There’s no denying that anorexia recovery, while life-changing and often life-saving, can be a challenging process. Committing to treatment can transform your (and your family’s) life and well-being for the better, but it’s important to be aware of the most common obstacles that can impede or complicate the journey. For many people, the most difficult hurdle to overcome in anorexia recovery is weight gain.

Weight gain in anorexia recovery can be incredibly difficult—physically, psychologically, and emotionally. Understanding why weight gain is absolutely critical in anorexia treatment can help ease some of the concerns and discomfort that often accompany the process, as can learning coping strategies. Read on to learn more about the role of weight gain in anorexia recovery and how you can come to tolerate and accept it.

Introduction to weight gain in anorexia recovery

Without adequate weight gain, full recovery is impossible, making it one of the most important factors in healing from anorexia. “Re-nourishing the body is essential for improving health outcomes and minimizing lasting impact,” says dietitian Ana Pruteanu, MS, RD, who likes to equate weight gain in anorexia recovery to “a process of healing the body and healing ourselves, and regaining the freedom to feel strong again, be able to eat with others, and be able to be ourselves again.”

But for those recovering from anorexia, gaining weight isn’t an easy thing to accomplish. It can be challenging for a number of different reasons, including emotional and mental overwhelm, loss of a (maladaptive) coping mechanism, and our weight-obsessed culture. “Gaining weight feels like a loss of control to many of the people I work with,” Prutaneau says. “Societally, we are told that gaining weight is a sign that we are doing something wrong.” The weight gain process can also take a toll physically, and sometimes even be painful because of digestive distress during nutrition rehabilitation.

The good news is that there are a variety of ways to manage every part of the weight gain process, like developing new coping tools, surrounding yourself with supportive people, and creating boundaries with diet culture content—all of which we’ll break down together today.

Why you need to gain weight in anorexia recovery

Commonly known as “weight restoration,” gaining weight during the eating disorder recovery process is crucial to both short- and long-term mental and physical health. While it’s true that people with anorexia who are severely malnourished may need to be admitted to a hospital to receive more intense treatment and monitoring, you don’t need to “look” thin or malnourished to require weight restoration.

“It’s important to highlight that not all people need to be ‘medically underweight’ to be sick with anorexia,” says Equip Therapy Lead, Maddie Friedman, LCSW. She explains that for young people, falling off their growth curve is an indication that weight restoration may be required, regardless of whether or not they are “underweight.”

And for adults, it’s crucial to recognize that the marker many providers use to determine whether or not someone needs to gain weight—the Body Mass Index (BMI)—is deeply flawed. A person may fall into a “healthy” BMI range and still be below their body’s natural set point, in which case they would require anorexia weight restoration. Research shows that BMI is a faulty tool for setting target weights, and that if a person is even a few pounds below the weight their body wants to be, this deficit can fuel eating disorder behaviors. Those with atypical anorexia—an eating disorder diagnosis that shares almost all the same characteristics of anorexia, except for low weight—often need weight restoration, despite not falling into the “underweight” BMI category.

Being weight-suppressed has a variety of different health risks, including:

• Heart conditions
• Low blood sugar
• Dizziness
• Fatigue
• Being cold all the time
• Gastrointestinal issues
• Headaches
• Anxiety
• Death

“Breaking the cycle of restriction is often the first step to treatment, as it allows the brain and body to relearn hunger and satiety cues that align more with nutritional needs outside of the eating disorder,” Friedman says. “Target weights are calculated for folx in need of weight restoration to get back on track with their growth, development, and overall well-being. Malnutrition can impact all of the systems in the body and can lead to infertility, brain damage, and bone loss, and, in some cases, can be fatal.”

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Weight suppression can also exacerbate the mental symptoms of the eating disorder, while gaining weight naturally quiets these symptoms. Equip’s Director of Peer Mentorship, Maris Degener, says weight gain was an essential piece of her recovery journey for multiple reasons. “Gaining weight is what the eating disorder feared, and so much of my recovery was continuously facing the eating disorder’s fears in order to overcome them,” Degener says. “If I were to try and avoid gaining weight over the long term, it would have reinforced the eating disorder belief that weight gain was something that must be feared, and would have also meant engaging in the restrictive behaviors I was trying to move away from in order to try and control my body size.”

