Can You Lose Weight in Eating Disorder Recovery?

Trigger Warning: This post deals with weight loss, eating disorders, calorie counting and other topics that could be upsetting to someone with a history of an ED. Please proceed with caution. Remember, I am not a medical professional, so consult your doctor before making any changes to your diet or exercise routine.

It’s been awhile since I talked about eating disorder recovery, but with the emphasis on weight gain during quarantine in the media lately, I think this blog post is overdue. Although I titled this blog post “can you lose weight in eating disorder recovery?” I think the better question is “should you try to lose weight in eating disorder recovery?”

I’m turning 22 in July, which means I’ve officially been in eating disorder recovery for almost five years now. Those of you who know my story know I suffered from orthorexia / EDNOS on-and-off from ages 14 to 17. Since then, I’ve had relapses — especially when I was first diagnosed with IBS and began skipping meals to control my symptoms — including attempts to purge, but thanks to the help of a dietician at my alma mater, Boston University, and a long stint in an intensive outpatient program (IOP), I now have a healthier relationship with food than I have had in a long time.

As someone in eating disorder recovery, I’m no stranger to fluctuations in my weight. In high school, when I first began eating intuitively, I gained so much weight that my prom dress no longer fit. (Even though I’d taken the tags off, my mom took me to the store and helped me lie about receiving the gown as a gift so we could exchange it for a larger size.) But this year, I experienced weight gain in a different way than I ever had before.

I’m going to mention some numbers here, so if you’re triggered by that specifically, I recommend you skip this paragraph! I believe in set-point theory, and my set point weight has always been 115 to 120 pounds. However, this year, I started taking progesterone to help with my suspected endometriosis and soon found myself gaining almost 15 pounds in a matter of months. Weighing in at 132 pounds, I was three pounds away from being classified as “overweight” for my height — not to mention, I’ve spent hundreds of dollars replacing clothes that no longer fit, and coping with the blow that’s inflicted on my self-esteem.

I believe in Health at Every Size (HAES) and that weight gain is natural at certain points in our lives, especially when it’s a result of age or a side effect of a medical condition or treatment. I’m even okay living in my larger body (though I do miss some of my clothes that no longer fit), especially given that it means freedom from debilitating cramps. Nor do I believe that food should ever, ever be about guilt. But to me, becoming almost overweight served as an important sign that I should pay more attention to the way I am treating my body.

For me, that raised an important question: is losing weight in a quest for better health going to trigger a relapse? Here’s what my experience has been and what I’ve learned from doing some research on the subject.

You Need to Be Fully Recovered.

Do you consider yourself fully recovered from your eating disorder? To me, this is a tricky question. I’ve been in eating disorder recovery five years and I think some part of me will always struggle with the urges to restrict and purge. Yet at the same time, I’ve also achieved a milestone in my recovery where I can look at the scale objectively. Gaining weight isn’t a measure of whether I am a good or bad person, nor is it a death sentence. It’s just a number.

Viewing my weight as just a number allows me to weigh myself and track my weight without my daily mood being tied to what I see. I still struggle with the urge to weigh myself more often than I probably need to, but with the exception of the occasional bad day, my weight no longer has such immense power over me. To me, this is what it means to be “fully recovered.” The worst of my EDNOS days feel so far behind me that I feel comfortable pursuing a small amount of weight loss for the sake of improving my diet and exercise routines.

If you are new to recovery or not fully weight-restored, then weight loss should be the last thing on your mind right now. Whether or not you are overweight or obese (because no, “skinny” people aren’t the only ones who get eating disorders), your main focus should be on maintaining healthy eating patterns and overcoming your ED thoughts and behaviors. Methods used to lose weight, even in a “healthy” way — i.e. weighing oneself or tracking calories consumed and burned — can lead to a relapse if you are not firmly set in your eating disorder recovery.

You also need to be honest with yourself about your reasons for wanting to lose weight. Wanting to fit into your favorite pair of jeans because you miss wearing them? Wholesome reason to lose weight. Believing that weight loss will make you happier and fix your life’s problems? Insidious eating disorder urge. When you have not been in recovery very long, you may not be able to tell the difference between these two types of thoughts, which I like to call your “eating disorder self” and your “genuine self.”

That’s why it’s imperative that you consult your treatment team, and potentially seek the support of a nutrition and/or mental health professional, if you want to lose weight in eating disorder recovery. They may be able to better grasp whether or not your reasons for wanting to lose weight reflect a healthy self-esteem or stem from your eating disorder.

