Weight Restoration: The Elephant in the Room when Healing from a Restrictive Eating Disorder
Written by CCTC Staff Writer
The weight loss that can* occur as a result of an eating disorder is a testament to the incredible capacity of our bodies to survive starvation. However, as anyone in recovery from an eating disorder can attest, bodies that are below their natural weight are not thriving. And, once this weight loss happens, the prospect of any weight gain – even necessary weight restoration – becomes scary, so scary that it causes many people to delay getting live-saving treatment. The purpose of this post is to prepare you to face the elephant in the room that is weight restoration. When you know what to expect, facing weight restoration becomes a little less scary.
In this article, we will discuss:
The reasons why weight restoration is necessary for a full recovery
Common concerns associated with weight gain
Tips to cope with weight gain in recovery
*While this article specifically addresses weight restoration in recovery from restrictive eating disorders that have resulted in weight loss, please know that eating disorders and malnutrition occur in people of all shapes and sizes, and not all eating disorder behaviors result in weight loss. If you have been struggling with disordered eating or suspect you may have an eating disorder, please seek out a multidisciplinary treatment team! A Registered Dietitian will be able to help determine if your body is at its natural weight.
Why You Have to Gain Weight in Recovery
A body that has been deprived of nutrients becomes malnourished, no matter what the number on the scale reads. While in this restricted state, your body redirects energy from nonessential functions (i.g., temperature regulation at the extremities, hair and nail maintenance, optimal digestion, etc.) to keep your essential organs working. This can become very dangerous, very quickly and your body will need more fuel (i.e., food) to be able to repair itself.
Medical complications of restriction aside, our brains (which are quite energy-hungry) undergo cognitive changes when energy is restricted. We can think only of food; what food is “good,” what food is “bad,” and how we can control it. The real work of recovery can’t even begin if your body doesn’t have the energy function properly and your brain can’t do much of anything other than obsess about the food you’re eating.
Your body has a natural resting place of sorts — it has a set point. This is the weight range where your mind and body work best. It’s a weight that you can maintain, long term, while meeting your body’s nutritional needs. It’s where your body needs to be for you to reach a place of freedom from your eating disorder.
Challenges of Weight Gain in Recovery
Physical Discomfort
Increasing the amount of food you are eating can be physically uncomfortable at first. This is normal and in no way means that you are doing something “wrong” by following your meal plan.
Very common physical symptoms associated with increasing intake include:
Nausea
Bloating
Abdominal discomfort
Constipation
Diarrhea
Headaches
Early Satiety (or feeling very full after only a few bites of a meal)
Again, it is normal to experience these physical sensations in response to increasing your food intake. Your Registered Dietitian or Physician can help to manage some of these symptoms, but your meal plan is actually the best medicine in this case. The physical discomfort associated with eating more is a direct result of restriction. The more energy your body has, the more quickly it can restore and repair its digestive process.
It is also likely that you will experience increased anxiety during this process. Emotions such as anxiety, guilt, and shame, can and often do manifest physically in our bodies as pain, nausea, or discomfort. These experiences are real and it is important to work through these emotions (and symptoms) with your therapist.
Body Changes
All bodies respond differently to weight restoration. The earliest changes you may see will likely be fluid shifts as the body becomes rehydrated and re-nourished. You may notice fluid accumulation around your face or in your arms and legs. For most people, this will redistribute naturally and relatively quickly. Your physician will monitor this and may prescribe medication to help.
Once you begin to restore weight, much of it will likely go to your midsection. This is because your body is creating an extra layer of protection around your essential organs, before spreading the weight around anywhere else. This is normal, and your weight will redistribute itself later on in a way that is normal for your body.
Body Dysmorphia and Negative Body Image
Bodies restore weight at different paces. For the best outcome, the weight restoration process happens relatively quickly, over a few weeks or months. It can be challenging to cope with this change, simply because it happens so fast and it’s hard to adjust. In addition, what your body feels like, and how you perceive it, can seem to change even more rapidly, creating confusion and increasing anxiety.
