‘Extremely Terrified’ of Weight Gain for Anorexia Recovery

By February 6, 2013

I’ve been anorexic for several months, and I have decided to finally seek help. I’ve started going to a psychotherapist and a nutritionist, both of whom have told me that I need to gain some weight. They have given me a meal plan to follow. My parents think I have been trying my hardest to follow it, but I haven’t. I just can’t seem to commit to it, because I am extremely terrified of how the weight will be stored and how my body will cope with the weight gain (Will it immediately turn into fats, will there be bloating, and what if the weight doesn’t stop increasing after I hit my “ideal”?) Also, I think that the amount of weight they want me to gain is too high. I want to maintain a weight a little lower than they have suggested for me, but I know that the dietician and doctor will force me to carry on beyond that weight. The reason I’m stuck on the weight number I’m stuck on is because I know it isn’t exactly underweight; my friend who is the same height is that weight, and she looks stunning, without looking sickly, and she is deemed to be of “acceptable” weight. However my doctor and dietician said it was extremely unlikely that my period will not come back at the weight I’m comfortable with, and a normal period is how they gauge if someone has fully recovered from anorexia physically. I want to maintain a toned, healthy body in future, but with the diet plan, I can’t see that happening. I really want to know, where does the weight go when I first start re-feeding (how will it be stored)? Will I balloon/bloat up immediately (physically) and just fatten until I become obese? What happens if I reach my doctor’s suggested weight and continue to gain instead of maintaining, like they told me I would or promised to help me to? Thank you so much. I know I need help, and the questions I ask are shallow beyond belief, but please, if it’ll help me, I need to know it. – R.

Dear R.,

Congratulations for taking that very first scary step of seeking help and looking for real answers to your struggle. You are making a good start. Let me share with you that these are common fears and questions that individuals like you have asked again and again over the years; you are certainly not alone.

Since I am not your personal dietitian, I cannot recommend the “right” healthy weight for you. I do however, strongly support the therapist and nutritionist in their work with you. To start, a healthy weight for you means you have a healthy, natural relationship with food and activity (not going to extremes with either one), a weight that you can naturally maintain without health problems (such as losing your period) by eating intuitively and engaging in pleasurable activity. The exact number remains to be seen; time will tell. It does not however, have to do with how you look at a particular weight. Comparing what you should weigh to how your friend looks is simply basing belief on false information. That is not the truth for you. Your healthy weight is unique to you. That may be the first struggle to come to terms with.

How will weight be restored? This depends on the needs of your body and how depleted you are. In general, the internal organs on your trunk (the mid-section from your heart to your bowels) need to be restored, and this can feel uncomfortable. If you need adipose (fat), it will restore adipose; if you need muscle/tissue/organ repair, it will restore that, etc. Your body knows best what it needs. You will likely feel bloated as well since your body will work hard to maintain proper fluid balance. You may also be constipated as your body works to properly eliminate all the nutrition you are taking in. Your bowels may have become slightly sluggish and out of shape during the course of restriction/anorexic behaviors. Constipation sometimes feels “fat” and this can be uncomfortable—hang in there! This won’t last as long as you restore weight back to what is healthy for your body. Your body is designed to slow down hunger and weight gain once you resume your body’s natural set point weight; your weight will not mysteriously keep creeping up higher and higher unless you are abusing food by eating much more than you’re hungry for or using food to meet emotional needs. If you are listening to your body, eating when hungry and stopping when satisfied, your set point will remain steady for your particular body.

You mentioned that you were afraid your doctor and dietitian would force you to gain more weight than you were comfortable with. Remember that only YOU can make choices for your recovery. If you don’t follow recommendations, you may not like the natural consequences, but remember you are the one who has the power to make better or worse choices. Nobody can “make” you do this; only you. I suggest you give yourself a first goal of 48 kg then reevaluate once you get there. You will likely be able to keep on going toward your body’s set point weight. Cut down the recovery steps into smaller chunks. I think it helps to make attainable goals for yourself to keep your motivation high. There will continue to be fears along the way. Keep asking yourself, “Is this anorexia working for me? Is this really achieving what I hope to accomplish in my life? Do these behaviors of restriction/dieting/changing my body really align with my values?” If not, keep working toward positive change and be the best you can be. You can do this!

Juliet N. Zuercher, RD