I need to gain a few more pounds to reach a ‘healthy’ weight. I am afraid to gain weight beyond that number because what if I lose control? I already feel so unworthy, and ugly. I will have to make sure to maintain it. ~ Mirjam, 2008
Restoring physical health and reaching a healthy weight is the first priority in eating disorder treatment. It may even be a prerequisite for psychological treatment. Many people recovering from an eating disorder experience gaining weight as one of the most frightening parts of the process. Often, treatment professionals determine a healthy target weight by taking into account growth charts and BMI guidelines. This number can be considered as the lowest acceptable weight within the healthy range. Why is the use of static guidelines and target weights problematic?
The problem with BMI
There are many problems with using the BMI to determine a target weight. As a ratio using weight and height, BMI doesn’t consider body composition, age, and genetics. Achieving a healthy weight in recovery is important, there is no doubt about that. The problem lies in the way target weight is determined. It’s tempting to believe that reaching a target goal weight implies being in a healthy state. I remember being confronted with a target weight my doctor set. As a result, I became obsessed with focusing on weight gain and the number on the scale. Also, I considered it as a maximum weight acceptable for me (because why would I go any further, right?) Logically this just fueled my unhealthy eating and disordered way of thinking.
The truth is, there is no pre-determined number that can define your health, nor your most optimal weight.
Like each individual eating disorder is unique and calls for a personalized treatment plan, so does each body. Your body has an optimal set point weight. This is the weight where it reaches optimal health. In most cases, the set point weight differs from the target goal weight. This holds many people back from full recovery because they try to maintain their unhealthy target weight.
This is something many people in recovery struggle with. It is very normal to have many questions. How do you know your set point weight? Do you need to eat less once you reach your target goal weight? What if weight gain doesn’t stop?
How do you know your set point weight?
A huge fear for people recovering from an eating disorder is letting go of control. Exercising control used to be the way to cope with difficult situations and negative emotions. In recovery, you have to let that go. Focusing on a target goal weight reduces anxiety and fear because you “know where you’re heading.”
After years of destructive eating habits, you can’t know upfront what your set point is.
But in most cases, it isn’t the lowest weight in the so-called “healthy range.” Depending on your age, you could only make a rough estimation by looking at your weight before your eating disorder.
Letting go
Physiologically speaking, there are only a small number of people whose set point weight corresponds with a BMI of exactly 20.
In order to fully recover, you need to let go of the weight you consider acceptable.
From my own experience, I know this isn’t easy. But you can trust the wisdom of your body. At some point, your weight will stabilize at its most optimal weight. This isn’t a specific number, but a range in which your body genetically wants to be. Even when you have celebrated the holidays with elaborate dinners or spent an evening with a pint of your favorite ice cream.
How will you know when you have reached your set point weight?
You will know you’re at your set point weight when all body functions are restored and your menstrual cycle has returned. However, the return of menstruation is not always indicative of reaching your optimal weight. You also must be eating in an unrestricted way, without rules or compensatory behaviors. If you are doing this, and your weight remains stable, then you have reached your set point weight.
When you change your diet once you have reached a pre-determined target weight, your body does not get a chance to fully recover. It is not able to restore deficits and reach your natural set point weight. I’ve been in the stage of partial recovery for years by maintaining the lowest acceptable weight set by my doctor while simultaneously pretending to be recovered. (I mean, I looked “normal” so I convinced myself I was better). This is a combination that can never work. I was convinced the weight gain would never stop, and this held me back from going the extra mile.
Learning to trust
This is a fear many people in remission struggle with. Is it realistic? No! When you don’t change your food intake and continue to re-feed, your body is allowed to recover and your metabolism is restored. Your weight will stabilize when it reaches its optimal weight.
In some cases, your body may need to overshoot its set point weight in order to return to a normal fat mass to a fat-free mass ratio. However, this is only temporary and your body will settle at its natural set point weight. Be patient and trust your body!
Do you accept your body at its optimal natural weight or are you holding on to an unnatural size? Leave your comment below. Where ever you are in your journey, I hope you choose the path toward full recovery. Learning to love and embrace your body at its natural set point weight will give you so much freedom and happiness in return!