In addition to pushing back against the eating disorder, weight gain enabled Degener to experience an array of physical and mental health benefits. “The more nourished I became, the more fueled my brain and body was to continue to challenge the eating disorder,” she says. “Gaining weight, for me, supported better sleep, more energy throughout the day, and a greater ability to practice regulating my emotions during the ups and downs of recovery.”

Why weight gain can be so challenging

Given the fact that diet culture continuously and dangerously conflates weight loss with worth or moral superiority, weight gain can be hard for anyone. But for those in the grip of anorexia, it can be particularly difficult to tolerate.

Weight gain during anorexia recovery can be challenging on several different levels:

Emotional challenges

“Regular eating and weight gain can be so challenging during treatment and recovery because they can feel totally unfamiliar and distressing,” Friedman says. “Gaining weight often requires acting in opposition to the eating disorder, which has usually been driving behavior for a long time.” Degener says that for her, weight restoration was particularly difficult on an emotional level: “I remember explosive meal times where I fought and argued with my parents because of how fearful I was of gaining weight—and the time after meals was difficult, too,” she says.” I carried a heaviness of anxiety, worry, fear, and anger with me for some time, and had to learn strategies for sitting with and tending to those emotions.”

As she continued to restore weight, Degener also encountered new emotional experiences in recovery, like parting with clothes that no longer fit. “I look back on these experiences as important moments that ultimately taught me and gave me so much perspective—and in the moment, they didn't feel that way,” she says. “They felt scary and frustrating and difficult.”

Social challenges

Diet culture plays a harmful role in perpetuating fatphobia and glorifying thinness at any cost, which can make intentional weight gain a challenging proposition.

“One element that I don't want to overlook is the role of living in a society embedded with anti-fat bias and diet culture,” Degener says. “We are continuously taught and sold the idea that losing weight or living in a thin body is our obligation and necessary to living a fulfilling life. Gaining weight and experiencing changes in our body in a society that is so often unsupportive of doing so is a challenge we shouldn't overlook in this discussion.”

Psychological challenges

Restriction itself can have significant deleterious effects on the brain, making it even more difficult to fathom listening to your body’s cues and purposely gaining weight.

“The brain has often lost touch with hunger cues due to restriction, and when certain body signals are overlooked for a period of time, they may stop showing up altogether,” Friedman says. “As a result, we often encourage patients to eat by the clock. Eating more regularly will help the brain and body relearn hunger cues. This may initially feel uncomfortable due to most of us learning that feeling hungry is a requirement for eating.”

Physical challenges

For many, the physical sensations of fullness and eating in a way that supports adequate nutrition can be unfamiliar and uniquely uncomfortable.

“Many people recovering from anorexia will get full very quickly during the renourishment process, due to not being used to eating the amount of food that is often required to combat weight suppression,” Friedman says. “This discomfort will improve over time with consistency.”

Deneger recalls feeling substantial physical discomfort during the weight restoration process, which took time to navigate. “My body was getting used to a new pattern of eating, and reintroducing foods that the eating disorder had led me to avoid for quite a while, which wasn’t always comfortable,” she says. “I spent a lot of time resting after meals—watching movies, making art, or reading to distract myself from emotional discomfort and allowing my body time to digest and settle.”

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Strategies for making weight gain more manageable

While recovery from anorexia is different for everyone, and you’ll have different challenges at different stages in the journey, there are a few general strategies that can make weight gain more manageable.

Here are some expert-endorsed tips for coping with weight gain in anorexia recovery:

Cultivate self-compassion and mindfulness

Practicing self-compassion can provide relief in the hardest of moments when you’re struggling with weight gain in recovery. According to researcher Kristin Neff (who offers free, guided self-compassion exercises), self-compassion involves mindfulness instead of over-identification with thoughts or feelings, self-kindness instead of judgement, and common humanity instead of isolation.

There are many forms of mindfulness practices that can be helpful in building tolerance for the potential emotional and physical discomfort of weight gain, including calming meditations and breathing practices. Pruteanu recommends a nervous system regulating exercise: “Activate the vagus nerve—the main nerve network of the parasympathetic nervous system—by humming for a couple of minutes before eating,” she says. “This can help shift your body into rest-and-digest mode and decrease digestive issues.”

