There are certainly problems that arise with “target weights” in Anorexia recovery. The biggest, overarching theme is that they are set too low. I wrote about this in length in this post titled Anorexia Recovery: Why is it that treatment seems to serve my eating disorder better than it serves my recovery? Here are some more thoughts to help build on that understanding.
Oh the irony that a person facing starvation and offered professional help is then set a target weight that equals BMI (Bloody Misleading Index) 19, or even more tragically, in some cases, lower!
BMI 19! When I was BMI 19 I was drastically underweight. When I was MBI 19 I was sick in the head — my eating disorder was very strong at this weight. I would not have reached full recovery at a BMI as ridiculous as 19.
I hate this. I hate hearing this. At the risk of sounding like our friend Donald, it is a huge problem. Not only does it kick people out of treatment before they are even a quarter of the way to recovery, but once a sufferer is told a low “target weight” it gets tattooed on their brains as a “maximum” and can affect them for years or a lifetime after.
I tend to work with adults in recovery who have already been through many recovery attempts and IP stays. Most of them have been kicked out of treatment at a magic number that is TOO LOW and they are not recovered. So of course as soon as they are out they lose weight again because even through their weight has risen a bit, they still have a very active mental illness telling them that they are too big.
One of the biggest battles for me as a recovery coach is getting that “target weight” that someone with a BMI chart on a clipboard told them 6 years ago out of their heads. Like I always say, the body is not a calculator, so doing math in order to determine what size a body should be isn’t the right way to go about it. But, the more immediate problem is that when a target weight is set too low, it doesn’t allow the body to get to the buffer weight it needs in order to fully make the repairs and take on the healing it has to in order for the brain to fully recover.
In brief: target weights are set too low and this doesn’t allow the brain to recover and, therefore, the mental illness is still present despite any relative weight gain.
Piled on top of this, is that the RDA for caloric intake is ridiculous. I see meal plans set at 2,500 calories a day. If I had only eaten 2,500 calories in recovery I would never have made it to full recovery. If I were to eat 2,500 calories a day now, I would be in relapse by next week. Seeing these low calorie meal plans makes me want to cry. It creates a visceral pain in me. I would still be living a life infested with Anorexia if I had tried to recover or even maintain recovery on 2,500 calories.
The body is an organism, but for the sake of this story, lets pretend we are talking about an organization. A business.
If a business had Anorexia, it would have been operating at a loss for years. Years and years for some of us! Money going out and not enough coming in to cover costs. This business would be bankrupt. It would be worse than bankrupt. It would have gone under, but for the sake of argument let us assume that this business is salvageable.
If the business’s annual operating costs are $1,000,000, to save the business, you cannot give it $1,000,000 and expect it to be okay, can you? No. It needs $1,000,000 + whatever it owes to pay off its debts + whatever it needs to repair infrastructure + + + etc.
The point is that when there is a large deficit, it is not enough to only raise enough money to cover present operating costs. Years of deficit will have meant debt has accrued. Therefore, the sum to get that business operating well again has to cover present operating costs and cover the accrued debt.
Another example. I’m overdrawn and homeless. If you give me the money I need to pay off my overdraft and put my bank account at zero, and then give me a job that pays enough to just cover food and shelter, I am going to be living paycheck to paycheck. I will not have any extra money to do anything else. In order for me to really get back on my feet, I need enough to pay off my overdraft, and pay for things like a deposit on a place to live, buy new clothes, go get a checkup at the Drs.. etc.
When you take a person to a (too low) target weight, then instruct them to only eat enough to maintain that weight, you are making them live paycheck to paycheck. There is no slack. There is nothing extra leftover to make repairs and to give the body that buffer zone that it needs in order for the brain to heal.
Okay, I get that the human body is not a bank account so those analogies only go so far. Ironically though, it’s actually even simpler with the human body in some respect. Simpler because bodies, unlike businesses and bank mangers, are pure with the way that they distribute income. The body will use calories in the best way to serve the organism. Every time. Sure, throwing excess money at a person may result in spending on items or purchases that don’t serve that person. Throwing excess money at a bankrupt business holds no guarantee on a return on investment either. But putting extra calories in a starving body holds no such risk. The body will use those calories to serve the organism, and therefore serve the human the most efficient way.
TL;DR: If a person has been in energy deficit for a number of years, they need to weight restore plus some extra and then keep eating a LOT of food so that their body can not only deal with the day to day caloric expenditure of running a body, but it can also invest in making repairs etc. This is why I had to overshoot my pre-ED weight by a bit and stay there for a year before my period came back and my hair began to grow normally etc. This is why overshoot should be normalized and not considered “extra.”
I know I go on about this. I tell you what; I’ll quit ranting about it when I stop receiving emails from people with Anorexia that contain statements along the lines of “I tried to tell my dietician I am still hungry but she said that I should stick to my meal plan,” or “I am afraid to eat more in case I eat too much.”
