One of the most common concerns patients have at the start of eating disorder treatment is wanting to lose weight, or often even stronger, the fear of gaining it. Because of the inescapable presence of diet culture, it’s understandable that some patients enter treatment hoping to lose weight. But regardless of a patient’s diagnosis or BMI, having weight loss as an intentional goal in treatment is almost always harmful to recovery.
Some of the core goals in recovery are to normalize eating habits, become more aware of body image issues, build new coping skills, and find community. In this process, many people start to recognize the influence that diet culture has had in their life and to embrace how their body feels when it’s being nourished. As a result, the desire to lose weight often lessens.
That process may feel a long way off, or even impossible when considering treatment, and that’s okay. Read on to learn more about why experts don’t encourage weight loss in eating disorder treatment, and why it’s so important to seek support anyway.
Why weight loss is rarely the goal of treatment
For starters, weight loss goals are simply ineffective, even for people who don’t have an eating disorder. As Carise Rotach, MA, LMFT, Equip’s Therapy Manager explains, “When restricting food for weight loss, you may experience temporary results, but you’re statistically more likely to gain the weight back that was lost, or more. This is a completely predictable and normal bodily response to putting the body into a state of starvation.”
This cycle is what can cause many eating disorders in the first place. So for people already experiencing one, it can have even more dangerous risks. Here are two reasons why.
A weight loss goal can re-trigger disordered habits
One reason that weight loss isn’t part of eating disorder treatment is that it can reinforce the very disordered beliefs, thoughts, and behaviors that created the eating disorder in the first place. Food restriction is at the root of most weight loss efforts and most eating disorders. If someone starts restricting in the hopes to lose weight, it can become counterproductive to their healing. This holds true regardless of a patient’s size or weight.
It could become a health risk
Many people who are beginning eating disorder treatment are in need of weight restoration, a process of reaching a stable, healthy weight. This can include folks who aren’t deemed “underweight” by their BMI, but still require weight restoration in order for their body to function optimally. If someone is in need of weight restoration, losing even more weight could set off a series of health concerns related to malnutrition, like a weakened immune system and organ damage.
Health takes many sizes
It’s important to recognize that health can exist in many shapes and sizes. At Equip, we take a Health At Every Size approach, which aims to counteract medical weight bias that assumes illness for fat people and wellness for thin people. Institutions built around weight loss perpetuate this myth that skinner means healthier. Eating disorder treatment (when it’s evidence-based at least), does the opposite. They aim to help patients achieve a weight that help them live nourished, fulfilled lives.
The importance of weight restoration
Weight restoration is often a part of eating disorder treatment (but not always.) According to Rotach, “Weight restoration is the process of stabilizing nutrition and interrupting eating disorder behaviors in order to restore a person's weight to the optimal range for their individual needs.” While many people assume weight restoration is only for patients who appear ‘underweight,’ that’s not always true. Someone might not be considered ‘underweight’ by the flawed BMI system and still require weight restoration to reach a weight that would be healthiest for them.
Rotach points out that each person has a unique target weight range measured by a wide range of factors, including:
- Historical data (like growth charts and family history)
- Regular menstruation
- Stabilized mood
- Experience of range of emotions
- Stable vitals
- Lack of eating disorder intrusive thoughts
In short, our bodies and minds function differently when we’re at a stable, healthy weight – and that number is a unique calculation for every individual.
Not only is weight restoration crucial to helping patients feel their best and interrupt harmful patterns, but it also helps to mitigate the chance of relapse. According to Rotach, “The number one risk of relapse for eating disorders is weight loss or restriction.” This is why weight loss goals continue to be off the table for most people in long-term eating disorder recovery, no matter their body size. “These folks are aware that their eating disorder can return swiftly if their body is put in a state of starvation again,” says Rotach.
When weight loss might occur in treatment
Some patients may end up losing weight when their nutrition becomes stabilized and they stop certain disordered behaviors, such as binge eating. This was true for Jerica Mosello, Admissions Operations Coordinator at Equip, who was diagnosed with anorexia nervosa, binge-purge subtype as an adult. Becoming a mother inspired her to seek treatment to address her relationship with food. “When I entered treatment, the goal was not to lose weight. But for me, that was the natural byproduct as I healed from disordered habits and stopped restricting what I ate.” she says. Although she ended up losing weight she reflects, “For the first time in my life I was unconcerned with the number on the scale and more concerned with the fact that I was eating well.”
Rotach adds that sometimes weight gain can be either short or long-term; “Sometimes weight loss is quite temporary as a patient’s metabolism learns how to process nutritional energy again. Other times it’s a fluctuation that meets a patient’s optimal functioning weight range for that season of their life.”
That said, weight loss is uncommon in treatment, and rarely will it ever be the goal. One exception being if a transgender patient is required to be a certain weight in order to receive a gender-affirming surgery that’s essential to their recovery.
What to do if you’re nervous about gaining weight in treatment
“It's okay to question what will happen to your body when you are in treatment,” says Rotach. “The problem is that diet culture has taught us to fear weight gain all our lives.” If you’re struggling with the idea of weight gain while healing from an eating disorder, Rotach recommends asking yourself of these open-ended questions:
- How will my body function differently with adequate and stable nutrition?
- How will I experience eating, moving, exercising, and existing in a body that is optimally functioning?
- What will I like most about having energy to get through my day?
- What will I do with the extra brain space that's currently occupied by obsessive thoughts of food?
“Being curious about your own body is okay as long as we stay open to many different outcomes. When we become rigid in how we think our bodies should look, that’s when we become a stones-throw away from engaging in restriction or over-control,” says Rotach.
Your mindset may change during treatment
A common part of eating disorder treatment is learning new information and unpacking the diet culture messages that may be at the root of disordered behaviors. In the process, your fears might subside. As Mosello says, “Your mindset really changes throughout treatment. You might have gone in for one reason, and changed in a way you didn’t expect. Before treatment, what I wanted was self-love. Of course, I thought I could only have that with weight loss. Through treatment, I learned that losing weight was no longer the catalyst I needed to love myself.”
Therapy can play a big role in this process, where you learn to identify and “shed harmful mentalities and patterns,” says Rotach. Dietitians and medical providers can also help you better understand what nutrition your body needs, and redefine what health looks like for you. Lastly, peer mentors provide the opportunity to talk with somebody who’s been through recovery and these feelings before.
Equip is a virtual eating disorder program that matches you with a care team including a therapist, dietitian, medical provider, and mentors. This care team is dedicated to helping you break free from your eating disorder, and embrace whatever that looks like for you.
1. Hall, Kevin D., and Scott Kahan. “Maintenance of Lost Weight and Long-Term Management of Obesity.” Medical Clinics of North America 102, no. 1 (2018): 183–97. https://doi.org/10.1016/j.mcna.2017.08.012.