Find comfort and safety where you can

Gaining weight in recovery can feel uncomfortable and unsafe, so it’s a good idea to bolster your mealtimes and day-to-day experiences with tools that support you and remind you that you’re safe in the most difficult moments. Friedman’s suggestions include applying a heating pad on your belly when experiencing fullness, bloating, or stomach discomfort, bringing a blanket or safe object to the table while eating, and engaging in distraction during mealtime to prevent hyperfocusing on feelings of fullness or discomfort (for example, watching a show, listening to music, petting your dog, talking to a safe person, or playing games).

Cultivate a supportive circle

It’s also helpful to consider who the people are in your life that make you feel safe, and to enlist them for support during potentially distressing moments. “Having support around you for tough moments like shopping for new clothes or parting with ones that no longer fit can be incredibly supportive,” Degener says. “Having someone with you who can offer validation and support can help make a difficult experience a bit less lonely and a bit more doable.” Start by letting them know that you’re struggling with gaining weight, what your triggers are, and how they can be there for you.

Stock your closet with clothes that make you feel good

“It’s really important to have clothing available that feels comfortable regardless of size,” Friedman says. “In fact, I often recommend cutting out tags from clothing altogether since sizing is totally inconsistent and tends to just fuel further discontent and stress in the weight restoration process. Removing or donating clothing that no longer feels comfortable can be a very helpful part of this process, and having new clothes that feel good will hopefully decrease focusing on what no longer fits.” (And, as Degener notes above, it’s a good idea to have the support of someone close to you when you’re doing this.)

Audit your social media

Whether you’re aware of it or not, social media can impact how you feel about your changing body in recovery. “One thing that was impactful for me was switching up my engagement with social media,” says Degener. She found that taking breaks and following accounts that reflected body diversity allowed her to see people of all body sizes living their lives and finding joy. “In recovery, I came to realize that I grew up really only seeing a very narrow representation of body sizes portrayed in the media and this negatively influenced beliefs I held around my own and others' bodies,” she says.

Structure your meals

One of the most important and helpful tools for weight gain in recovery is a meal plan or structure (developed by a dietitian) tailored to meet your needs and preferences. Generally, some good guidelines to follow are eating regularly throughout the day and including carbs, fats, and proteins at every eating experience. Pruteanu recommends starting with foods that feel safer and to be mindful of how much you drink at meals. “Limit liquids during mealtimes to avoid overfilling your stomach with fluid," she says. “Feeling too full can trigger physical discomfort and bring up urges to restrict or purge.” She also suggests using mechanical eating or eating by the clock. “Don’t wait for hunger cues, as these are often not consistent at the initial phase of recovery and when under-nourished,” she adds.

Consider gentle movement

Sometimes, gentle movement like walking or restorative yoga can help alleviate distress associated with gaining weight, as long as it’s for the right reasons (and not dictated by the eating disorder brain). For example, taking a walk in nature can be calming and soothing, and a restorative yoga practice can help the body process difficult emotions. However, whether or not you can incorporate movement into your recovery is a tricky topic that requires discussion with your treatment team.

Working with professionals

Anorexia recovery requires the support of specialists. Weight restoration in particular isn’t something you should try to accomplish alone, but rather alongside a team of experts who can help you do so safely and in a way that leads to long-term recovery.

The role of registered dietitians

Registered dietitians are typically the ones who set target weights—and often use weight ranges instead of one specific weight, since bodies fluctuate on a regular basis. Target weights are typically determined by several factors, including pre-eating disorder weight, how much weight was lost, and sometimes growth charts (if the patient is a child or teen and still growing). BMI is sometimes still used to calculate target weights, but it's not a reliable indicator of health on its own and must be used mindfully and in the context of a person’s overall health. Sometimes, a person’s target weight is higher than what seems to be an acceptable weight, according to society’s standards.

Keep in mind target weights are estimates and can sometimes change, depending on how a person’s body responds to nutrition rehabilitation and how they’re doing otherwise (medically, mentally, and emotionally). Additionally, dietitians may adjust meal plans or structures throughout treatment depending on how the body responds and needs change.

