Will I Lose Weight in Eating Disorder Treatment?

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, intentional weight less will never be part of an eating disorder treatment plan at Equip. This is because research shows that dieting is a trigger for eating disorder onset or relapse, undermining recovery efforts.

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.

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 comes in 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 the myth that skinnier means healthier—evidence-based eating disorder treatment does the opposite. Our approach aims to help patients achieve a weight that helps them live nourished, fulfilled lives, rather than focusing on being smaller.

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 can be risky for those in 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

Many patients with eating disorders that involve binge eating wonder if they will lose weight in treatment. The reality is, we cannot predict how a patient's weight will change in recovery: some patients lose weight, some gain weight, and some stay at the same weight.

Rotach adds that sometimes weight changes during recovery 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,” she says.

That said, weight loss will never be an explicit goal treatment goal at Equip (though it's okay and normal for a patient to start treatment still desiring to lose weight).

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.

Jerica Mosello, a Medical Records Specialist at Equip who is in recovery from anorexia binge-purge subtype, 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, according Rotach. Dietitians and medical providers can also help you better understand what nutrition your body needs, and redefine what health looks like for you.

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.

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