Concerned About Daughter’s Weight Fluctuations During Anorexia Recovery

By January 7, 2013

My daughter is anorexic and is seeing a nutritionist and a team of doctors. This week she lost 2 ½ pounds. Her Dad has been with her when she eats, and she has been eating well. She has not been bulimic. Is it possible to lose weight after gaining a few pounds if your body is trying to refuel? I need some insight as to why this could happen since she is not throwing it up. Thank you. – Karen

Dear Karen,

Great question. There can be many reasons for weight fluctuations; usually fluid shift is the main culprit. Assuming there is nothing organically wrong with her kidney function, sometimes the weight drop looks worse than it is because the initial weight was “inflated.” Reasons for an inflated weight include: constipation, water loading (secretly, in the shower, etc.), excessive sodium intake and/or PMS water retention (if she is even menstruating). In these cases, it only makes sense to see a drop because the body is trying to establish homeostasis by resuming normal fluid balance.

Other reasons why her weight may have dropped too rapidly include: self-induced vomiting (which you have ruled out), laxative or diuretic abuse. Or at the very least, even though she is eating well, she may not consistently be taking in adequate calories. Otherwise, it is very unusual to see such a drop if none of these behaviors is happening. In my experience, when an individual in the refeeding process is consuming roughly 1000-2000 calories above maintenance needs (~3000-4000 total calories) per day, there are very few times that weight drops more than a half pound or so. The next day, it typically restores back to the expected rate of weight gain.

Be sure to discuss these scenarios not only with the treatment providers, but with your daughter as well. Try to make it as easy as possible for her to make good choices and as uncomfortable as possible to make poor choices. I know, easier said than done.

You are asking the right questions and it sounds like you are very supportive of your daughter’s recovery – I commend you!

 Juliet Zuercher, RD