The role of therapy and counseling

Since weight restoration can take a toll mentally and emotionally, it’s important to work with a therapist who can hold a safe space for you to express and navigate eating disorder thoughts and difficult feelings (about body image and otherwise) and develop coping skills and strategies to use outside of therapy. There are many therapeutic techniques that can be helpful in the weight gain process, and often a combination of techniques is used, including cognitive behavioral therapy, dialectical behavioral therapy, family therapy, acceptance and commitment therapy, and mindfulness-based therapy.

The role of medical monitoring

It’s critical that you’re having regular medical visits during the weight gain process where your medical team will review factors (aside from weight), like heart rate, blood pressure, and lab values, to ensure medical safety. Often, people in anorexia recovery are at risk for refeeding syndrome, which is a physical process that occurs when some patients who are malnourished start eating regularly again. Medical providers can help monitor and mitigate this risk.

Tracking progress

While we’ve focused primarily on the struggles that come with weight gain in recovery, weight gain also brings so many improvements and benefits, not only in the short-term but throughout life. As you gain weight from anorexia, you’re likely to experience a number of quality-of-life improvements—like improved energy levels, better sleep, more stable moods, increased focus, and healthier vital signs—which are all signs of progress. It can be helpful to journal about any positive changes that occur as you gain weight (even if they’re small), like laughing with a friend, enjoying a slightly better mood, or being able to finish a book.

There’s no need for you to track your weight, since this is your team’s job and it can often cause more distress for the one in recovery (since weight and weighing are often a hyper focus of the eating disorder). You can work with your dietitian to decide how you’ll track progress (outside of weight), how (and how often) you’ll discuss weight, and whether open (seeing your weight) or blind weighing (not seeing your weight) is best for you.

Long-term acceptance and body appreciation

While gaining weight during anorexia recovery is almost inevitably challenging, any distress it causes is a short-term and necessary part of the journey. As you work toward your body’s set point, you can work toward not only acceptance of your new body, but, eventually, even appreciation.

From tolerance to acceptance

At first, it may feel impossible to know how to accept weight gain or your changing body, and that’s okay (and common). The first step is tolerance—being able to manage the multi-layered distress that can come along with anorexia weight gain—and that’s enough until you’re ready to move forward. The next step is acceptance of weight gain. To achieve this, your team will ideally meet you where you are and sit with you in each stage of readiness to accept the weight gain process and eventually your recovered body.

Building body respect

It’s hard to take care of something you hate, so while loving your body is not a necessity in recovery, respecting it is. Here are some of my favorite ways to take steps away from body hatred and toward body neutrality, or taking a neutral yet respectful stance toward your body:

• Practicing neutrality in the mirror. When you’re standing in front of the mirror, intentionally describe different body parts in a neutral way (e.g. “There are my arms. They have freckles.”) to remind yourself that your body isn’t here to be criticized.
• Applying mindfulness to negative body thoughts. Start noticing negative body thoughts and put the phrase, “I’m having a thought that,” before the negative thought, which will help put space between you and the thought, giving it less power. Remember, you are not your thoughts and you don’t have to believe everything you think.
• Celebrating function over appearance. Take stock of all the activities your body allows you to do on a regular basis and focus on that, instead of how your body looks. When you start recognizing all that your body enables you to do, it can feel easier to respect it a little more.

Frequently asked questions

People navigating anorexia recovery—and their loved ones— often have questions about anorexia weight gain, why it’s necessary, how much is needed, and more. Here are answers to some of the most frequently asked questions on this topic:

How much weight will I need to gain?

It depends. Your target weight is based on a variety of factors, including your weight history, your growth chart, your symptoms, and your treatment teams’ recommendations. The amount of weight you have to gain may be very different from another person going through recovery.

“It makes sense to ask this question—when we begin a journey that's challenging, we want to know the destination,” Degener says. “Ultimately, the answer to this is different for every person, and working with a professional you trust will help you identify goals that support your unique recovery. Something I often say is, I had to gain much more weight than my eating disorder thought was ‘okay,’ and overcoming that belief was actually an essential step in my recovery.”

Who decides my target weight?

