Written by Frances Molé & Talia Cecchele
Overcoming the Fear of Weight Gain in Eating Disorder Recovery
For many people in recovery from an eating disorder, the thought of weight changes (specifically weight gain) may cause a lot of anxiety, fear and overwhelm. Understanding and navigating weight restoration can be a difficult but necessary step to achieve full recovery. To overcome this fear, we will discuss why weight restoration is essential in eating disorder recovery, some of its challenges, and practical tips for dealing with weight gain.
Weight Restoration in Eating Disorder Recovery
Not all individuals need to restore weight as part of their recovery, but it forms part of a treatment plan for many. Weight restoration is required to reverse physical complications and improve cognitive function to make treatment effective (1), regardless of if you are underweight or not.
Remember, it isn't just people who would fall into an "underweight" category that need to restore weight, people in bodies that are weight suppressed (living at a weight lower than what is healthy for them, but not classed as underweight) will need to restore weight as well.
In either scenario, returning to a healthy weight for you is essential when going "all in" and achieving full recovery. Anything less, and your brain will still believe that there is an element of restriction or deprivation. If you aren't nourishing your body with enough fuel, a low level of dietary restriction, food rules, and food obsession can remain. When you build healthy eating habits and behaviours, your body will know what weight to restore to in order to function optimally. Read our blog on What is a Healthy Weight? to understand more.
Challenges of Weight Gain
Being underweight or weight suppressed can bring many mental and physical side effects from dietary restriction and malnutrition (1,2). Physical side effects such as muscle loss and weakness, metabolic changes and gut function alteration can present as a challenge during the restoration phase.
An increase in dietary intake can lead to digestive issues such as bloating, abdominal pain, constipation, diarrhoea, early fullness, and nausea. These physical symptoms are typical and can be managed with your dietitian. However, it can be a Catch 22 situation in that the very thing that you need to do (eat) can have the opposite effect (a drive to stop eating). The body needs time to adapt to changes and adjust to the increased food intake (1)
When some people step on the scale and see a significant change in the number, the ED mind jumps to the conclusion of 'fat gain' or 'gaining weight too rapidly'. It is common for some people to gain up to 2-3kg per week for the first few weeks of weight restoration due to a few different processes:
Rehydration - if you were dehydrated due to fluid restriction or behaviours such as purging or laxative abuse, becoming rehydrated will contribute to the number on the scale
Oedema - some people might develop swelling and accumulated fluid on their face, hands and around their ankles. This will improve with adequate nutrition over a few weeks
More food in the digestive tract - a simple one but often forgotten. Increased intake = more food weight in the gut
Constipation - it is common to experience constipation in the early days of weight restoration as the digestive system is weak and sluggish (more poo = more weight)
Glycogen repletion - glycogen is the storage form of carbohydrate. It is a heavy molecule that is stored in your liver and muscles - each gram of glycogen carries 3 grams of water when stored. Glycogen repletion may cause weight shifts of 2-3 kg per week for the first few weeks
Weight distribution - you may also see a redistribution of fat in certain areas like your midsection, this is normal, as your body wants to add protection for your organs (3). Both fluid accumulation and fat distribution will readjust to what is normal for you once weight is restored
Practical Tips for Dealing with Weight Gain
1. Let go of your weight loss goal
Eating disorders thrive off control, and for many people the drive for thinness and fear of weight gain can be a significant barrier to achieving full recovery. Regardless of the body weight or shape you are currently living in, having a weight loss goal is not conducive to recovery. If changing your weight or appearance is the eating disorder’s main priority, it means that health is second place (and it should always be first).
2. Challenge your eating disorder beliefs
There is no denying that eating disorders are complex, but the unhelpful beliefs that the ED self imposes (such as I will be happy/loved/successful at x weight) are all learned beliefs. You weren’t born hating your body, knowing what a calorie was or giving value to a number on a scale. Unhealthy beliefs can be challenged and unlearned, replaced by healthy ones.
You can always go back to your eating disorder behaviours, so what’s to lose from trying a different way?
At TCN, we find one of the most effective ways to challenge ED beliefs is to commit to an experiment. For example, if your ED self is telling you that you will gain x amount of weight by eating a piece of cake, commit to having the cake and seeing what actually happens. With repetition, the strength of your original hypothesis will likely reduce, as your healthy self gathers evidence that the disordered belief is not true.
3. Go back to your “why”
You can’t rely solely on motivation to keep moving forward in recovery. However, going back to WHY you chose (and continue to choose) recovery, can be a powerful tool in reconnecting with life outside of thoughts and fears about weight and body shape. Don’t waste 95% of your life trying to weigh 5% less.
