• Catherine Lott

Weight Restoration in Eating Disorder Recovery


I'm often asked what's the best way to restore weight in recovery The advice around weight restoring in eating disorders and general weight gain can be pretty lacking or a little simplistic. That’s why I wanted to write this article to answer some questions you have about weight restoration, so you can be clear and know you’ve got the right information.


That being said, the information in this article is not prescriptive and does not replace medical, mental health, meal planning or other advice you can get from one- to-one support. If you are in eating disorder treatment, please consult with your therapist, or doctor before taking any of the recommendations in this article.

What is weight restoration?

Weight restoration is a term in eating disorder recovery where a healthy weight for a person is reached, via weight gain. Weight restoration does not only include weight gain, it also increases other markers of health like physical symptoms, emotional health, resolution of medical complications, and improved cognition.

A common misconception is that restoring weight is the main part of eating disorder recovery. But actually, weight restoration is only one part of recovery.

Who can help with weight gain in recovery?

Depending on the amount of weight you need to restore, therapy, coaching, or inpatient or outpatient support may be needed.


Ultimately, eating disorder recovery is a complex and challenging process and there is no such thing as too much support. So consider telling people you trust-it won't change how the people who care about you view you, and the extra support and understanding will be a great help in those times when you're challenging yourself or really struggling.


COMMON QUESTIONS ABOUT WEIGHT RESTORATION

Do I just need to increase portion sizes?

Something I’m often asked by people is if they can just keep eating the same as they are now, just more of it. This is a good option, especially if you're at a very low BMI. In this situation, you need to worry less about the fear foods and challenging yourself right now (unless you feel able to), and more about working to increase your energy intake in any way you can. The fear foods and the challenges are things you will need to address when your BMI is higher.


This isn't always appropriate though, for instance If you're eating very little, are only eating a small variety of 'safe foods' and you have a huge list of fear foods or foods you can't/won't eat. So if you were only to continue to eat your 'safe food' but more of them, you're probably won't be able to eat enough to gain weight- that's because most often 'safe' foods will be the so-called 'clean' or 'healthy' foods, like vegetables, fruit, proteins, lentils and whole grains. While these foods can definitely be included in recovery, it's essential we challenge the eating disorder rules and work to increase the type of foods we're eating, so that means adding in the scary richer, higher calorie choices.


It can be really difficult to increase portion sizes. Especially if you’re going to recover on your own. Most people I speak to have no idea how much food they need to eat to restore weight. If you're doing this on your own, try to get some professional advice about how to start increasing, especially if you're at risk of refeeding syndrome. So if you’re concerned about refeeding syndrome, for instance if you're at a very low weight, have eaten very little food for five days or have restricted carbohydrates for a long time, make sure to consult with your GP who can offer medical monitoring while you weight restore. .(learn more about refeeding syndrome here).

So, initially, portion sizes might be increased with safer foods and a good first goal is to aim to double your portion sizes. Over time exposure to fear foods and richer, higher calorie foods are going to be essential for a full recovery. To be fully free of your eating disorder, there can't be any rules or anxieties left around food.

Do I just need to “binge” to gain weight?

This is another question I’ve been asked. Let's be clear about definitions here.

To the extent that bingeing can mean eating more food than you are right now; then yes. However there is the intrinsic associations in 'bingeing' of eating a large amount of food very quickly, feeling out of control, eating in secret and feeling ashamed of how much they're eating, so this is totally different from eating to restore weight.


Also it's important to note here that bingeing episodes are common after periods of restriction. When we experience extreme hunger paired with an increased mental preoccupation with food and eating, we're more likely to binge; this is a survival mechanism and the way to avoid this is first to establish a pattern of regular eating. Ultimately a huge part of eating disorder recovery is to normalise your eating and your relationship to food Since bingeing is not a 'normal' relationship to food, bingeing is not what we're looking for.


Since healthy hunger and fullness cues can be way off in recovery, it will often feel like you’re eating way past comfortable fullness. But this isn’t 'true' fullness; it’s part of recovery that will pass.

Should I go 'All In' in recovery?

If you’ve never heard of 'All In', it’s a common term in eating disorder recovery spaces. It was popularised by Youtuber, Sophie Buttermore, There’s no set definition of all- in, but I think of it as:

  • No tracking calories or following a meal plan in recovery.

  • Never weighing yourself or measuring your body in any way.

  • Giving up all eating disorder behaviours, cold turkey.

  • Giving yourself permission to eat all food, at any time, with no rules or restrictions until you are full (physically and mentally).

  • Resting, and giving yourself a full break from exercise and activity.

I have worked with a lot of clients who come to me feeling like failures because they haven't been able to go all-in. Recovery isn't a pass/ fail situation- It's a long , challenging process and anything that makes us feel like we've failed, or we're weaker than these people we've seen on Insta or YouTube (it's an illness that thrives on comparisons after all) is going to make us feel more broken and hopeless, which is more likely to increase our eating disorder behaviours. It is an approach that works well for some people but there is never going to be a one-size fits all solution to recovery.


Also the thing is that when we're recovering from an eating disorder telling ourselves to 'just eat' or 'stop exercising' ',is kind of what everyone around us is saying, and for so many of us, the levels of panic and anxiety created by trying to change these thing is literally incapacitating. This distress can take over and make restriction or compensation even worse.

In terms of meal plans, often these are a necessary tool in eating disorder recovery. To make sure people are eating enough to heal and nourish their body, sometimes they are needed. But going without a meal plan can mean people, especially when they're at a low BMI can mean they have no idea what to eat, how to make choices, or how much to even try to eat. It can also be super confusing to go all-in as most people in recovery will experience sky-high anxiety and distress, intense hunger, horrible digestive issues and other physical symptoms.

Some of the positives of going all-in include:

  • More quickly overcoming fear foods and rules by exposing yourself to foods that have been off-limits.

  • The commitment to “full recovery” is often higher in people who take this approach.

  • Weight restoration can happen sooner, depending on the person.

  • Committing to a regular eating schedule, which can help normalise mental and physical symptoms of your eating disorder.


Some of the negatives of going all-in include:

  • You may weight restore and eat more, but that’s only a small part of recovery.