When I had anorexia, I did not suffer from body dysmorphia, so I was acutely aware of how thin I looked and unattractive it was. I know that this is not the case for all sufferers, but I think that regardless, many will find this account useful for recovery purposes.
Recovery takes a lot of work—both mental and physical—and it is a process. Anorexia affects everything from behavioral pattens to biological systems. I was scared to eat, and then when I did I felt sick and bloated. Nothing about recovery was easy, but thankfully I was one sufferer who relished having some flesh to cover me when I did begin to put on weight.
Emaciated had never felt good to me, it felt uncomfortable. Literally: my seat bones would dig into even the softest of seats and sitting always gave me a sore backside. I was covered in ugly reddened patches of skin where the bones rubbed against my clothes. Whoever thinks that eating disorders are a vanity problem I’ll show you pictures of me looking haggard and dead at age 20. Eating disorders make you ugly.
In my biggest recovery effort, I finally I started to put on weight again. It felt good. I could sit down without getting sore. Clothes looked and felt better. I actually enjoyed feeling my thighs rub together, that spelled victory to me over anorexia. I was winning. I was living again.
But then, the “fat tummy” came. Whilst I knew that gaining weight was what had to happen in order for me to get better, I wondered if this disproportionally fat tummy was normal.
I seemed to be putting on more weight in my abdominal region than anywhere else. The distribution of my bodyweight seemed uneven. And it bothered me.
As a person recovering from anorexia, it was difficult to talk to people about this sort of thing, as any mention of belly fat and people would immediately jump to assuming that I was having negative body issues (sigh) or even worse … a relapse.
I was having neither of these things. I was hell bent on recovering and honestly felt that if I needed to be overweight in order to not have anorexia than so be it. I also knew how great I looked, but I found myself covering up my stomach, which was certainly disproportionately large.
Is the Fat Tummy a “Normal” part of Eating Disorder Recovery?
I just wanted to know if this belly was normal. I asked Google, but initially all the answers that I got were fluffy feel- good memes such as accept yourself and you are beautiful. I was frustrated. It was as if questioning the distribution of fat on my body was taboo. It is hard for people to understand that I was not questioning my self worth, I just wanted to know why my weight gain was so uneven.
Finally, after turning to science for an answer, I found this study. The highlighted red line made me feel so much better:
One of the cardinal symptoms of anorexia nervosa (AN) is the fear of gaining weight and becoming fat (DSM-IV, criteria B). With near-delusional conviction, patients tell us that if they gain weight, it will be “all fat and no muscle.” Another common complaint during treatment is that weight gain isn’t being evenly distributed, but is collecting “all in my stomach.”
I realized even after reading that much that was all I had needed. I had been looking for something that would tell me that this protruding stomach was ok.
Yes: The Fat Tummy is a Normal Part of Eating Disorder Recovery
The conclusion of that particular study was that:
patients with anorexia nervosa may demonstrate an abnormal distribution of body fat (lipodystrophy) that preferentially deposits fat to the trunk and away from the periphery
Why this matters to me:
This is not a blog post that I have put up without really considering what my point is. I do not want any sufferer to ever read anything that might put them off recovery, and the knowledge that belly fat will be gained is certainly something that could do just that.
However, this fact is important to be aware of in terms of recovery, and just because it is not easy to talk about I do not think it should be ignored. It is very likely that a sufferer in recovery will experience stomach fat like I did, and steps should be taken to ensure that it does not cause them to restrict calories again.
Many sufferers of anorexia have a distorted body image also, and if it was hard for me to come to terms with the amount of fat around my middle it will be even more difficult for a sufferer with body dysmorphia to deal with.
This is a tricky topic, and I think for child sufferers who are being re-fed by parents and food intake is out of their control it is not something that needs to be brought into discussion unless it comes up as a sticking point. But for those of us who are adult sufferers and ultimately responsible for ourselves in recovery it is vital that we know what we are up against. We need to be aware of the things that are likely to come up in our recovery path that we are on so that we can protect ourselves against relapse.
Why it matters to sufferers in treatment:
I think that in terms of preparation for long term recovery, sufferers need to know from the start what that might look and feel like. The acceptance of an increased amount of fat around the stomach in the short term should be something that is worked on from the very beginning of recovery, rather than something that is not spoken about in the hope that it will not happen.