You Need a HAES Approach.

In my humble opinion, if you’re going to pursue weight loss as a person in eating disorder recovery, losing weight should be your secondary goal. You need a primary goal to drive your behavior that doesn’t stem from a place of self-loathing or food policing. For me, that goal is wanting to improve my food and exercise habits and wear my favorite clothes again. Losing weight is simply a side effect of that larger, overarching goal.

Weight loss on its own will not help you achieve health, happiness or even body satisfaction. In my experience, if you want to lose weight for the sake of losing weight, it’s more likely to come from a place of insecurity and self-judgment than from a place of holistic health and self-love. But that’s not the only reason why I feel that weight loss should not be your primary goal. As a person in eating disorder recovery, I also firmly believe in the HAES movement, which tells us that weight is not, in fact, a true measure of health or wellness.

Conventional doctors read the number on the scale, classify patients into categories based on our BMI (such as “overweight” or “obese”) and make suggestions about how much weight to lose accordingly. Their sole goal is to force you to fit neatly into the “normal weight” box, because that’s all many doctors are taught in medical school: maintaining a normal weight helps minimize health risks. I would know, because I helped my doctor boyfriend study for all his board exams!

But as I’ve learned in my eating disorder recovery, correlation does not equal causation; being overweight does not directly lead to death or disease. And I’m not even going to get into the unethical relationships between the diet industry and the so-called pioneers of studies that promote the false idea of the “obesity epidemic.” All I’ll say is that doctors shouldn’t look at a patient’s weight or appearance to make final judgments on their health status. Better measures of health include blood pressure, fasting blood sugar, cholesterol and other biomarkers that tell us what’s actually going on inside our bodies.

That being said, I think it’s important to consider all perspectives, without engaging in fear-mongering. We can and should be able to appreciate fat bodies and end weight discrimination while still promoting a healthy population. At the same time, one would argue that when eating healthfully and exercising, a person is unlikely to remain morbidly obese, regardless of whether weight loss was an actual goal of theirs. Currently, the empirical research does seem to suggest that weight loss in obese populations reduces disease risk and mortality rates (though admittedly, many of these studies are sponsored by companies promoting weight loss drugs or boasting other links to the dieting industry). HAES healthcare providers recognize this, and have identified the need for more quantitative studies to support their work.

Personally, I believe in the importance of physical and psychological health, which is why I support HAES over the lose-weight-at-all-costs approach triggered by obesity alarmists. Initial studies have found that people who are satisfied with their weight are healthier both mentally and physically — which is a pretty great start if you ask me. So, how do you follow a HAES approach to nutrition? According to HAES and intuitive eating, the most important thing is that we avoid fad dieting (which has been shown to fail 95 percent of the time) and focus on foods that make us feel good. You can lose weight with an HAES approach, as long as you love yourself the same whether you weigh 400 pounds or 150 pounds and avoid unsustainable patterns of eating. Linda Bacon and Michael Pollan, founders of the HAES movement, outline the following guidelines for following a healthy diet with an HAES approach:

  • Enjoyment should take first priority. Don’t force superfoods into your diet if you hate eating them — nor should you force yourself to indulge in something you don’t really want for the sake of “proving” your eating disorder recovery. I also interpret this to mean that you should pay attention to the way foods make you feel in addition to the way they taste. For example, I love macaroni and cheese and will always have days when I choose to eat it — but most of the time, I avoid dairy because the satisfaction of cheese doesn’t outweigh the physical side effects of my lactose intolerance.
  • Variety is the best way to ensure you are getting all the macro- and micronutrients your body needs to stay healthy. Pay attention to building a colorful plate, as bright colors signify the presence of different vitamins and minerals.
  • Plant-based foods should be the centerpiece of your diet. That doesn’t mean you have to follow a prescriptive diet, such as vegetarianism or veganism, but meat and dairy should be considered side dishes.
  • Not too much means grasping your hunger cues and only eating until you are comfortably full. You should avoid distractions while eating (though I’ll be the first to admit that I’m frequently guilty of snacking and scrolling!) and distinguish between physical and emotional hunger.
  • Most of the time is the final tenet of the HAES approach to food. In short, it means that there are no hard-and-fast food rules. You should strive to follow the healthful approach described above whenever you can, but also accept that sh*t happens! Some days, you’re only going to have time to eat a granola bar while driving on your way to picking up the kids, meaning you’re going to need to eat while distracted. Other days (like Thanksgiving, for one), you might choose to eat beyond full because you love what you’re eating. AND THAT’S OKAY! It’s about moderating, not avoiding, your consumption of processed and so-called “unhealthy” foods. As Linda Bacon says, “there’s plenty of room for Twinkies in the context of an overall nutritious diet.”