This can also vary, but it’s typically the dietitian on your treatment team who determines your target weight.

“For many, determining a target weight means working with a registered dietitian who has a strong understanding of eating disorder recovery,” Degener says. “They have a wealth of knowledge and experience working with others who are navigating recovery, and can offer incredible support.”

Why do I have to gain that much weight? Can I still recover if I’m a few pounds short of my target weight?

Adequate weight gain is one of the best predictors of reduced eating disorder symptoms. Not gaining enough weight for your unique body (even if you’re technically in the “healthy” BMI range) can make your recovery more fragile, and set you up for a potential relapse. This is sometimes referred to as 'quasi recovery.'

“Weight is one data point that the treatment team evaluates to monitor progress, and additional factors such as mood and behavior are evaluated as well,” Friedman says. “Generally speaking, the target weight is thoughtfully identified, and achieving this can be critical for ensuring additional growth, return of menstruation, bone health, brain health, and so much more. When folx are able to exceed their target weight they are often in a more stable place to protect against future fluctuations as well.”

What if I don’t think I’ll ever be okay with my weight gain?

Fearing weight gain is often an inherent part of anorexia, so it’s not unusual to worry about this. Self-compassion is one important tool that can help quiet the eating disorder voice.

“Be gentle with yourself,” Friedman says. “Eating disorders are often very effective in convincing us that weight gain is the worst possible outcome. In reality, malnutrition is more likely to rob folx of their futures and steals joy and hope from them in real time. Focus on taking treatment meal by meal, moment by moment, and day by day.”

While it may feel overwhelming or unrealistic to imagine “loving” your body, there are actionable steps you can take to move away from the other extreme on the spectrum and learn to appreciate your body for what it does for you.

“It might feel more manageable to start with finding ways to tend to your body's needs with warmth or neutrality—making sure you get enough rest, wearing clothes that feel comfortable, spending time engaging in hobbies or activities you enjoy,” Degener says. “Don’t expect yourself to accept body changes overnight. This is a process that takes time and has its ups and downs.”

How do I accept the emotional impact of weight gain?

Gaining weight in recovery often causes intense, difficult emotions, which can feel overwhelming and everlasting, but once emotions are fully felt and processed, they can be released.

Additionally, the emotional backlash of weight gain can be an opportunity to get curious about any conditioned beliefs you may have about weight, learn how to safely feel the full spectrum of human emotions, and build more emotional resilience. It’s important to work with a therapist to help you develop coping tools to manage your emotions and create safety within yourself, and to provide a compassionate space for processing anything that surfaces during your weight gain process.

What if I fear relapse due to gaining weight?

Fear of relapse is common in recovery at any point, but it can be particularly strong while gaining weight, so know that your feelings are valid and you’re not alone. The good news is that you can treat this fear like any other hard emotion. Be sure to voice your concern to your treatment team and safe people in your life so you can process the fear and find effective coping skills to help you build more emotional tolerance. It can also be helpful to create a relapse prevention plan with your team.

How long does weight restoration usually take?

The timeline of achieving weight restoration is different depending on many factors including initial weight, target weight, and severity of eating disorder symptoms. For most people who need weight restoration, they can expect to start gaining weight in the first few weeks of treatment. At Equip, for example, 86% of patients are gaining weight by week 8, and 70% have achieved full weight restoration after one year.

Can gentle exercise help me feel better without risking relapse?

Gentle movement can be one of several coping tools to help manage weight gain distress in recovery when it’s done safely and for the right reasons. For example, yoga can help to process big emotions and cultivate body appreciation, which can certainly be helpful while gaining weight. However, it’s important to work with your treatment team on deciding whether to integrate movement or not, and if so, which types and how much.

How do I discuss weight gain with loved ones?

If you feel the need to discuss weight gain with loved ones, or it comes up in conversation, how you respond depends on how safe you feel with them. It’s likely that some people will be supportive, and others may not, depending on their own weight biases and perspectives. If they’re questioning your weight gain, you can let them know that you and your treatment team are working together to make sure you’re as healthy as possible. It may also be necessary to set boundaries in case their opinions are making the process harder for you. It’s best to discuss weight gain with the people in your life that are supportive and understanding and help you along on your road to full recovery.