Weight Gain Plateau in Anorexia Recovery

By November 15, 2012

I used to eat very little and lost a lot of weight. My BMI dropped to **. I realized the dangers of anorexia and have gotten back to eating normally. Now my BMI has increased to ***. However, my weight gain has reached a plateau even though I am already taking 3 servings of Ensure a day between my 3 meals and have stopped all exercises. This is getting quite frustrating because I simply dislike drinking Ensure and hope that I can reach my normal weight as soon as possible so that I can stop drinking it. Following is an illustration of my daily meal plan: BREAKFAST: 2 slices bread, 1 bowl cereal, 1 cup milk. SNACK #1: 1 can Ensure LUNCH: 1 bowl rice/noodles, 1/2 to 1 cup vegetables, 1 palm-size meat, 1 fruit. SNACK #2: 1 can Ensure. DINNER: 1 bowl rice/noodles, 1/2 to 1 cup vegetables, 1 palm-size meat, 1 fruit. SNACK #3: 1 can Ensure. I would like to know if it is dangerous to remain such a low weight even if I am eating properly now. Thanks. – anonymous

Dear anonymous,

There are basically three reasons why it takes a great deal of extra calories to gain weight following extreme weight loss:

  1. When one loses a large amount of weight, a good deal of that is lean body tissue composed of protein. It takes about three times as many calories to synthesize a pound of lean body tissue as it does adipose (fat) tissue. So where it would take a small increase in calories to produce a gain in fat tissue, it takes quite a bit more to add lean tissue.
  2. The mindset of one who has lost weight and now struggles to cope with gaining weight produces a hyper-metabolic state. The fear of gaining weight often produces acute stress and necessitates a high caloric intake while at the same time the appetite quickly diminishes.
  3. The ability to digest and absorb calories is greatly diminished as a consequence of starvation. The body has diminished its reserve of digestive enzymes (composed of protein) to compensate for the absence of nutrients during the starvation period. Also the mucosal cells lining the absorptive surface of the small intestine are diminished which must be replaced to allow for healthy absorption of protein and fat.

An individual should strive to achieve at the barest minimum a BMI of 19. This is about 90% of the lowest value acceptable for healthy body weight. Reasons for this are not intended for aesthetic purposes but health reasons. At this BMI, all of the bodily protein needs are restored.

Complete restoration is essential for two significant reasons:

  1. The restoration of neurotransmitters (monoamines made from protein) which allow the brain to function properly and support mood.
  2. To establish a reserve of antibodies and interferon which fight inflammation, bacterial and viral infections. Less than a 19 BMI puts an individual in jeopardy should they get sick. They are potentially unable to mount a defense by their body’s immune systems. At a very low body weight (<13 BMI) the body was protected by cytokines and prostaglandins that were on high alert and give the starving person a sense that in spite of starvation, sickness was rare and non threatening. As they move from starvation (between BMI 13 – 19) to healthy body weight they are in jeopardy of not having the capacity to fend off diseases such as avian flu, Aids, cancer etc.

Recovering from a disease as devastating and life threatening as anorexia is hard work. This is one reason that treatment centers are so beneficial. They accelerate recovery 3 – 6 fold and lessen the burden on the patient by having certified eating disorder dietitians available 24/7 to monitor and assuage this difficult task of re-feeding and achieving minimal weight. If one chooses to deal with this on an outpatient basis it takes incredible resolve to work through difficulties and challenges like consuming Ensure and the frustration of painstaking slow gains and plateaus. Even going it alone necessitates a nutritional program designed to contain a food plan much higher in calories (and probably more fat) than the current intake reported. (Your current intake might be ideal to maintain a healthy weight but I would be surprised if it would produce a significant weekly gain).

Dr. Carson

Dear anonymous.,

First, I’m so glad that you recognized the serious and dangerous path you were following. You have taken some very positive steps in trying to eat more and attain a healthier weight. You are on the right track, but need much more help.

Although I don’t have enough information and can’t do a full assessment via the Internet, I would agree with Dr. Carson that you are still not consuming enough calories, especially considering the current physical needs of your body. Ensure is an excellent supplement to help replenish some of your depleted nutrition reserves and add much needed calories, but you still need to be gradually increasing your food intake from other sources. I suspect that this is difficult for you to do, because your appetite will take a while to normalize; you probably still feel full very easily.

I am very concerned about your still very low weight. You really need medical support and careful monitoring because your body is in such a vulnerable state and calories have to be increased gently to avoid other complications, such as re-feeding edema. And there are other options that can be tried besides Ensure, to give you more variety (or something that tastes better to you). In addition, you need professional guidance not only for your physical needs, but to help you understand the underlying emotions and issues that triggered the weight loss.

Dr. Carson has given you excellent advice in recommending that you seek out an eating disorders treatment center, in which you would have a whole team of experts helping you to get stronger and recover. Read the article “Finding Treatment” for more information on this point.

Keep moving forward and take good care of yourself!