The following post was originally a document I created for myself to read whenever I was stressing out about weight gain (i.e every second of the day). I read through many recovery websites and blogs, and picked out the information and facts that I found most helpful and reassuring. After showing it to some of my close friends, I found that not a lot of people knew anything about what I had shared with them. And so with that, I thought I would edit the text and make it into a blog post for all you lovely people:
Underweight = being at a weight that is lower than the weight that your body would be if you did not suppress it with restrictive eating or exercise. Therefore, it stands to reason that a person can be underweight at any size. Yes, you can be underweight in a larger body just in the same way you can be underweight in a smaller body. If your natural unsuppressed bodyweight is in the range of a BMI of 23, then you are underweight if you are BMI 20. You can be underweight at any size. You can have anorexia at any size. You can be in a state of malnutrition at any size.
A minimally healthy BMI (say around 20) is usually an inadequate basis for full recovery from a severely underweight state (i.e. a BMI of 17.5 or below). This is something you need to bear in mind when you find yourself wondering whether you really need to regain more weight. If you’re just within the 20-25 ‘healthy range’ BMI but many anorexic symptoms till seem to be in place, the are going to need to regain more weight. The numbers are not your guide to where to stop. There is absolutely no way you will ever recover fully if you decide on an arbitrary BMI like 20 and, once you reach it, start restricting again to make sure you stay there. Dieting is incompatible with recovery from anorexia, both physically and psychologically. This should be trivially obvious, but with all your anorexic instincts screaming at you not to lose control and let yourself get fat and ugly, it can be easy to forget.
Your metabolism won’t normalise until you reach your natural bodyweight. Your bodyweight will stabilise without restriction – but only if you let your weight increase to where it’s meant to be. Otherwise, your still lowered metabolism will force you to keep restricting to stabilise your weight. Set point weight is our bodies natural healthy weight no matter if you eat some days more or some days less, you still end up at the same weight range, and everyone’s set point weight is different. Set point weight = the weight at which your body functions best at and the weight your body is meant to be according to your genetic makeup. Just as you have a predetermined height or shoe size, you also have a predetermined biological weight or set point that your body tries to defend.
Weight restoration is a crucial component of treatment for anorexia nervosa. You are so malnourished that your brain cannot function and so food is quite literally your medicine at the start of your road to recovery. However recovery is such a hard and draining process. As well as having to deal with the psychological and physical effects that come with weight gain, individuals with anorexia nervosa tend to require increasingly more calories to maintain the same rate of weight gain during weight restoration eg. an individual weighing 45 kg may need to eat 4,500+ calories to continue gaining 1-1.5kg a week.
In terms of reminders for after becoming weight restored:
A scary aspect for most people is what to do when they are weight resorted. Should I reduce my intake? Should I start counting calories again? Should I start restricting again? When in reality, you MUST continue to eat even when you have reached a ‘healthy weight’. Weight gain and recovery is never just about the weight itself. In fact, its perfectly normal to be at a ‘healthy weight’ and continue to eat, yet still have an eating disorder due to the way you perceive and think about food. Recovery and weight restoration is about rekindling a positive relationship with food, without guilt and shame, while also learning to eat in line with your psychological and social needs – not just the physical ones.
When an individual is at a healthy weight and has adjusted their intake to maintain that weight, they sometimes assume that the physical healing process is over. Research suggests that it can actually take up to 12 months for the body to fully heal from malnutrition. By about one year out, there is no difference in shape between a weight-restored body and someone who has never had an eating disorder. Most people report a “redistribution” of weight within six months, although many report they begin to feel more comfortable within a few weeks.
Even if you are currently at a ‘healthy weight’ or not severely underweight, by no means should this undermine your deservingness of getting support for an eating disorder. Eating disorders happen at all different weights, shapes and sizes, and just because you don’t fit a certain stereotype, doesn’t mean that you can’t reach out for help. Everyone deserves to be able to develop life long positive relationships with food, and this means seeing recovery beyond numbers, weights and ideals. The real routes to recovery arise when we look within ourselves, and use food to nourish our souls on many different levels. For that reason alone, it is 100% ok – essential even – to continue eating and challenging yourself well into the weight gain process, and even after you have gained a ‘healthy’ amount of weight. Let recovery be defined by the nourishment of your soul, where re-feeding it with love and enjoyment around food is the essential nutrients and vitamins required.
I think recovery really begins to become much more challenging once you are weight restored. Everyone has seen that you are now no longer under weight, that you are now eating regular meals and snacks again, and so that you must be ‘recovered’ (see previous blog post about this). Yet we all know this isn’t true. Weight restoration to your pre-eating disorder body weight is NOT full recovery.
At the end of the day, you either recover or carry on suffering. And it may be hard, but please remember that this goddamn disease will never stop breaking your heart.