I need to gain a few more pounds to reach a ‘healthy’ weight. I am afraid to gain weight beyond that number because what if I lose control? I already feel so unworthy, and ugly. I will have to make sure to maintain it. ~ Miriam, 2008
Restoring physical health and reaching a healthy weight is the first priority in eating disorder treatment. It may even be a prerequisite for psychological treatment. Many people recovering from an eating disorder experience gaining weight as one of the most frightening parts of the process. Often, treatment professionals determine a healthy target weight by taking into account growth charts and BMI guidelines. This number can be considered as the lowest acceptable weight within the healthy range. Why is the use of static guidelines and target weights problematic?
The problem with BMI
There are many problems with using the BMI to determine a target weight. As a ration using weight and height BMI doesn’t consider body composition, age, and genetics. Achieving a healthy weight in recovery is important, there is no doubt about that. The problem lies in the way target weight is determined. It’s tempting to believe that reaching a target goal weight implies being at a healthy state. I remember being confronted with a target weight my doctor set. As a result, I became obsessed with focusing on weight gain and the number on the scale. Also I considered it as a maximum weight acceptable for me (because why would I go any further, right?) Logically this just fueled my unhealthy eating disordered way of thinking.
The truth is, there is no pre-determined number that can define your health, nor your most optimal weight.
Like each individual eating disorder is unique and calls for a personalized treatment plan, so does each body. Your body has an optimal set point weight. This is the weight where it reaches optimal health. In most cases, the set point weight differs from the target goal weight. This holds many people back from full recovery because they try to maintain their unhealthy target weight.
This is something many people in recovery struggle with. It is very normal to have many questions. How do you know your set point weight? Do you need to eat less once you reach your target goal weight? What if weight gain doesn’t stop?
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How do you know your set point weight?
A huge fear for people recovering from an eating disorder is to let go of control. Exercising control used to be the way to cope with difficult situations and negative emotions. In recovery you have to let that go. Focusing on a target goal weight reduces anxiety and fear because you “know where you’re heading.”
After years of destructive eating habits, you can’t know upfront what your set point is.
But in most cases, it isn’t the lowest weight in the so-called “healthy range.” Depending on your age, you could only make a rough estimation by looking to your weight before your eating disorder.
Physiologically speaking, there are only a small number of people whose set point weight corresponds with a BMI of exactly 20.
In order to fully recover, you need to let go of the weight you consider acceptable.
From my own experience, I know this isn’t easy. But you can trust the wisdom of your body. At some point, your weight will stabilize at its most optimal weight. This isn’t a specific number, but a range in which your body genetically wants to be. Even when you have celebrated the holidays with elaborate dinners or you spent an evening with a pint of your favorite ice cream.
How will you know when you have reached your set point weight?
You will know you’re at your set point weight when all body functions are restored and your menstrual cycle has returned. However, return of menstruation is not always indicative of reaching your optimal weight. You also must be eating in an unrestricted way, without rules or compensatory behaviors. If you are doing this, and your weight remains stable, then you have reached your set point weight.
When you change your diet once you have reached a pre-determined target weight, your body does not get a chance to fully recover. It is not able to restore deficits and reach your natural set point weight. I’ve been in the stage of partial recovery for years by maintaining the lowest acceptable weight set by my doctor while simultaneously pretending to be recovered. (I mean, I looked “normal” so I convinced myself I was better). This is a combination which can never work. I was convinced the weight gain would never stop, and this held me back from going the extra mile.
Learning to trust
This is a fear many people in remission struggle with. Is it realistic? No! When you don’t change your food intake and continue to re-feed, your body is allowed to recovery and your metabolism is restored. Your weight will stabilize when it reaches its optimal weight.
In some cases, your body may need to overshoot its set point weight in order to return to a normal fat mass to fat-free mass ration. However, this is only temporary and your body will settle at it’s natural set point weight. Be patient and trust your body!
Do you accept your body at its optimal natural weight or are you holding on to an unnatural size? Leave your comment below. Where ever you are in your journey, I hope you choose the path towards full recovery. Learning to love and embrace your body at its natural set point weight will give you so much freedom and happiness in return!