(Last Updated: October 21, 2022)
Dearest Recoverywarriors!!
First off: WOW
I am deeply impressed by this site and wish I had know it when I began to recover!
Almost all of my questions and wonderings have been addressed here in the blog and I find it so lovely, positive, greatly designed and just cool!
Now if you don’t mind I’d like to ask how long internal damage needs to repair? I haven’t had my period in a year but am at 19 bmi,
I walk my dog for 20 min a day and eat 2800 ? Is that ok?
Any advice would be highly appreciated! 🙂
Thank you very much!
Yours NB
Hi Natalie,
Thank you so much for your nice message. That means a lot to us!
That’s awesome you’re doing so much better, you can be really proud of yourself! 🙂
Unfortunately, we can’t provide you with any medical/nutritional advice, because we aren’t certified professionals. We recommend you to ask your question to a MD or RD.
You can now find treatment and support through the Rise Up + Recover app and website. If you go to ‘Get Help’ it redirects you to ConnectED, our treatment directory! Take care! Miriam
Before I was diagnosed with anorexia So I was overweight, I had obesity, my highest BMI was 34 if I remember correctly, I was only 10 years old.
In two years, I went down to the BMI 19, and held a fairly stable weight, ate without compensation, without feeling guilty and anxiety.
Two years after BMI 19 I fell down to the BMI 15, (where I stand in the moment).
So now to my question, how likely is it that my set point is the weight I had as overweight.
I’m terrified that my body’s set point is the overweight limit. What are the chances that I end up there?
Should add that I have some in my family who is obesity and overweight.
And before I got anorexia so I felt depressed, sad, I never was healty, I literally have had some kind of eating disorder throughout life, binge eating without compensation, then ortorexi, to self-starvation, then bulimia and now starving again and reached underweight .
Thanks for the reply.
Hi Mirjam, I recommend you ask these questions to a certified professional. Sending lots of strength! – Miriam
Hi Miriam. Great article. I am recovering from 20 years of AN and have overshot what I used to weigh pre ED as a teenager by quite a bit to BMI 22-23 ( not that that necessarily means anything) and am still so darn hungry and exhausted with it. No one I work with even at the ED unit has ever had anyone hungry like me and I have eaten a lot of food over almost 2 years to get here…..meaning I rely on what I can find online for overshooting information and it is trial and error. What I would like to know is how did you deal with overshooting and the disproportional body that emerges…..I have no choice because I need to get rid of the hunger/exhaustion but it is such a struggle and I would love to know anything that you found helpful. I find the more I gain the harder it gets! Also would you know of any other resources that may be helpful? I have probably read most of them…..YE, minnesota starvation study, The hunger artist etc…..but would love to know if there is anything I have missed. Three cheers for you recovering by the way full recovery sure is a mission……mine got totally hijacked by the hunger and exhaustion that went with it once I started gaining….and that has run the whole thing. I was also interested to know did you have extreme hunger at all? Not a problem if you can’t answer or its not appropriate. Thanks heaps Jean.
I am in an advanced stage of recovery from anorexia. I do well with mechanical eating and my weight is restored, but I am over my pre-ED weight and trying so hard to trust this process and going that “extra-mile” you mention. I have no idea what my set-point is and wonder if I’ll ever stop gaining weight. It’s hard when you get a place in anorexia recovery where a traditional BMI scale would tell you you’re “overweight,” but you’re recovering from a serious illness.
