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Navigating Weight Restoration From An Eating Disorder

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What Is Weight Restoration?

Weight restoration is the process of restoring our weight to our natural blueprint following weight loss from an eating disorder. 

The process of weight restoration will be unique to everyone.  Individual variation in weigh restoration will include: 

  • The timeline to restore weight (this could take months or years)
  • The amount of nutrition that needs to be consumed to restore weight
  • The symptoms that come along with weight restoration 
  • How much weight needs to be restored.  

The best predictor of exactly how much weight someone needs to restore will be the growth curve that they have followed since childhood.  

For example- If someone from age 1-15 was on the growth curve of the 60th percentile, that is the ideal weight to restore to following weight loss from an eating disorder. 

BMI is not the best indicator for where someone needs to restore weight.  However, if limited weight history if available BMI may be used along with previous weights to determine a starting point for weight restoration. 

Lets talk about what to expect in weight restoration, how to ease symptoms, and common medications and supplements used in weight restoration from an eating disorder. 

Does someone who is at a “healthy BMI” need to restore weight with an eating disorder: 

Yes.  Just because someone is at a “healthy BMI” does not mean they’re meeting the nutrient  needs of their body.  

Someone at a “healthy bmi” that is under the weight of their natural blueprint can experience all of the symptoms of someone at a “low bmi.” These symptoms might include: 

Physical Side Effects Of Weight Restoration

What Happens When I Stop Purging? 

If you have been purging, there can be some fluid and electrolyte shifts when you begin weight restoration and stop purging. 

When we stop purging we may experience acid reflux. 

Heavy levels of a hormone called aldostrone can cause edema in someone who stops purging. 

During weight restoration and cessation of purging a person should hydrate adequatey but not overdo it (about 2-3 liters of fluids a day). 

 Spironolactone is a potassium sparing gentle diuretic that can be used to help with edema (it’s important other diuretics are not used!)

It’s important to note that spironolactone likely won’t work well for those who abuse laxatives as a form of purging. Other remedies should be discussed with your doctor. 

What Does It Feel Like During Weight Restoration For Anorexia? 

  1. You may experience extreme fullness after just a few bites into the meal. This does not mean you should stop eating at that time. Your HAES dietitian and PCP can help you work through this. 
  2. Extreme fullness early in the meal is often related to gastroperisis. When starving, the movement of smooth muscle in the stomach is not prioritized for survival. 
  3. There will likely be some bloating (distended stomach). This may feel both physically and emotionally uncomfortable. 
  4. Resist the urge to try to eat intuitively.  Until normal hunger/fullness cues return, eating should be prescriptive. 
  5. You May Feel Nausea
  6. You May Feel stomach pain/bloating
  7. You might have developed intolerances to foods previously intolerated
  8. Constipation will likely be present (the colon doesn’t want to waste any calories on this in the beginning!)

These symptoms should be expected for about 4-6 weeks.  If symptoms of weight restoration last longer than 6 weeks it might be a good idea to see a GI specialist. 

Gastroperisis and Weight Restoration 

Gastroperis can happen because the smooth muscle in the stomach has stopped functioning optimally. 

If your’e experiencing gastroperisis with weight restoration, here’s a couple things that might help:

  • Choosing a low fiber diet for the first six weeks
  • Choosing fluids calories such as smoothies, soups and protein shakes to meet some of your nutrient needs. These can move through the digestive tract more smoothly in the beginning. 
  • Choose lower protein foods that don’t make you feel as full
  • Small frequent meals 
  • Use a hot pack
  • Relaxation techniques

The good news is, gastroperisis usually goes away when we eat normally again.

Bathroom Habits For Constipation In Anorexia Recovery: 

When and how we use the bathroom is also really helpful when it comes to constipation with weight restoration. 

Good bathroom habits for weight restoration include: 

  • Practice going at the same time each day. Sit on the toilet for 10-20 minutes with no expectations. 
  • Use a squatty potty or stool to get your body in the best position to poop. 
  • Practice relaxation before and during the bathroom use. 
  • Relax with a book, podcast or other distraction so you’re not thinking about poop and creating anxiety. 

When we restrict eating, the body isn’t used the muscles used to digest food and move the stool.  Creating bathroom habits can help the body learn to use these muscles again. 

Common Medication For GI Issues In Weight Restoration: 

  • Spironolactone (A potassium sparing diuretic for those who stop purging)
  • Polyethylene glycol (for constipation)
  • Metoclopramide (prescription for constipation)
  • Glycerin suppositories (for very hard stools)
  • Magnesium hyroxide (for constipation)
  • Magnesium citrate (for constipation)
  • Digestive enzymes (if intolerances are present)

Supplements Recommended While Weight Restoring 

  • B1 0r Thiamin (helpful with high metabolic rate)
  • Zinc
  • Probiotics (for altered gut microbiome-type should match symptoms)

What Are Some Risks Of Weight Restoration In Eating Disorders? 

Any time there is weight gain with the weight restoration process in eating disorders, there is risk. 

