Weight Restoration in Eating Disorder Recovery: What It Is, When It’s Appropriate, and Why It Matters
Weight restoration is often a critical component of eating disorder (ED) recovery, and clients and family members alike often have tons of questions about it. As a certified eating disorder specialist, allow me to shed some light on this process: what weight restoration is and what it entails, when it’s necessary, and why full restoration can be crucial for full recovery.
Before we dive in, I want to highlight a key element of the weight restoration process. I have often heard some version of this question from clients with eating disorders over the course of my career: “You want me to obsess less about what I’m eating and how much I weigh in order to recover…why, then, does the treatment team seem so fixated on me achieving a certain weight?” It’s a fair and valid question. My response goes something like this: “You’re right- we don’t want a rigid focus on a particular number, that’s the kind of thinking that aligns with disordered eating. Instead, we are aiming towards a weight range that will lead to optimal, whole health for you- physical, cognitive, and emotional. Weight restoration is not just about the number on the scale; it is about reclaiming your health, your life, and your overall wellbeing.”
So What Exactly Is Weight Restoration?
Weight restoration refers to the process of refeeding or renourishing one’s self in such a manner that a stable and sustainable weight is achieved; again, this denotes a weight range that supports an individual’s physical, cognitive and emotional well-being. It’s important to note that an individual’s goal weight range won’t be dictated by societal standards or ineffective and outdated measures like the Body Mass Index (BMI) or height/weight charts. Instead, it is unique to each person and based on their natural, optimal weight—a range where their body can function optimally and maintain homeostasis. Often, an individual will be fueling their body more than they ever have before; this is necessary to fully nourish the body and to reestablish the individual’s ideal weight range.
When Is Weight Restoration Recommended?
Contrary to common misconceptions, weight restoration is not solely for individuals who are considered underweight by BMI standards. It can be necessary in multiple scenarios, regardless of a person’s shape, size or weight:
1. Weight Loss Through Disordered Behaviors: Individuals who have lost weight through restrictive eating, excessive exercise, or purging often need to restore weight to rectify the effects of these behaviors (see more below on the effects of intentional weight loss via disordered eating or weight suppression).
2. Chronic Weight Suppression: When a person’s weight remains below their body’s healthy set point—even if they fall within a “normal” BMI range—weight restoration can be critical for recovery.
3. Children and Adolescents: For young people, any deviation from their expected growth trajectory, such as a drop on their growth chart or failure to gain adequate weight, signals a need to investigate further. In many cases, weight restoration will be the key ingredient to ensure proper physical and cognitive development.
The key takeaway is that weight restoration is about returning to a state where the body can thrive, not merely survive.
Why Is Weight Restoration So Important?
Weight restoration is foundational for several reasons:
1. Restoring Physical Health: Prolonged weight suppression—where the body remains below its natural weight—can lead to a variety of adverse health consequences. Symptoms of weight suppression include:
o Cold intolerance
o Heart conditions, such as bradycardia
o Dizziness or fainting due to low blood sugar
o Gastrointestinal (GI) issues like bloating or constipation
o Persistent fatigue and headaches
o Anxiety or heightened emotional distress
In severe cases, weight suppression can compromise immune function, increase the risk of osteoporosis, and disrupt reproductive health, such as amenorrhea in individuals who menstruate.
2. Supporting Cognitive and Emotional Recovery: Malnutrition impacts brain function, leading to difficulties with concentration, decision-making, and emotional regulation. Adequate nutrition and weight restoration are prerequisites for engaging fully in therapeutic interventions and developing new coping strategies.
3. Reducing Risks of Long-Term Complications: Persistent malnutrition or weight suppression increases the likelihood of chronic health conditions, including cardiovascular issues and irreversible bone density loss. Weight restoration mitigates these risks and lays the groundwork for lifelong health.
How Is Weight Restoration Determined?
Determining an appropriate target for weight restoration requires a nuanced approach tailored to the individual. This process often involves:
· Growth Charts: For children and adolescents, growth charts help track expected weight and height trajectories based on age and developmental stage.
· Weight History: Evaluating a person’s natural weight range prior to the onset of disordered behaviors provides valuable context.
· Clinical Assessments: A comprehensive evaluation of physical and psychological health ensures a holistic approach to recovery.
Addressing Challenges in Weight Restoration
Weight restoration can be one of the most challenging aspects of ED recovery, both for the individual and their support system. Common barriers include fear of weight gain, body image distress, and societal stigma around larger bodies. Another difficulty is when the individual “settles” for what is often referred to as “quasi-recovery”, which is often at a weight lower than the optimal range, where the eating disorder can remain somewhat under the radar. I have often seen in these folks that the eating disorder is still very much in existence; it’s just in a form that is less alarming and more socially “acceptable”, but it still causes pain and distress (e.g., there are still rigid, obsessive thoughts and behaviors around food). This is why attaining that optimal weight range, while also considering other markers of whole health, remains so important. Be sure to find a treatment team that can provide compassionate, evidence-based care that normalizes this entire process and addresses these fears head-on.
My clients probably get sick of hearing me say “trust the process” (such a cliché I know), and yet it’s true. Part of healing from an eating disorder is learning to trust our bodies again. The discomfort along the way is real and can feel very scary; however, it is temporary. Also- when we zoom out and take a big picture perspective, the discomfort can be viewed as a blip on the radar, one that is completely worth it to achieve a life free from a debilitating eating disorder.
A Whole-Health Approach to Recovery
While weight restoration is essential for many individuals, and serves as a cornerstone of recovery for many, please remember- it is not the sole measure of recovery success. A comprehensive, whole health approach includes:
· Other Physical Health Markers: Improved energy, normalized vital signs, normal bloodwork, resolution of physical symptoms (e.g., amenorrhea in menstruating individuals, improved sleep, etc.)
· Emotional and Psychological Well-Being: Reduced anxiety, enhanced mood, decreased rigid or obsessive thinking about food, and an overall improved relationship with food and body.
· Sustainable Behaviors: Developing intuitive eating practices and self-care habits that support long-term well-being.
Weight restoration is a key component in eating disorder recovery for many individuals. The process requires a ton of patience and compassion. If you’re a loved one supporting someone through this process, please seek out help and support for yourself, since it certainly be an arduous journey. For all those affected by an eating disorder, please remember: you’re not alone and recovery is possible… just take it one step (or bite) at a time.