Weight Restoration... What's it all about?

Weight Restoration 101 in Eating Disorder Treatment

If you or someone you know is going through eating disorder treatment, you may have heard the phrase “weight restoration.” For some, weight restoration is a familiar concept, but for others it can be a term frequently thrown out but never fully explained. For anyone with lingering questions or confusion, below is an overview of the what, when, why, and how of weight restoration in eating disorder treatment.

The “What”

Weight restoration is the process of restoring an individual's weight to an appropriate and expected place as a part of eating disorder treatment. Weight restoration at the basic level is the process of gaining weight.

Eating disorder treatment and weight restoration requires supervision under the care of an entire team, including but not limited to; an eating disorder specialized Registered Dietitian, an eating disorder specialized therapist, and a medical provider.

The “Why” and The “When”

Weight restoration is necessary if an individual has lost weight or failed to gain an appropriate amount of weight to maintain proper growth and development. Not achieving and maintaining an appropriate weight can result in medical complications such as the inability of organs to function properly, abnormal heart rate, bone loss, loss of menstrual cycle in individuals with uteruses, lack of appropriate height growth, changes to the gastrointestinal system, impaired

immune functioning and cognitive and psychological changes and impairments. Higher levels of weight suppression, that is, the difference between current weight and highest weight, are associated with more severe eating disorder behaviors and less improvement in eating disorder symptoms. Research shows that full weight restoration is associated with improved outcomes in eating disorder recovery.

The “How”

Nutritional rehabilitation, or establishing appropriate and adequate nutritional intake, is vital in the process of weight restoration. During weight restoration, the body will use food to rebuild tissues and to repair and restore normal body functioning that was hindered or lost. It is normal for an individual to have elevated nutritional needs during weight restoration, as the body requires an increased amount of food to restore proper functioning. Symptoms such as constipation, headaches, bloating, early satiety, nausea, and gas can be common during weight restoration and often resolve as eating and weight are normalized.

How long the weight restoration process takes is highly individualized, based on a variety of factors such as treatment setting, individual biology, the amount of weight needing to be restored, and more. Some individuals may be able to restore their weight within a few weeks, while others might require months or more. In the outpatient setting, weight restoration often occurs at a slower rate than at higher levels of care.

How a provider determines an individual's expected weight can also be variable. For adolescents and young adults, expected weight is usually determined through an assessment of eating disorder history, growth charts, and growth history. It’s important to remember that for children and adolescents, expected weight is a moving target, as growth and development are still occurring and weight should be changing per that. For adults, expected weight is usually determined through an assessment of eating disorder history and weight history. Medical complications and symptoms, cognitive and psychological concerns, eating disorder behaviors, and eating patterns are additional factors that are used to determine an expected weight range.

The “But”

If a doctor or other healthcare provider has told you that your weight is fine when your eating disorder treatment team has told you that you need to weight restore, that can be a confusing situation. Your doctor may not have experience in eating disorder treatment and they may have concluded that your weight is appropriate by using “normal weights” (an average weight range based on an individuals sex, height, and/or age group) versus an individualized recommendation based on your personal weight history and eating disorder history. Your treatment team can talk with your doctor to coordinate care regarding what is most appropriate for you and your eating disorder recovery.

Final Thoughts

It is necessary to remember that while weight restoration is an important part of eating disorder treatment and recovery for those who need it, being weight restored alone does not indicate an individual is done with treatment and/or in recovery. Also, regardless of an individual's weight or the need to weight restore, engaging in eating disorder behaviors is dangerous and a serious concern. Full recovery from an eating disorder is based on many factors including; beliefs around food/eating/body image, flexibility and freedom in eating, cessation of eating disorder behaviors, nutritional rehabilitation, resolution and/or improvement of medical complications, achievement of an appropriate weight, and more.

If you think you may be in need of assistance with eating disorder recovery, please contact us today!