Weight restoration in eating disorder recovery: What to know

I’m often asked what's the best way to restore weight in recovery by people on social media. I’ve found the advice around weight restoring in eating disorders and general weight gain to be pretty lacking. That’s why I wanted to write this article and answer all the questions you have about weight restoration, so you can be clear and know you’ve got the right information.

That being said, I don’t know you and your specific needs. And of course, this information is not prescriptive and does not replace medical, mental health or nutrition therapy advice. This article isn’t going to be anywhere near as helpful as support from a registered nutritionist or dietitian. If you are in eating disorder treatment, please consult with your treatment team before taking any of the recommendations in this article.

What is weight restoration?

Weight restoration is a term in eating disorder recovery where a healthy weight for a person is reached, via weight gain. Weight restoration does not only include weight gain, it also increases other markers of health like physical symptoms, emotional health, resolution of medical complications, and improved cognition.

A common misconception is that restoring weight is the main part of eating disorder recovery. But actually, weight restoration is only a tiny part of recovery.

Who can help with weight gain in recovery?

Your registered nutritionist or dietitian is vital to recovery. Depending on the amount of weight you need to restore, virtual or in-person support, or inpatient or outpatient support may be needed.

Ultimately, your registered nutritionist or dietitian are responsible for your nourishment in recovery.

Eating disorder recovery is also best with a whole team of professionals, such as your registered nutritionist or dietitian, a therapist, a GP, and anyone else who’s needed.

Common questions about weight restoration

I thought the best way to structure this article is to answer the common questions I'm asked about weight restoration. I think I've answered most of the popular ones I'm asked, so I hope this is helpful.

Do I just need to increase portion sizes?

Something I’m often asked by people is if they can just keep eating the same as they are now, just more of it. While that makes sense - in the context of eating disorder recovery it’s not always appropriate. Depending on your eating disorder, you might be eating very little, only eating a small variety of foods, and there might be many foods that you feel fearful of or that you wouldn't eat. So if you were only to eat “safe foods”, but more of them, you probably won’t be able to eat enough to gain weight.

That’s because most people’s “safe foods” tend to be so-called healthy foods. Like vegetables, fruit, proteins, lentils, and whole grains. While these foods can definitely be included in recovery, a key part is to challenge the eating disorder and increase the types of foods you’re eating.

In my approach to helping people recover, in the early stages, my clients do eat more of what feels safe. Then after portion sizes have increased, we start to incorporate higher-calorie foods, some of which might feel less safe.

It can be really difficult to increase portion sizes. Especially if you’re going to recover on your own. Most people I speak to have no idea how much food they need to eat to restore weight. Your registered nutritionist or dietitian can offer guidance on this after you have an initial consultation.

So, initially, portion sizes might be increased with safe foods. But over time exposure to less safe foods and higher calorie foods are needed for a full recovery.

You might be thinking, “I will just eat safe foods forever, but eat more.” I know this feels like the best option; eating foods that don’t feel comfortable is scary. Your eating disorder won’t be a fan. But ultimately to recover from your eating disorder, all foods need to fit.

Do I just need to “binge” to gain weight?

This is another really common question I’m asked. When I start working with someone, they often ask me if I’m going to “make them binge eat.” 

If “bingeing” means eating more food than you are right now; then technically you could call that bingeing. But binge eating is totally different from eating food to restore weight. Someone who’s struggling with binge eating tends to feel out of control, eat in secret, and feel ashamed of how much they’re eating.

And, for transparency, it’s not uncommon for people to binge after restriction. In fact, many people who have restrictive eating disorders end up struggling with binge eating. It’s a way for the body to feel safe; for your body, bingeing always trumps restriction.

If you’re trying to restore weight, food intake needs to be gradually increased. In fact, if you’re someone who has a very low BMI or someone who has restricted carbohydrates for a long time, eating much more quickly can have critical effects. This can increase your risk of refeeding syndrome. So if you’re concerned about refeeding syndrome, make sure to consult with your GP who can offer medical monitoring while you weight restore. Your registered nutritionist or dietitian will be aware of this risk and can support you before you start eating more.