To bring this discussion to a close, because I know it’s been a long one, weight loss isn’t your primary goal when following a HAES approach. But, you may find that when you begin to focus on eating plant-based foods, following your body’s hunger cues and enjoying treats in moderation, your body settles in at a set point weight that’s lower than you thought it would be. That doesn’t mean you should view HAES or intuitive eating as a “diet,” per se. However, if you’re someone who’s been stuck on the yo-yo dieting rollercoaster for years and struggles to lose weight, you’ll likely have more luck achieving your weight loss goals while following a truly satisfying intuitive eating approach than a strict fad diet.

You Need Support.

The first thing I did when I decided to lose a few pounds? Tell David. Our conversation went a little something like this….

HALEY: Hey, can I talk to you about something?

DAVID: Sure.

HALEY: So, I’ve been dissatisfied with the weight I’ve gained on my medication because a lot of my clothes aren’t fitting and I’ve decided to try to lose a few pounds. I’m going to be tracking my weight and calories to help me out. I’m telling you this because of my history of disordered eating, so that if this triggers my old habits, you can knock some sense into me.

DAVID: Okay. Thank you for telling me that. I will be sure to let you know if I notice anything.

If you have a history of an eating disorder, you cannot and should not go about weight loss on your own. You need the support of your medical team, as well as your friends and family, to keep you on track and prevent you from relapsing during your journey to lose weight. Alternatively, if your weight loss is something you feel the need to conceal from others, that might be your first cue that it’s coming from a place of disordered thinking, rather than a genuine concern for your health and well-being. You shouldn’t need to hide your goals if you are truly acting from a place of self-compassion.

It’s absolutely essential to be open and honest about any disordered feelings or thoughts that arise during your weight loss journey, and to be prepared to abandon your goal in the event that this pursuit leads to a relapse. Having the support of a registered dietitian and/or mental healthcare provider can provide you with an outlet to discuss your relationship with food and addresss any disordered thoughts or behaviors you’re still struggling with. If you’re not comfortable with this approach to weight loss, that’s a clear sign that your weight loss may not be coming from a healthy place and that you should wait until you are further along in your recovery journey to reassess whether losing weight is the right move for you.

I’ve also found it incredibly important to support myself by monitoring the types of content I’m taking in online. Despite my goal to lose a few pounds, I’m not following fitness influencers or searching for “flat belly tips” on Pinterest, because I know thsoe are things that trigger me. Instead, I’ve been watching a lot of videos by the dietitian Abbey Sharp on YouTube, where she criticizes fitness influencers’ “What I Eat in a Day ” videos for both nutrition content and any disordered eating patterns she notices, and searching for recipes that follow the plant-based, DASH diet or Mediterranean diet approaches, which emphasize overall nutrition and heart health over weight loss.

Orthorexia is a Real Eating Disorder: I Know, Because I Had It

I was never thin enough to be anorexic. Exercised obsessively, but never became underweight. Had thought about purging, but never done it. Occasionally went on binges, but not often enough to be considered a binge eater. And hadn’t seen a therapist, who would’ve diagnosed me with EDNOS: “eating disorder not otherwise specified,” the catchall term given to those of us with disordered eating that doesn’t quite fit the laundry list of DSM-V criteria.

It wasn’t until I read about Jordan Younger, formerly The Blonde Vegan (and now The Balanced Blonde), that I first discovered the term “orthorexia.” As I was reading her story, I kept thinking “this is me.” Jordan became so obsessed with “eating clean” and going on “cleanses” that she lost her period, suffered sallow skin and experienced thinning hair — classic symptoms of anorexia nervosa.

Though someone who looked at her might not have told her she had anorexia based on her weight, Jordan knew her eating patterns were disordered, and even discovered a name for them: orthorexia. Yet orthorexia nervosa is not yet formally recognized as an eating disorder diagnosis in the DSM-V, and won’t earn you a bed in the nearest treatment center.

As John Oliver would say, “And now, this.” The Internet is swimming with questions like, “Is orthorexia a real eating disorder?” Well, let me let you in on a little secret I learned in psychology class: the DSM-V manual, while helpful (especially for insurance purposes), is not the be-all, end-all of mental health diagnoses. The DSM-V is flawed, and one such flaw — IMHO — is excluding orthorexia nervosa from the list of official eating disorder diagnoses.

