When is weight restoration necessary in the the treatment of eating disorders? (Note that this entry is based on opinion only. I am not a health care provider and am not giving health advice.)
I would say weight restoration should be reserved for those anorectics who are significantly under their pre-eating disorder, adult weight and/or those whose weight is significantly affecting their physical health.
Now, when I began seeing a therapist a few months ago, she considered me alarmingly thin and felt I needed residential treatment. My coworkers, who saw me sparingly, felt I had lost a significant amount of weight and thought it was quite noticeable. But those who knew me best and saw me on a daily basis rarely commented on my weight, and my husband, the person who saw me every single day and the only person to ever see me naked, didn’t even recognize I had a problem. In fact, he still considers me curvy and does not think I am too thin.
So why is this?
Those who don’t know me well don’t know I am naturally underweight. My normal, adult weight is around 93 pounds. And for those wondering, I am 5’0. So 93 pounds is actually fairly normal, and given that I am 80 pounds now, it’s not that big of a deal compared to a 120 pound person who starves their way down to the same weight.
My therapist and corworkers don’t think to take these things into consideration. I have always been small regardless of my eating disorder.
So when I say I would like to at least maintain my weight, I don’t think that’s irrational. Is it that imperative that I gain a measly 13 pounds? Is my body going to drastically work better at that weight? And on the other hand, am I really doing any damage at the weight I am now? I can’t fathom a 13 pound difference would change anything either way.
Feel free to correct me and I will humbly take your evidence, but until someone can give me a rational explanation as to why the weight I am at is dangerous, I won’t consider weight restoration.
I am tired of doctors saying, “You may be fine now, but later down the road your body will start deteriorating.” Well, ten years of on-again, off-again anorexia seems to be treating my body just fine. Am I irritable? Sure. Am I fatigued? Definitely. Do I find it hard to move on some days? Absolutley. But my period is in tact, my head seems to think clearly, I’ve never fainted, dizziness is non-existant, my hair is long and thick, my EKGs are awesome, my vitals are normal, and doctor’s give me a clean bill of health every time I go for a visit.
Is weight restoration really critical in ALL anorectics, or is it just ingrained into society that weight restoration is a must? I feel like my past weight and history are not taken into account when people see my body shape and they assume I must gain 30 pounds to be considered healthy.
I am not writing this entry to rationalize my eating disorder. I am writing it to get people’s opinions on the subject. Do you feel like weight restoration is a must, regardless of the person’s natural body weight?
I think the “only 13lbs” is irrelevent. What is relevent is that 13lbs from a natural 93lbs means you’re ‘missing’ 14% (from an already underweight natural). Whether that puts you in real danger or not I have no idea, so I don’t know whether for you recover has to equal weight restoration.
I think you’re right in that it’s wrong to assume the same process is required for everyone. But remember too that weight restoration isn’t just meant to be about avoiding physical danger. What if 14% means you don’t have the cognitive ability to work the 12 steps. Not in a -too stupid- or anything like that way, but just in a way that that 14% prevents you from being able to understand yourself and your eating disorder enough to break free again? The kind of flip flopping you’ve been doing recently between “its a choice” and “disorder – recovery” etc might even be an indication of this.
I have no idea if/how your ED affects you other than what you write here. So I’m not saying any of that ^ is necessarily true. Just that it could be.
I say look at your thinking. You are still firmly entrenched in the Ed thoughts. It’s there pretty much all the time right? Well that shows you need to restore weight. Or put it on for the first time, whatever (because anorexia can also be a failure to gain weight as expected in line with age and maturity. You might ‘normally’ be this underweight but it does not mean you ‘should’ be this underweight. Just that you never reached a normal weight.)
again and again, studies and in the real world, we have been shown that in order to be able to cognitively recover from the eating disorder, weight restoration is ESSENTIAL and unfortunately there is no way around that ( how I WISH. To recover and not have toput on weight is my own holy grail) It stands to reason, if you are still cognitively stuck in Ed, you need to gain.
Good luck xx
This is denial. You are letting your Ed do the talking.
I see both sides. Weight restoration is important, even in cases where the post-disorder weight is not in a medically “critical” range, simply because the unwillingness to accept weight gain suggests an unwillingness to commit fully to moving beond disordered patterns. If you’re (and I’m using “you” generally, not just personally) afraid to gain and working hard to justify why it shouldn’t matter, it’s unlikely you’re in a place where you’re actually committed to being healthy. And I don’t mean this as an attack on you–I just recognize myself in what you’re saying. A few years ago, I was insistant that my “natural weight” was a BMI of 15, and I argued myself blue in the face about how “well” I was and how I shouldn’t need to gain, because I was eating and I was medically stable etc etc etc. I clearly wasn’t well, and I was rationalizing. I was willing to play at “recovery” as long as I didn’t have to gain weight.
On the other hand, as someone who doesn’t actually believe in the traditional definition of “recovery”, I don’t believe weight gain has to be essential. Symptom management, the term I prefer, works on a continuum. For me, right now, it’s progress to eat anything at all without purging, or to limit my daily exercise to 1000 calories. I’d consider it progress to adjust my “goal” weight from bmi10 to bmi13. Someday I hope to have healthier goals, and to include gradual weight restoration–but even if I NEVER reach the weight my doctors would like to see, if I can stop purging, stop fasting, and learn to moderate my exercise, I may be as “recovered” as I can ever be, and I’ll certainly be healthier.
So no, weight restoration is not essential to survival. But if you want to meet textbook standards for “recovery”, rather than symptom management on your own terms, moving beyond rationalizing an unnaturally low weight will need to be part of the process.
(…if that makes any sense at all. haha.)
I completely agree with your thinking. I think that unless the weight a person is at is actually dangerous for them then they should gain weight, but I really believe that the most important part of recovery is not the weight gain but healing the mental aspect. It didn’t make any sense to me at all to make me gain weight before I saw a therapist to deal with it when I went into recovery. That probably made it harder than it had to be. I was at a dangerous place with my weight, so weight restoration was important for me then, but it’s not for everyone. If they would have treated the mental aspect first I think I would have been a lot more willing to recover and might even be farther along now than I am.
Weight doesn’t mean a damn thing. Your period and EKG doesn’t mean a damn thing. Your Doctors might as well address their advice to the trash can because they don’t mean a damn thing. The unrelenting voice in your head that tells you how to feel is the only thing that matters. And that voice is a motherf***er. I know because I have listened to that voice for over 20 years.
I was under the impression that weight restoration was, if not for those who are unnaturally thin, but to bring metabolic rate back to normal. I myself am beginning recovery but already am BMI 21, so when I was told I would need to eat 3000 calories just to fix my metabolism, I know I had my mouth agape in horror.
Rather late comment, but I just found your website and am just starting to educate myself (:
I thought this same thing myself but after restricting heavily for seven years (yet only maintaining a BMI of 16, whereas it’s 15.1 now) I realize it was a slow decline to the major health issues I have now. Three months of constant hospital visits because I had signs of cardiac arrest, my EKG’s were awful, I’ve intestinal numbness, delayed gastric emptying and the only time I’m ‘regular’ is on my period – all dangerous things. Especially when you think about all the food you’re not digesting fast enough that’s just sitting in there. Talk about filling the body with toxins.
I thought for the longest time I was okay, and then it just hit swiftly – all of the health problems – last November and it’s been a steady decline since. At this point, I’m attempting to get into IP because I have nothing to lose except dying at the rate I’m going. I hope I get in, because really, I’m pretty damn shocked at the fact that I was “okay” for so long and now my body is all ~fuck this and slowly killing off important functions. :/