These rapid changes can be attributed to body image disturbances, sometimes referred to as “body dysmorphia.” The cause of body image disturbance is multifactorial, but having a malnourished body (and brain!) plays a significant role. Because of this, weight restoration is often seen as a precursor to positive changes in body image, and many people who have fully weight restored report improved body image later on in recovery.
You will get used to your recovery body. And after you get used to it, you can learn to accept it — you may love it, but you don’t have to. You can just start to appreciate what your body can do for you: you can attend birthday parties, take walks with friends, go to work or school, anything you want. Most importantly, you get to remain present for beautiful moments of your life.
Loss of Identity
When you’re deep in your eating disorder, you feel like your eating disorder is your identity. You’ve built your whole life around rigid rules and routines, and there was no room left for anything else.
Once you start recovery, and your body changes, it can feel like you have no identity. But the beautiful thing about recovery is that, without your disorder controlling your life, you can be anyone you want. You are in control of your life, and you can do anything you want with it.
How to Cope with Weight Gain, No Matter Where You Are in the Process
1. Recognize that your body will change.
For real recovery to happen, you can’t go on believing that your body will not ever change, or will stop changing at any one point. You don’t have to love the idea of weight gain. But you have to live with it. (That is obviously hard to do, but we’ll talk about how to “live with it” below).
2. Don’t expect to stay at one “ideal body weight.”
Reliance only on flawed predictive equations, such as BMI or Ideal Body Weight, may result in a clinician setting a recovery weight that is too low for a full recovery. Holding onto one specific number, especially one that is below your true set point weight, causes many to engage in restrictive behaviors just to stay at that weight. Instead of making a specific number your goal, focus on recovery-related goals, like eating intuitively or decreased anxiety about food choices.
3. Wear what makes you feel comfortable.
It’s highly recommended that you get rid of all your “sick clothes.” This helps remove a sense of nostalgia about your eating disorder and keeps you from comparing your “sick body” to your healthy one by trying on old clothes.
Some people like to dress up to make themselves feel better in their new body. Others may like to wear loose clothing so that they don’t have to experience the feeling of tight clothing on their skin. Wear whatever you need to feel okay, if not great, in your body.
If you are in a place where you can handle it, you can make the new wardrobe process fun. Go out with one of your supports and find clothing/accessories you like. Try to remember that sizes on clothing vary wildly by brand and that the number doesn’t mean anything, anyway.
After letting go of old clothes/buying new ones, plan something soothing to do in case of high anxiety. Use your coping skills, call up a friend to distract yourself, or talk through your feelings with someone in your support system.
4. Work towards not body checking so much.
Constantly engaging in body checking will make you hyper-aware of your body, and cause acute anxiety. It can hinder your recovery.
Your treatment team can help you develop alternative coping skills and leave body checking behind. Some ideas to get started could include covering up your mirror(s), setting a timer when getting ready or using the restroom so you don’t get “stuck” staring at the mirror, and practicing noticing and labeling other body checking behaviors.
5. Think about appreciating everything your body does for you, rather than how it looks.
Learning about the Health and Every Size and body positivity movements have been profoundly helpful for many people in recovery as choosing to love and respect your body no matter what it looks like is truly empowering.
Early on in recovery, however, ideas such as loving your body or even simply respecting your body may be challenging to embrace. To address this, there is another movement gaining traction right now: the body neutrality movement.
Body neutrality focuses more on mental health than physical image. At its core, body neutrality is about appreciating what your body does, not how it looks. You can view your body as a vessel for your soul, a vehicle that graciously allows you to do all the things that matter to you.
Remember, gaining weight is not a “failure.” It’s a sign of recovery.
For those in the grips of an eating disorder, being thinner may feel like an accomplishment, and gaining weight may feel like a failure. But it’s not. In fact, weight restoration is a sign that you are making progress towards recovery, and everything that comes with it.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.