The lean and fit-looking track athlete came into my office with a smile. Her college coach suggested that she come see me after she had told him that she felt her running times would improve if she lost a few pounds. Our first visit went smoothly. She told me about her eating and exercise patterns, I calculated her energy and macronutrient requirements, and made some suggestions designed to improve the balance of her intake with expenditure. She left as she came in, with a smile, expressing confidence in her ability to follow through with the recommendations. During subsequent visits she reported feeling stronger and more energized although unhappy that the scale didn’t budge. It wasn’t until our fourth time together, as I asked her more specifically about her feelings about eating and why she felt she needed to see the number on the scale go down, that she burst into tears. “I just don’t know what to eat. I’m so afraid.”
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