Ultimately the goal of eating disorder recovery is to normalise your eating. Since bingeing is not a “normal” relationship to food, we wouldn’t recommend bingeing to recover. Since hunger and fullness cues can be way off in recovery, it can feel like you’re eating way past comfortable fullness. But this isn’t “true” fullness; it’s part of recovery that will pass. I have written more about physical symptoms when you’re restoring weight in a section below.

Should I go 'All In' in recovery?

If you’ve never heard of 'All In', it’s a common term in eating disorder recovery spaces. A well-known Youtuber, Sophie Buttermore, documented her All In journey, which is when it rose in popularity. There’s no set definition of All In, but I think of it as:

• No tracking calories or following a meal plan in recovery.
• Never weighing yourself or measuring your body in any way.
• Giving up all eating disorder behaviours, cold turkey.
• Giving yourself permission to eat all food, until you are full (physically and mentally).
• Resting, and giving yourself a full break from activity.

The tricky thing with All In is that when someone is recovering from an eating disorder, things that All In depends on can be really shaky. For example, if someone goes All In and tries to give themself permission to eat everything their eating disorder has put off-limits; it’s likely going to not work. The eating disorder can take over and make restriction or compensation even worse. 

In terms of meal plans, often these are a necessary tool in eating disorder recovery. To make sure people are eating enough to heal and nourish their body, sometimes they are needed. But going without a meal plan can mean people don’t really know what to eat. It can also be super confusing to go All In as most people in recovery will experience intense hunger, digestive issues, and other physical symptoms.

Some of the positives of going All In include:

• Overcoming fear foods and rules by exposing yourself to foods that have been off-limits.
• The commitment to “full recovery” is often higher in people who take this approach.
• Weight restoration might happen sooner, depending on the person.
• Committing to a regular eating schedule, which can help normalise mental and physical symptoms of your eating disorder.

Some of the negatives of going All In include:

• You may weight restore and eat more, but that’s only a small part of recovery.
• Going All In doesn’t mean that eating behaviours will normalise, or that mental health will improve.
• Eating larger portions or more fun food than people around you can lead to feelings of guilt and shame.
• Risk of binge eating and trying to compensate with food.
• Extreme fullness is a common side-effect of eating more after restriction and/or being underweight for your body. So eating in accordance to your hunger cues is not appropriate when weight restoring.
• Depending on your individual needs, going All In can increase the risk of refeeding syndrome. This is a condition that needs to be medically monitored, with support of your treatment team.

I have met people who have gone All In and found it super helpful in recovery. But I’ve met others who have found it a super difficult experience that they wish they hadn’t done. I often hear people say that they feel like going All In is “real recovery.” But there are no quick fixes to eating disorders, and no approach to recovery is right for everyone.

Do I need to focus on eating a specific food group?

I often surprise my clients when I tell them that fruits and vegetables are on the bottom of the priority list in eating disorder recovery. Usually, they expect the opposite. They argue that fruits and vegetables have essential nutrients. Of course they do. But in weight restoration, they provide really little fuel and energy. And fruits and vegetables contain very little fats and protein, which are needed to gain weight.

Instead, I encourage clients to focus on eating a range of the food groups. And making sure to eat starchy carbohydrates, proteins, fats, and dairy with each meal and snack. Then adding in fruits and vegetables if it doesn’t interfere with eating these other food groups.

What happens to my body when I weight restore?

The physical and mental symptoms of weight restoring can be challenging for many people. The first stages of weight restoring (i.e. the first few weeks, and months) are usually where most of the physical symptoms come into play, and mental symptoms come soon after. These symptoms include:

• Fluid shifts and swelling (oedema, a build-up of fluid).
• Gastrointestinal discomfort, like constipation, bloating, acid reflux, and pain.
• Feeling full all the time, like there’s no break from it (this can also be mentally distressing too).
• Stomach may appear rounded after eating.
• Fear of gaining “too much” weight, which may lead to using eating disorder behaviours.
• Feeling like recovery isn’t worth weight gain, and second guessing recovery.

Closing thoughts

While weight restoration is a small part of eating disorder recovery, it’s often the part people fear most. It is extremely difficult to go against your eating disorder. It can also be really difficult when you feel like others just don’t get it. People might be telling you to “just eat” or “just gain weight” - but it’s so much more difficult than that.

That’s why one to one support might be needed. You deserve someone to help you navigate your recovery journey. Perhaps I can be that person for you. You can get in touch with me using the contact button below.