Reading your story I could have written it myself! Although my anorexia was only critical in the last 5 years I too have reached a bmi 23 when I was always below 20, I am 23 and after a long inpatient stay, relapse and liver failure something happend and I woke up hungry, since then I’ve been constantly exhausted and hungry ( I’ve gone from running 5k to sleeping 13 hours a day plus naps). My family think I am depressed and that is the cause but I’m actually just need and want that sleep! The hunger is still persistant and although its more like 3500-4000kcal instead of the uncountable amout in the first 3 months I also feel my recovery has been hijacked! I have no interest in getting back to a bmi 13 but just want to feel normal again! I’m sorry for rabbiting on but it’s so rare to hear this most people are exclaiming the endless energy recovery gave them and my treatment team didnt know what to do with the hunger either! Hope you are doing better Katie
Hey Katie,
fellow hunger exhaustion friend! Do i ever know what that exhaustion is like. I went from running 25-30 km a week to being unable to run or bike at all the hunger was so severe…..and my legs so wobbly and dead with it, it was impossible! And I remember going to an ed therapist for the first time and she told me it was in my head, I never went back. I was so addicted to exercise that nothing in my head would ever have stopped me. The hunger seems to effect people differently. My body just says no exercise and I’m not going to let you……loads of sleep and a lot of food. I never had any hunger in AN. If it helps I feel a thousand times worse in recovery…..with the hunger I get nausea, headaches and its like I am running on empty all the time, my life I did have has been really limited and the whole experience has been crap! I am just trying to hang on that it must get better…..one the odd no hunger day I feel incredible. but they are so few and far between. Overall it has gotten better gradually….although right now again I have a really bad patch……and to be honest I want to quit it feels like its never going to be over….and I have eaten 2 years without a relapse. So it was very very nice to get your message today. would love to message you outside of here but wouldn’t know how if you want to. You have read the stuff that explains why you overshoot and how the hunger is driven by the bodies need to repair muscle? If you haven’t at least that helps point out we are not entirely crazy. Anyway three cheers for us! And our remission state should be great after these recoveries! Take care Jean
oh and I often sleep twice a day plus long night sleeps on home days. So I so get you about the sleeping thing!
Im so sorry for some reason i did not get notified of a reply! No I definitely would! I have read extensively aswell finding “a Hunger Artist ” and the Minnesota starvation study have been of some comfort but living with it is very diffrent! Exactly as you discribe it is like permanently running on empty and I just want to get home and collapse! Is your concentration awful? You are so strong! 2 years is fantastic!haha we better have the energy of Olympic Athletes and live till 90 with these recoveries! Do you email?
hi Katie,
would love to email you 🙂 how shall we swap addresses? I use my work one so would rather not put it on here……
I think it has taken me two years so far as I did this at home and i didn’t get told to eat enough as no one I saw had seen hunger like this, and they didn’t really know what to do with it calorie wise. I run my own business and work 3 days a week…….and yes I totally agree…..with the hunger you can wave goodbye to good concentration. But like you I am going for the olympic athlete, live to 90, brains like Einstein as the eventual outcome!
mine is katienoonan.92@gmail.com ! Sorry it won’t let me respond below! One thing I’ve learnt is that the professionals are all baffled by these disorders, when your so emaciated your organs are failing they are able to get you stable but recovery and the starved body is so unpredictable. Mine told me ( at a bmi 14) I needed to stop eating so much as I would end up with a weight problem. I too didnt go back! I think you are so brave for pushing through it all and you are so not alone! Did you b/p as part of your disorder? I did but this feel so different, not binge but genuinely hungry! And how do you manage work? Haha Einstien would be the icing on the cake!
Have emailed you Katie 🙂 I know won’t let me reply either!!
I reached my pre Ed weight after anorexia – which was quite fast acting and severe weight loss over a short period. The whole weight loss over 6-7 months before being admitted to inpatients. However after doing well weight and eating wise for about 10 months I relapsed…. Not as bad. Now that I’ve got myself out of this lapse I’ve gained weight again but a bit more weight than I’ve ever weighed. My weight is still slowly going up though and I’m started to really confused. Trying to trust my body will sort it itself out and my eating becomes more normalised. But at the same time I feel so frightened! When I was recovering first time my body was gaining anything more past my previous weight no matter how hard my team and I tried!
Hi Elizabeth,
Eating disorders cause a lot of damage to your body and it takes time and energy to reverse the damage. Try to trust your treatment team and your body’s wisdom because the human body has the miraculous ability to restore itself. Be patient with yourself – and the process. 🙂
thanks for the article!
i had bulimia and disordered eating for 12 years, and have been recovering for the past several months. my period has been back for four consecutive months and my initial water retention has disappeared (along with bloating). but i’m still at my highest weight ever. how do i know if i’m at my set point weight? i’m wondering if my weight will slowly fall off to my pre-ed weight or if this is my set point weight now.
