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 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 accompanies 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.

Why you need to gain weight in anorexia recovery

Commonly known as “weight restoration,” gaining weight during the anorexia 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 important to note 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 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.

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.”

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 those 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 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 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.”

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:

• Find comfort where you can. “Taking comfort measures can be very useful,” says Friedman. Some comfort measures she suggests 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, or playing games).
• Cultivate a supportive circle. “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.”
• 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. “One thing that was impactful for me was switching up my engagement with social media,” Degener says. “Sometimes this looked like taking full breaks from it, but other times this meant making sure I was following a diverse crowd of content creators and seeing folks in all different bodies living life 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.”
• Become aware of your words. This strategy is for friends, family, and other folk whose loved one is recovering from anorexia. “If you're supporting someone who is seeing body changes in recovery, being mindful of the language you use can have a tremendous impact,” Degener says. “It's common to want to offer reassurances, like, ‘we won't let you gain too much weight,’ or ‘you don't look like you've gained too much!’ While this can be well-intentioned, it ultimately serves to reinforce the idea that weight gain is something to be feared, and places importance on one's appearance.” Degener instead recommends using emotionally validating statements, like “I can see that this is a really difficult experience for you, and I'm here for you.”

It’s important to understand that often, distress and discomfort is part of the process; at first, your goal may not be to embrace or even accept the weight gain, but simply to tolerate it. As you move toward recovery, you can also move toward a deeper acceptance and, eventually, appreciation for your healthy body.

Common questions about weight gain in anorexia recovery

People navigating anorexia recovery—and their loved ones— often have questions about 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 usual 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. “You don't need to expect yourself to accept body changes overnight. This is a process that takes time and has its ups and downs.”