Eating disorders are complex issues affecting people from all walks of life. They are an expression of anxiety, social pressures, family dynamics, biochemistry and unhealthy coping strategies. Individuals who suffer with an eating disorder come in various body types and present with different behaviors, but at the bottom of it all is one core fear – the intense fear of weight gain. This fear becomes so loud that it takes on a life of its own. It begins to dictate the thoughts, emotions and behaviors of the individual. Even the threat of a few ounces of weight gain can send someone into days or weeks of spiraling behaviors. Avoiding weight gain becomes the focal point of the individual’s life.
In the treatment of all types of eating disorders, facing down this fear is cornerstone to the recovery process. This becomes especially important for clients who present with low body weights, such as patients with anorexia nervosa. A very low body weight is one of the diagnostic criteria for this disorder which, if left untreated, will hinder the recovery process in every way. Let’s look at some of the changes brought on by low body weight and why it is so important to address body weight early on in the treatment of anorexia.
Physiological Changes – When a client maintains a very low weight, especially for a prolonged period, it will begin to take a toll on their body. This can be reflected in labs, bone health, hormone levels, sleep, gastrointestinal discomfort, sexual drive and ability to maintain physical activity. Those suffering with anorexia will often try to convince their family members that they are “fine” despite the decline in their physical wellbeing. It is important to support the sufferer with solid evidence that they are indeed not “fine” and are in need of medical care.
Cognitive Instability – A low body weight will make it difficult to stay alert and concentrate, which takes away from the client’s ability to engage in their lives in meaningful ways. Additionally, clients will describe a constant preoccupation with food, finding their thought life dominated with food rituals, cooking shows and recipes. This is agitating and will often fill clients with shame as they find themselves dominated by disturbing food fantasies.
Emotional and Social Distress – Withdrawal and isolation are typical of people who are underweight from anorexia.. The eating disorder causes individuals to pull away and to spend more and more time alone with their behaviors in order to avoid the questions and concerns of others. To further complicate the situation, anorexics may experience mood swings or apathy toward things that previously brought them energy and delight. This inevitably leads to strained relationships and in extreme cases can turn into social anxieties, especially around eating situations.
Unwanted Behaviors – For some, maintaining a low body weight will develop into patterns of binge eating. As the body begins to “scream” for the calories it so desperately needs, clients will feel terrified as they “lose control” around certain foods or situations. The eating of the calories itself is not the problem, but the way the client relates to the food during the binge episode and the intense shame that follows can lead into the development of purging behaviors, further complicating the eating disorder.
Gaining Weight in Treatment
As you can see from the list above, weight restoration needs to be the top priority in treatment for anorexia. Increasing the daily caloric load and decreasing the physical activity will get the weight going in the right direction. At first, the amount of food will be overwhelming. It is typical to support the diet with nutrient dense liquids and foods such as juice, protein shakes, peanut butter and avocado. This will maximize the amount of calories going in while controlling for volume in order to avoid feeling uncomfortable. Support and supervision are of the utmost importance as the weight gain process is physically and emotionally very difficult for the client.
The early stages of weight restoration can be done at a residential facility where a patient is admitted for 30 days of supervised meals, or it can be done from home, with the support of family and friends. Rarely is a patient able to adequately restore their weight, and maintain it, when living alone. Partial hospital programs are also an option, which offer clients support for part of the day while still allowing them to stay in school or at work.
How Much Do I Need to Eat?
This question comes up often as patients engage in treatment. Typically, this decision will be made by a registered dietitian, physician or a nurse who is experienced in the care of eating disorders. There are some medical risks associated with refeeding, and these must be closely monitored, especially in cases of very low body weight. If you, or a family member, have been diagnosed with anorexia and are trying to gain weight, it is safe to make gradual increases, but a treatment team needs to be established as soon as possible.
What do I Need to Eat?
There are many ways to healthfully restore weight. Clients often want to know a list of “perfect foods” to eat to help them gain muscle and not fat. There is no such list. Clients need to be discouraged from this “fat phobic” language and need to learn that for them, the healthiest thing is indeed, to gain fat. Again, many foods will reach this goal. As long as the client is getting enough calories, they will begin to gain weight. During the early stages of refeeding, adequacy of calories and a balance of the appropriate food groups will be the primary goal. Later in treatment, variety, spontaneity and social eating experiences will be encouraged.
Gaining weight is the first priority in the treatments of anorexia. It is critical to reverse the effects of malnutrition and to get the clients brain and body back online. With each pound gained, we are helping the client to understand that weight gain does not need to be feared, and that their life is worth living, even at a higher weight. Furthermore, as the anorexics weight is restored, they are able to begin meaningful engagement in therapy. Though weight restoration is key, it is not the only goal of eating disorder treatment. Extensive exploration with a specialized therapist is required to fully heal from an eating disorder and as a client becomes better nourished, this process can begin.
If you or your loved one is maintaining a very low weight and is concerned about the possibility of having an eating disorder, please reach out to our clinic or another medical provider for a thorough assessment. Health and healing are within reach and we are here to support you.