Energy expenditure and the abnormal eating pattern of a bulimic: a case report

Bulimia nervosa has been characterized by binge eating, which is often followed by either vomiting or laxative use. However, some bulimic individuals restrict caloric intake rather than purge as a means of controlling their weight. Treatment may include psychiatric evaluation, drug therapy, and nutrition counseling. This study evaluated the eating pattern of a bulimic woman from food records made before and while she was receiving nutrition counseling at an eating disorders clinic. Energy expenditure was also determined and examined in relation to patterns of eating behavior. The Harris-Benedict equation was used to estimate basal energy expenditure (BEE). Actual measured energy expenditure (MEE) was determined by indirect calorimetry. On initial assessment, this woman was eating 600 to 3,800 kcal/day, reflecting the range from a semi-fast to a binge day. At this time, her BEE was significantly higher than her MEE. Following modification of her eating pattern to three meals a day, providing approximately 1,200 kcal, there was a 50% increase in her MEE, which closely approximated her BEE. Modification of eating pattern appeared to be associated with a normalization of energy expenditure in this woman; however, each case must be considered individually. These results imply that certain eating patterns in bulimic individuals cause a decrease in energy expenditure that may resemble starvation.