Written by Andrea Clares & Talia Cecchele
Eating disorders (ED) are mental health illnesses which impact both the psychological and physical health of individuals. Recovery consists of two parts; nutritional rehabilitation and psychological treatment (neural rewiring). For many, weight changes occur as part of recovery when there is a shift away from dietary restriction and reduction or cessation in compensatory behaviours.
Weight changes can be extremely distressing for many reasons including fear of continued weight gain, confusion about how much to eat, internalised fat phobia, societal pressures to be in a thin body and distorted body image which is a common feature in eating disorders.
“Weight restoration is not an option but a necessity to achieve a full recovery”
Why is weight restoration a priority in recovery?
Weight restoration is a crucial part of eating disorder recovery for several reasons:
to reverse physical and psychological side effects experienced from starvation
the final stages of overcoming disordered eating and normalising eating behaviours (intuitive eating) can only be addressed at a healthy weight when hunger and fullness cues can be interpreted
to overcome the fear of not engaging in compensatory behaviours like dietary restriction, purging (vomiting), laxative abuse and compulsive exercise
body image work and body acceptance is counter-productive unless weight restored
it is only when weight is restored that full recovery is possible
The duration of the weight restoration will vary between individuals, depending on the severity of the eating disorder and progress. The early stages of weight restoration usually result in both physical and psychological side effects as a result of overcoming nutritional deprivation. Physical side effects such as bloating, constipation and early satiety, and psychological side effects such as anxiety and body dissatisfaction are common. These will improve with time as nutritional intake is established and cognitive therapy begins.
I'm not underweight, do I still need to weight restore?
Most people think that weight restoration only applies for those who are underweight but that isn't the case. Most people with eating disorders are not underweight. You can be at a clinically calculated BMI within the "healthy" range but be engaging in disordered behaviours which suppress your weight to below where it is naturally meant to be (known as your set point weight). Human bodies are meant to be different shapes and sizes.
Anyone who is engaging in behaviours in an attempt to change their body shape or weight, and is below their genetically healthy weight range will need to weight restore for their physical and psychological health to return to normal.
Understanding the nature of weight change
Fear of weight gain is widespread in eating disorder recovery, but it can be overcome. There is a common misconception that weight restoration means just gaining body fat. However, weight restoration and changes to the number on the scale are actually due to several body composition changes including:
glycogen (our storage form of carbohydrate) being replenished and stored in muscles and liver. Glycogen is a heavy molecule when it is stored as for each molecule of glycogen, it attracts 3-4 molecules of water
body fat - you can read about why we need fats here
fluid and hormonal changes
bone density increasing
increase in gut contents and gut bacteria restoring (gut health issues are common in eating disorders but did you know that in a healthy gut there is up to 2kg of bacteria!)
At the beginning of weight restoration, the rate of weight change might be more rapid as glycogen and fluids are replenished or slow due to metabolic rate speeding up - learn more about hypermetabolism during weight restoration. During weight restoration it is common for weight to fluctuate or even stabilise which could be an indicator that dietary requirements need to be reviewed by your dietitian or other lifestyle factors need to change (such as physical activity).
How to manage weight gain in eating disorder recovery
In recovery, the weight restoration process can feel uncomfortable and can be a highly distressing time for many. It is common to feel bloated or full (which your eating disorder will likely misinterpret as being "fat") and like you are losing control as you learn to trust your body again. Here are some tools that you can use to help during this time:
Remind yourself of the reasons why you chose to recover. Writing down your goals and reasons why you are choosing recovery can be useful to help you stay motivated and refer back to on difficult days. Our Recovery Kickstarter ebook helps you find your why.
Be kind to yourself. Instead of focusing on the physical aspects of weight changes, shift towards practicing gratitude and kindness for what your body allows you to do every single day. When critical thoughts creep in, reframe them e.g. I'm grateful for my legs which have allowed me to explore new countries or I'm grateful for my body's ability to play and dance with my children.
Donate clothes that no longer serve you - dress your body as it is now. Move away from pursuing to fit your body in clothes that no longer fit you or that make you feel uncomfortable as this reinforces the eating disorders goal and can impact your feelings of self-worth. Wearing loose-fitting clothes during weight restoration can help as tight clothing could exaggerate even small changes (like bloating). Remember too that dress sizes vary greatly between different clothes and brands - most people buy clothes in a range of sizes!
Stop body checking behaviours as they reinforce the eating disorder mindset. The first step to this is creating awareness of when and where you body check. Keep a journal of this and then work on reducing body checking behaviours
Ditch the scale! There will come a time when it is appropriate to ditch the scale for good and we are 100% on board with that!
Challenge diet culture and the thin ideal. Research what the idealised body shape has been through the ages (all the way back to ancient times) and write down what you find. There is a pressure in our weight-centric world to look a certain way and the eating disorder self might latch on to that. Part of eating disorder recovery will involve challenging your beliefs. We recommend reading The Beauty Myth by Naomi Wolf.
Become an observer. We encourage you to do a little experiment and people watch. Instead of noticing body shape and size, look beyond the body - are these people having fun, are they loved, do they appear to have strong relationships and thriving lives? Your eating disorder-self will probably try to tell you that these things can only be achieved in a thinner body - which is far from the truth!
Need some recovery inspiration?
Listen to these incredible IG lives with two amazing women who have recovered from their eating disorder as we discuss how to overcome fears during eating disorder recovery:
Andrea Clares & Talia Cecchele
Andrea is a Registered Nutritionist and Clinic Co-ordinator at TCN! Her mission is to empower and equip you with all you need to live a healthy and fulfilling life, diet and guilt free. You can find Andrea on instagram @andreacm_nutrition and check out her website here.
Talia Cecchele Nutrition is a team of registered dietitians that specialise in eating disorder recovery, disordered eating, gut health 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 private consultation please fill out a contact form.