Check out our FREE Kickstarter Recovery Guide which is packed with activities to get you thinking about your “why.”
4. Acknowledge your thoughts and feelings
Weight restoring can be frightening and anxiety provoking, especially when your ED self is feeding you lies such as “weight gain will never stop”. Having awareness and identifying thoughts or feelings associated with weight changes can be helpful in receiving support and overcoming it.
Eating disorder behaviours often serve a purpose of numbing or avoiding feelings. Becoming aware and naming your feelings, speaking to people about it and learning not to act in an unhealthy way in response to certain thoughts or feelings is an important skill in recovery and beyond.
5. Shift your mindset
You can change how you think about your body by challenging your eating disorder-driven thoughts and beliefs. Instead of thinking “I've gained too much weight” try to shift your mindset to “I'm restoring the weight I should not have lost” or “I’m gaining my life back”. See more examples of shifting your thoughts and beliefs in eating disorder recovery here.
You might not believe it at first, but keep practicing. Shifting your focus from may allow you to appreciate your body and what it can do for you. Focusing on your positive qualities, skills, and talents will help you accept yourself regardless of how your body looks and how much you weigh. Focusing on the positive traits that represent your core self may help you think beyond the numbers on the scale.
6. Challenge fat phobia and the thin ideal
We are continuously exposed to what the media deems to be the ‘ideal’ beauty standard. Repeated exposure to thinner bodies may contribute to lower self-esteem and increased body dissatisfaction (4). When a particular body type is glorified, this appearance and weight can be highlighted as more valuable.
Appreciating diverse body shapes is a characteristic of having a positive body image, which can be a protective factor against disordered eating and improve outcomes (5). Embracing body diversity is acknowledging that everyone is meant to look different and there is not an ‘ideal’ way to look (for more check out our blog The Truth About BMI).
It is important to recognise natural variations in body shape, weight, and size to embrace body diversity. Variations in individuals may be due to age, ethnicity, and race (see our blog on Set Point Theory). Something you can do to embrace body diversity is to challenge the stigma associated with not being the ideal body weight by celebrating and respecting people of all different shapes and sizes. You can support this by curating your media to be more diversified as well.
7. Avoid comparison
It may be normal to compare ourselves to others; however, this can consistently interfere with happiness and how we feel about ourselves. Constant comparison in the social environment can give a false perception of reality, and we tend to choose what we see. This is called perceptual bias. For example, if you constantly think about buying a new type of car, you will suddenly start noticing this car more.
Perceptual bias can be the same when we think about body size. When we constantly focus on body shape, the body shape we desire, we will subtly look at other people and compare their size to our own. To avoid this, you can look at everyone. You will notice that people around you will be of all different shapes and sizes. The next time you go out and find yourself comparing, take a step back and look at the entire picture.
8. Be kind to yourself
Weight stigma is not only a stigma of other people but can also be a stigma of oneself. Stigmatisation of body types can become associated with feelings of inferiority, shame, and self-criticism (6). In turn, shame and self-criticism are associated with body image dissatisfaction and may disrupt eating behaviours (7). Shame can be both internalised (how one sees oneself) and externalised (how one sees others).
Shame can form in various ways, some individuals may scrutinise their own body by repeatedly checking and looking for evidence of ‘faults’. Body checking may include looking at the mirror for hours, pinching body parts and isolating certain areas. Scrutinising and over analysing your body may involve negative self-talk like "my arms are too fat…” or “I have too much cellulite... ”. With continuous negative self-talk you may start to believe it.
Giving yourself some compassion and being kind to yourself allow room for positive talk. You can practise this by practising self-love and kindness by saying “I love my arms as they allow me to hug my loved ones”.
Returning to a healthy weight for you can seem daunting and the road to get there long and confusing. If you think that you would benefit from specialist support through your recovery journey we invite you to book a free 15 minute discovery call with one of our eating disorder dietitians at the TC Nutrition Clinic to discuss how we can support you.
Frances is a student dietitian at Bond University, in Australia. She is upskilling in the area of eating disorders and enjoys recipe development and food photography. Her food philosophy is to always include favourite foods, a few simple changes can have the biggest impact on your health. You can find Frances on Instagram @wellnutritionn
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Talia Cecchele Nutrition is a team of registered dietitians that specialise in eating disorders, disordered eating, digestive issues and sports nutrition. We aim to bring balance back to nutrition, help you to break free from food rules and find food freedom. We offer virtual consultations and group programs so whether you are based in London, the United Kingdom or around the world we would love to support you. To enquire about a private consultation please fill out a contact form.
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