Personally I worked this out with myself my identifying my stomach fat as a trophy, it proved that I was winning.
Recovering from anorexia is hard enough. As an adult in recovery, I think that being set up for all the challenges that might have caused me to relapse from the beginning would have in the long run been helpful. When I knew that belly fat is a sign of recovery I could work on accepting it. I could even make myself love my sticky out stomach because I taught myself to see it as a trophy.
Does my experience mean that yours will be the same?
No. Because we are all different, we all experience anorexia differently and we all experience recovery differently; however there are many of us that share symptoms and experiences, and in talking about them we can help one another understand.
Why Does the Fat Go To Your Stomach When You Recover From an Eating Disorder?
I was underweight for over ten years, and I wondered if it was due to this that my body was so effectively storing fat on my stomach.
This study looked at the effect of weight distribution in terms of length of malnutrition period. It recognized that patients with eating disorders are heterogeneous with differing degrees of malnutrition and clinical abnormalities. It also states that due to earlier diagnosis nowadays, most cases of anorexia are getting less severe (I wonder if you agree this is true?). Their results showed that only patients with prolonged malnutrition have an altered fat distribution.
In this next study that I read there was some discussion of why.
‘A decrease in gonadal steroids has been reported in anorexia nervosa and may also contribute to the preferential fat distribution encountered in our subjects. It is well known that estrogen and progesterone modify body fat distribution by increasing peripheral or subcutaneous fat deposition”
But the writers are very clear that this is an unconfirmed hypothesis. What was also interesting in this study is that they found that after prolonged weight restoration that body fat redistributed itself more equally.
I remember reading this and bucking up a bit, was this implying that after a while my fat tummy would redistribute itself?
Another study also implied that this abnormal weight distribution was apparent in shorter term but that the longer term effects were unknown.
This study indicated;
….weight-recovered women with AN who are able to maintain a normal body weight show redistribution of adipose tissue back toward the distribution seen in matched control subjects over 1 y of follow-up.
And so does this one which showed that the abnormal distribution of body fat appears to normalize within a 1-y period of weight maintenance.
In short, if I kept eating and kept my bodyweight up my body would begin to store less fat in my stomach area and distribute it more evenly overall.
I have to say that this really helped me to accept it and to keep eating! I had my doubts that my bodyweight would redistribute for sure, but all I needed to help me keep pushing through recovery was to discover that firstly I was not the only person to experience this, and secondly I might even out if I kept going.
Thankfully, not every person suffering anorexia is malnourished for as long as I was. And hopefully due to sharper diagnostics and more efficient treatment those that do suffer need not do so for ten years like I did. With this in mind I am hopeful that most people recovering from anorexia will not experience as much of a distorted weight gain as I did. And even if they do, they should be made aware that this is their bodies short term response and that if they keep doing with recovery it will even out.
My body needed a long time at a restored bodyweight before it began to redistribute the stomach fat more evenly, I found that once I had educated myself and understood that this was probably normal for me, I had a much easier time with it.
Did My Fat Stomach Redistribute?
After over a year of a restored bodyweight, my stomach fat dispersed and my legs and arms looked fantastic. This was around the same time that I also got my period (I wrote about that in detail too).
The fat tummy was potentially a relapse point for me. When I educated myself as to the science surrounding anorexia recovery, I was able to develop confidence about the path my own recovery was taking. Education helped me avoid relapse.
I think it is something that adult sufferers should be made aware of when they embark on recovery, this way proactive steps can be taken that will reduce the potential for relapse should stomach fat occur.
Thank you for reading. If this post was helpful to you, my book—Love Fat—tells in detail my journey into, and out of, anorexia.
2017 Update to this post
I have since written a number of blogs on overshoot (fat belly) and the importance of it in eating disorder recovery. You can find them here
I now officially offer recovery coaching for adults with eating disorders. You can find out more here.
I am launching a meal support service for adults in active recovery from eating disorders. You can find out more here.
I am offering 2-day clinics in using principles of FBT to help adults with eating disorders recover. You can find out more here.