Here’s why.

What is Orthorexia?

First thing’s first: what is orthorexia? The term, according to NEDA, was coined in 1998, and refers to an unhealthy obsession with “healthy” or “clean” eating. This can take the form of obsessive exercising, eliminating processed foods, avoiding certain ingredients (or entire food groups) and a progressively stricter and stricter diet with an emphasis on promoting health and getting an athletic figure.

Orthorexia has garnered much media attention in the past few years, thanks to famous cases like Jordan Younger and YouTube fitness star Cassey Ho. Sadly, this attention has also attracted haters, who deny that orthorexia is a “real” eating disorder — or worse, dismiss those with orthorexia as attention-seekers and drama queens. But as someone who had the eating disorder myself, I can attest that orthorexia nervosa is very, very real.

The Consequences of Orthorexia

Thanks to my eating disorder story, I know that orthorexia is real. Some might wonder why I care so much if others acknowledge it — after all, if I know orthorexia is real, why does it matter what anybody else thinks? Yet the fact of the matter is that orthorexia, like any eating disorder, is downright dangerous, and may have detrimental health consequences if it goes unaddressed.

At the height of my orthorexia, it became clear that excessive exercise and a restrictive diet were taking their toll on my body. My hormones fell out of whack, leading to plunging estrogen levels and irregular periods. For the first time in my life, I began to miss my monthly flow. I also experienced constant fatigue and chronic pain all over — pain that continues to flare in my knees, shoulders, neck and back even today. The minute I allowed my body to rest, I began experiencing horrible anxiety attacks that took my breath away, accompanied by stabbing back and chest pains.

Most importantly, however, I was avoiding people and things I previously loved, including foods and social occasions. I even began to snap at the people who cared about me, especially if they questioned my obsessive diet or exercise routine. The way my disordered brain saw it, you were either on my team, or you weren’t — and if you didn’t unconditionally support my weight loss journey, then you weren’t with me; you were against me.

Why It Matters

Thankfully, I found recovery from orthorexia — yet I still care that orthorexia is not classified as a “real” eating disorder in the DSM-V. Orthorexia has caused myself and so many others so much pain, and this pain has yet to become formally acknowledged by the medical community.

Not only do I want the validation of having my eating disorder become a clinical diagnosis, but I also believe it’s dangerous not to diagnose orthorexia nervosa as a DSM-V disorder. Fatphobia already runs rampant in the medical community, especially in eating disorder treatment — and those of us with orthorexia often don’t fit the stick-thin, underweight description of a stereotypical eating disorder patient.

As a result, someone’s dangerously disordered eating patterns may fly under the radar (or, in overweight patients, even be encouraged by doctors), worsening their disorder and preventing them from receiving the help they need to get better.

Conclusion

“Other specified feeding or eating disorder” is not enough for patients who suffer from orthorexia nervosa. Because of weight discrimination and the lack of clinical support for the orthorexia diagnosis, patients like me face major obstacles to eating disorder treatment in the United States.

We may not be able to change the DSM-V, but there are things you can do to support the changing landscape of eating disorder advocacy and recovery. Namely….

  • Pledge to support Health at Every Size (HAES), which states that weight does NOT measure health. In other words, overweight individuals are not automatically deemed unhealthy — and individuals must not be underweight to suffer from the psychological consequences of disordered eating patterns. Click here to sign the pledge.
  • Skip the scale. Eating disorder advocacy begins at home, so if you haven’t already…. THROW AWAY YOUR SCALE! Go ahead. I’ll wait. *waits* Now that you’ve done that, you should also know that you have the right to refuse to be weighed (or ask to be “blind-weighed,” so you don’t see the number on the scale) at the doctor’s office. Note that there may be times when your weight matters — when determining anesthesia dosage before a procedure, for example — so ask to be blind-weighed when these occasions arise. Print these free HAES cards to start the conversation with your doctor, without feeling awkward or ashamed.
  • Become a Legislative Advocate for NEDA. Sign up for NEDA’s free legislative alerts to help advocate for legislation to support eating disorder recovery. Who knows? Someday, a law could mandate education about orthorexia in addition to other eating disorders, or that eating disorder patients be protected from size discrimination — and by signing up for NEDA’s alerts, you could be a part of it! Click here to become a NEDA Legislative Advocate.

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