Why weight restoration is important

What is weight restoration?

Before we dive into what weight restoration is, it’s helpful to understand what weight suppression is first. Weight suppression is the difference between the highest past weight at an adult height and someone’s current weight.⁹ It may also refer to the amount of weight an individual has lost from their highest previous weight, often as a result of dieting or other eating disorder symptoms or behaviors. 

In the simplest terms, weight restoration is the process of regaining weight after experiencing weight loss due to an eating disorder. Generally, the goal is to achieve a biologically appropriate weight, a term without an official medical definition but one that broadly indicates a return to better physical health and mental and emotional well-being. A biologically appropriate weight is a weight that is readily sustained without the use of dieting or engagement in disordered eating and exercise practices.¹⁰

The weight restoration process will vary for each individual, depending on the severity of their weight loss or eating disorder symptoms, their medical history, and other factors. Typically, a patient works closely with a treatment team that supports nutrition rehabilitation, which includes eating an adequate, consistent, and varied intake.

Why weight restoration is important for physical health

Eating disorders undoubtedly put a lot of stress on the body. Without adequate nutrition, many organs in the body will begin to malfunction, and sustained starvation can lead to mass organ failure.⁵

Weight restoration can, in many cases, reverse these issues. Studies have connected weight restoration with a reduced impact of osteoporosis, improvements in cardiac health, and a return to regular menstruation, among other benefits.^6,7 A loss of grey matter in the brain that sometimes happens with malnutrition has also been found to reverse after weight restoration.⁸

In general, a well-balanced diet is associated with optimal health, and weight restoration is the first step toward achieving this goal.

Why weight restoration is important for cognitive health

While it may be more obvious how weight gain can improve physical health, gaining weight can also make a positive difference on someone’s mental health. In fact, weight gain is an important predictor of improved thoughts and behaviors in adolescents with AN, with patients who gained more weight earlier in treatment showing fewer eating disorder symptoms a year later.³

Aside from reduced eating disorder symptoms, weight regain has been connected to fewer symptoms of depression and anxiety in adolescents with AN. It has also been linked to improved decision-making.⁴ And many eating disorder treatment programs will not begin psychotherapy with patients until they've achieved at least partial weight restoration.²

General weight restoration guidelines

Again, the weight restoration process is highly personal. There is no one "appropriate" weight for everyone, and each person has unique nutritional needs based on several individual factors. But the process does have some general guidelines.

In many cases, it's essential to restore weight loss slowly, especially if the patient has experienced extreme weight loss.¹ This is done to avoid a complication called refeeding syndrome, a potentially deadly issue that happens when electrolyte levels become unbalanced after rapid refeeding.

Once a patient is no longer at risk for refeeding syndrome, guidelines to safely and appropriately meet physiologic needs are available through multiple sources, including:

• The Academy of Eating Disorders 
• American Psychological Association 
• Literature (for example, see the article by Mehler et al.)

There's no set timeline for weight restoration, and every patient progresses differently. Thus, while some studies suggest weight targets for discharge from higher levels of care, such as inpatient or residential care,^1,2 the weight restoration process and timeline are individualized and depend on several variables, including distress with eating, avoidance of specific foods, fear of gaining weight, and body image distress.

Weight restoration and relapse prevention

Aside from easing both mental and physical symptoms of eating disorders, restoring weight lost may also play a part in reducing the chance of relapse.

One study found a connection between BMI at the time of treatment discharge and the likelihood of relapse, finding that patients with a lower BMI were at a higher risk of relapse. Conversely, those with a BMI in the "normal" range were at a lower risk of relapse.²

Regardless, eating disorders are difficult to recover from, and some studies show that as many as 50% of patients have been shown to relapse by 12 months after leaving treatment.²

Weight restoration challenges

While weight restoration is an extremely important part of eating disorder recovery, regardless of someone’s body size or shape, the process is not without its challenges.

Early in treatment a significant concern is refeeding syndrome, which is why numerous precautions are taken to provide patients with appropriate nutritional prescriptions. As patients exit that "danger zone" and continue to regain weight, the process may feel mentally and physically uncomfortable, or even frightening.

Discussing the reality and importance of the process, as well as its potential impact on metabolism and how it may manifest or feel over time, is key during this early period of recovery.¹ It can help patients better understand what they're going through and how long it may take.

When patients are well enough to begin other treatments, such as psychotherapy and nutritional counseling, these concerns can be reinforced. At this point in the process, patients can begin learning new techniques to cope with body image distress and gain a deeper understanding of what constitutes an adequate and fulfilling eating pattern that can support well-being and help someone thrive.

The combination of mental, physical, and emotional factors is what makes eating disorders of any kind such complex conditions, but with the right kind of comprehensive care, patients can learn to ease discomfort in all of these areas, giving them the best chance at sustained recovery.