Is this is some kind of sick joke? I mean, you cannot make this shit up really. It is utterly nonsensical, confused, cockeyed, upside down and disordered. Treatment professionals are telling emaciated people that it is possible for them to eat too much food.
I didn’t spontaneously combust after eating upwards of 10,000 calories a day in recovery — and very often a lot more than that. I didn’t develop Binge Eating Disorder either. I just lived happily ever after (minus the odd blip and having to do taxes). I’m not saying everyone has to do it this way — not all people in recovery get the bottomless pit syndrome like I did. We are all individuals and have to be respected as such. I am however saying that we have to see eating a lot of food in eating disorder recovery as the most appropriate course of action if the individual in recovery is able to do it. And that eating more should always, always be encouraged.
The most painful part of all this for me, is that all the damage that is so often done when target weights and caloric intakes are set too low is utterly avoidable. It is as simple as not putting a ceiling on intake. Furthermore, the risk of causing an individual damage by allowing them and encouraging them to eat as much as they want is minimal. So minimal in fact, that one wonders why limits are placed on intake and weight gain at all …
Oh yeah. I remember. It’s not just the individuals with Anorexia who are scared of fat — the treatment is too.
And that is as absurd as saying “Well, we don’t want to give Syrian refugees too many clothing donations … they might turn into fashion victims.”
dear Tabitha ~
I cannot thank you enough for your blogs. Thank you so much ! Do you do phone consultations ?
My niece is 18 has had an ED for at least 2 years. She is living with her Mom, my sister. They are basically
trying to do it just the two of them. My sister quit her job to take care of Brook, feed her etc.
Anyway, I would pay you to consult with one of them from time to time……
take care !
Your post is very interesting & I am most interested in who the Donald is that you mention in the Post?
I am a 14 year old.Before my ED began, i was around 39-40 Kilos, 155 cm tall.Somehow, i thought i was fat and i stopped eating so much junk food. My supposed eating regimen transformed into anorexia. I was an anorexic for around 5 months, the whole second semester of my year 8. My weight dropped to a stunning 30 kg, my hair start to fall, my memory was constantly foggy, i had iron deficiency. I couldn’t concentrate on my exams.It wasn’t that my folks didn’t talk with me or anything, i was quite recently stubborn.Finally after the exams were finished, i chose to recoup, at home. Keep in mind i was still effectively limiting my nourishment admission and endeavouring to keep away from – undesirable sustenance – , and since it was the period of Ramadan, i took out the risk to fast.After 1 month,my weight crawl ed to an all the more better yet in addition still low 34. My family chose that an occasion to Malaysia for 1 month would appear perfect.That’s the point at which i began eating like anything. 1 month is almost finished now, my weight went to a 36 – 37, 156 cm tall and i move and swim lesiurely around occasionally. Regardless I feel hungry constantly, so worn out, so denied of vitality, i eat till i am full , yet I feel hungry and need to eat up everything in the open smorgasbord or refrigerator , i wasn’t an anorexic for too long.So do you know why is this happening ?
PS. I didn’t have my period before i was anorexic , neither do i have it now. Does it have anything to do with it ?
Just testing to see if I could post from this computer. Five out of five stars for your article. I couldn’t agree more. I was a semi-anorexic male, 25 years old. I lost 30 pounds in one month. The ‘calories in calories out’ saying is utter BS. Lots of websites have recommended me to eat 2200-2700 calories a day, with my physical activity. I’m thinking, are you f***ing kidding me? I’d have to lay in bed all day for that to sustain me. I still monitor my calories but I don’t restrict anymore. I’m getting on average 3700-4200 cal a day and am still losing weight. On cheat days I go well above 6000. I became really depressed after a few weeks of strict dieting and it just got worse and worse. I realized that malnutrition-starvation does greatly effect one’s mood. Thanks again or your post.
Thanks for your post which I found really helpful. I’ve chosen to regain some of the weight I lost by deliberately undereating for a while as a result of getting focused on BMI. I lost from BMI 25.3 and a healthy body fat percentage to 22.1 and way below the body fat percentage recommended by Bodystat machines used by gym instructors in 11 weeks. I’m so glad I caught things early this time. I’m a slightly Autistic man with a manual job that needs a considerable amount of muscle. My recovery target weight gives a BMI of 23.8. This will be reviewed and increased if some of my weight goes on as muscle. I’ve been on a weight gain diet 13 days now and will retest weight and body fat only every 2 weeks. Any more is obsessive. I don’t count Calories. I just eat slightly more than I did before this episode and catch trains most of the way to work rather than a lengthy cycle ride in addition to a day’s physical work. I’ve accepted I may need to return to what I was before to be really healthy again. I was already experiencing: headaches, faintness almost every time I stood up, exhaustion, difficulty sleeping, increased anxiety, feeling cold in a warm room, feeling the saddle on my bike in contact with the bones in my bottom, ribs starting 2 show in the mirror and hair growing slower than normal even with the above weight loss. I will now put being healthy above trying 2 have a BMI below the midpoint of the “healthy ” range