Hello! I went through this at the beginning of the year as you can see my comment above! I was feeling very lost and confused too!
Well done to you, it’s sounds like your doing fabulous!
In my personal experience I found I went higher than what I had ever weighed. However over a time period (similar to how long it took me to gain this greater amount) it slowly disappeared without me even noticing.
I suffered from anorexia and am not sure if I did it unconsciously or not but it just happened for me. I’m pretty much the same weight as I had ever been, my eating is balanced and my body is starting to function properly :).
But what I have learnt from this whole experience, yes it was scary…. But my friends and family still loved me and didn’t even notice my body size or change. So I relaxed and let it all sort itself out. And it did!
So keep fighting and trust your body as it only wants you to be the healthiest you ????
You are absolutely right, Elizabeth. It sure does sort itself out! Take care! Miriam
Hi Pat, it takes time for your body to repair the damage living with an eating disorder for 12 years has caused. This doesn’t happen overnight, nor does it happen in a few months. Your body has an amazing ability to repair itself. Be patient! For advice from a licensed professional, use our Help Finder to find someone in your area. Take care! Miriam
Hi!! I’m a teen going through recovery right now and I don’t know if those rules up too apply to me as well. Do I have a set point? Should I eat whatever I want? My dietitian is telling me to eat only 2200 calories a day, but I go to sleep starved. I don’t know if I should keep listening to her…
They do apply to you! 2200 calories should only be a minimum, if your still hungry, keep eating!! Your body needs the food to repair the damage! Keep eating and soon your body will revert back to it’s set point!
I am really frustrated with recovery right now I’ve done well the past year following a near fatal accident after having lived with anorexia for 40+ years. Just recently I was diagnosed with diabetes. My set point has taken me to a place I’ve never been before which is frustrating enough trying to fit in my clothes but my BMI is28.09 and now I have diabetes. I blame it on my weight gain and am really struggling to stay in recovery and not start restricting again has anyone else experienced this side effect with weight restoration?
Hey Millie! I struggled with BN for nearly 20 years, always in a larger body. I was diagnosed with diabetes last year and my nutritionist, endocrinologist and primary doctor really helped with coping with the diagnosis (it still sucks, but I’m coping better). It’s not the weight gain that caused it. Diabetes is very complex and is much more than our weight and what we eat. The endocrinologist also said that the drastic shifts in my blood sugar while using behaviors definitely didn’t help any issues and being consistent with nourishing myself is the best way to keep my blood sugar stabilized. So know that it’s not the weight gain. It’s so much more complicated than that and it’s not our faults.
Hi all. I was drawn to the article based on its title. I too am on my own journey to try to reach what I call a “fully authentic recovery” from an eating disorder (i.e., not a quasi-recovery, or a partial recovery with compromises).
In my experience, the fear and resistance of letting go of my behaviors that convince me I am keeping my weight “in check” is one of the most difficult aspects of recovery. I think even harder than actually gaining weight, or looking “healthy”.
I appreciate this article, and yet I still feel as though I need more help with the “how”. As in even if I recognize I should let go and just trust my body, HOW do I actually let go?” What does eating look like for people who are actually doing that??
Of course, I understand why my question poses a challenge. Firstly, it’s very different for everyone, based on their needs. Secondly, that level of detail can be potentially “triggering”.
Anyway I thank you for sharing the article and the content on this set. Reading it again and again keeps it at the forefront of my mind as something I think is worth working through – even though it is a scary and vulnerable process.
hi cait! not sure if you are gonna read this message since it has been many years but yes i can relate so much 😭😭😭 doesn’t help that i’m still a teenager and my mum thinks that some problem with my health because my weight keeps increasing (she’s also perplexed about the fact that i’m “obese” and wants me to see a doctor for some nutrient plan) sending you well wishes and love, hopefully you have already recovered by now!! 💕🤞🏻
Hello all fellow warriors and recovery experts…I am really struggling with convincing myself to gain weight. I am so happy just maintaining my safe space and not challenging any of my habits. I know I need to as I am seriously underweight, but how do I convince myself to leave my comfort zone? Any help would be so appreciated, it has been almost 10 years now so my thoughts and habits are so ingrained
Thankyou, and love
Alice