Weight restoration in bulimia nervosa should be closely monitored for electrolyte and fluid shifts. 

Weight restoration in anorexia nervosa should be closely monitored for refeeding syndrome

What Is The Process Of Weight Restoration?

Weight restoration begins when we increase nutritional intake, reduce physical activity level or both in order to increase body weight to where our body should be.

I call the weight the body prefers to be at our genetic blueprint weight or set point weight. 

Here is what you should expect in weight restoration: 

  1. Energy is increased. You will often be provided with a eating disorder recovery meal plan by your dietitian. 
  2. You will begin to have changes in the body.  Weight changes of at least 1 lb per week are usually ideal. 
  3. Your metabolism will speed up in the first few weeks of increased intake. Therefore, there might not be immediate weight changes. 
  4. You may notice changes in your hunger/fullness cues
  5. You may experience binging if you have been restricting
  6. There will likely be an uptick in your eating disorder voice , food guilt, and body checking.  

It’s important to consider that some people will experience hypermetabolism in anorexia recovery. In hypermetabolism, energy needs are extremely high. You will need to work with your dietitian to create a meal plan which may be 3-5x greater than what is expected for weight restoration.

Eating Disorder Recovery Weight Gain Expectations 

Many measures are used to determine when someone is weight restored.  Soem things used to calculate what a good goal weight after an eating disorder will be include: 

  • Weight prior to eating disorder
  • Weight history (highest and lowest weights)
  • Growth charts (it’s important to see people continue on their own growth curve)
  • restriction/binge/purge behavior and relationship with food once the target weight is met
  • Cessation of eating dysorder symptoms such as lanugo, coldness and fatigue 

If there is limited access to these variables, ideal body weight can be used ONLY as a baseline.  A 10-20lb range should be calculated when determining if someone is weight restored after an eating disorder. 

While getting your period back after restriction might be a good indicator of becoming nourished, it does NOT mean one is fully weight restored.  

Even if someone is in the estimated range for beeing deemed “weight restored”, it may take several months for a period to become normal again. 

Why Am I Experiencing Extreme Hunger At A Normal Weight?  

Even if your body is deemed to be at a normal weight for your genetic blueprint, you may feel extreme hunger. 

Extreme hunger is very commonly associated with eating disorder recovery. 

Extreme hunger at “normal weights” can be related to: 

  • Hypermetabolism 
  • Hormonal changes that happen in a binge and restrict cycle 
  • The body has not actually reached its genetic blueprint.  It requires more energy even though we are at a “healthy BMI”

Is Weight Restoration Necessary?

Yes.  Even if we are consuming enough calories, our body needs to reach its genetic blueprint in order to function properly. 

Without adequate energy stores in our body we will continue to experience decreased bone mineral density, irregular hormones, and missed menses even if we are eating a prescribed amount of calories. 

How Long Does Weight Restoration From An Eating Disorder Take? 

This is highly variable.  The amount of time it takes to weight restore will depend on factors like

  • Genetics
  • Metabolism increases with now getting enough food
  • Hypermetabolism that can occur after malnutrition 
  • If a person experiences binge behavior 
  • If purging is present 
  • How long an eating disorder has been present
  • The amount of weight that was lost following the onset of an eating disorder
  • Stress

Weight restoration can take anywhere from a few weeks to several months.  For those that are struggling to meet their meal plan or engaging in purging behavior (diuretic use, vomiting or exercise), weight restoration can take years. 

There is no expected time frame for weight restoration following an eating disorder. 

How Can I Gain Weight Quickly?

Weight restoration is scary.  Many people suffering from an eating disorder go into the mode of “restoring as quickly as possible.” 

This makes sense since many with eating disorders have a tendency to want to do things “perfectly” or “recover and get it over with.” 

However it’s important to remember that a meal plan by a dietitian is designed to fit your specific needs for weight restoration.  The best way to gain weight in the a quick time frame is to follow your meal plan. 

While it is perfectly normal and encouraged to go above your meal plan if you’re feeling mentally or emotionally hungry, forcing yourself to eat extreme amounds of calories above your meal plan may cause an increase in some of the unpleasant side effects of weight restoration. 

Weight Restoration Is Not A Linear Process 

There is no single right way to go about weight restoration for everyone. 

While many symptoms will be present for those with restrictive behavior across the board, Symptoms will vary from person to person. 

It is important to consult with your doctor, dietitian and therapist on some of the best ways to alleviate symptoms associated with weight restoration. 

There is no specific timeline for when someone with an eating disorder will be”weight restored.”  Trust your own process and know that with a recovery mindset and the right support team, weigh restoration and recovery is possible. 

Shena Jaramillo. Registered Dietitian

Hi I'm Shena. I'm an eating disorders dietitian in Washington state. I hold bachelors degrees nutrition & dietetics, cultural anthropology & psychology. I believe in honoring your hunger, having your cake whenever you want it, and that critically analyzing diet culture can change the world!