.
Because I would sometimes hyper-fixate on my—like you said, I shouldn’t probably focus more so on the weight, but on how I feel on the inside.
Do I feel content or not? So I guess you’re right; the number really doesn’t matter.
But I guess, yeah, I guess I’ll just be excited for that change to come and for me to implement that change myself, and for you to be there in those steps.
Yeah, of course!
Perfect, sounds good. Let’s check in next time and see where things are going.
Thank you so much for coming in today. It was good meeting you.
Nice to meet you!