Myth: Weight Restored Equals Recovered

Early in my daughter’s treatment for anorexia nervosa, we were given a target weight. This was the magic number we were working towards as we followed the dietician’s meal plan—the end game.

According to the treatment team, this was the weight at which my daughter would be healthy again.

We were desperate. We knew nothing about this illness that had hit my family like a truck, destroying our home life and altering our child almost beyond recognition, both physically and behaviourally. The health and happiness of our beloved child lay entirely in the hands of the experts, and we deferred to their knowledge.

But even then I had my doubts. The target weight just seemed a little on the low side. I didn’t know much about BMI at the time—I’ve since learned a lot more—but the goal was set right at the bottom of the BMI chart. I had no idea what my child weighed before she developed anorexia; I’d always had better things to do with my life than buy bathroom scales and track my own weight, let alone the weight of my perfectly healthy daughters. But I did know that it very likely hadn’t been right at the bottom of the BMI chart. By the law of averages, most people wouldn’t be, and her healthy body was probably a fairly average size. And anyway, if the treatment team wanted to find out exactly what my daughter’s weight should be, they could always put her healthy identical twin on the scales. Of course, we all thought better of that idea. My other daughter’s own recent recovery was still fragile, after all.

It was a great relief when, with the help of the daily meal plan (three snacks, three meals, all hearty, traditional British fare), my daughter slowly began to put on weight. It wasn’t easy. It never is. In fact, it was excruciatingly painful to witness my child cry desperately over a small pot of yogurt or lie on the floor screaming after eating a plate of shepherd’s pie. I am sure it was far more painful and distressing for her. But I understood that it was necessary, and I believe a part of her understood it too.

Nobody but the families of people with eating disorders can possibly understand how traumatic mealtimes, and snack times, can become. This was the little girl who had loved her food, who would eat anything and who was so appreciative of any meal I cooked. Nothing was rejected. Ever. If I’m honest, before anorexia, I was pretty smug about what good eaters both my children were. As I watched my friends chasing their toddlers around, trying to coax them into eating a slice of apple, my daughters would be eagerly tucking into a plateful of mussels in vinaigrette or a bowl of ham and pea risotto.

Suddenly one of these children was crying uncontrollably because I had asked her to eat a yogurt. None of it made sense.

And because we couldn’t make sense of, or stop, the tsunami that was crashing over our lives, we had asked for help. That’s why we’d turned to the professionals. Our daughter had lost the ability to eat. And we were terrified.

It was a fantastic relief to be offered help, and for my daughter to be treated by people who had knowledge and experience of working with people with eating disorders. Back then I had nothing. It had taken a few months to find help, after a few knock-backs from our GP and no obvious route to treatment. Finally I called up the children’s eating disorders department at our local hospital, hoping that they’d be able to point me in the right direction. The woman I spoke listened attentively as I explained what was happening to my child. She kindly said that it sounded as though my daughter had anorexia, and that I could refer her for treatment. There was no need to involve the GP.

They would see us within a week.

So here we were, making a treatment plan, talking to doctors, therapists and dieticians. My daughter was weighed and measured and asked lots of questions. And she was given a meal plan that sent her into a panic. The doctor kindly, but firmly, told my daughter that her heart was in danger, that her muscles were wasting away, that downy hair was growing on her body as it tried to retain warmth—a common symptom of malnutrition. Surely this would help my child realise the extreme peril she was in, that she needed to start eating.

None of it sank in.

My daughter scanned the meal plan manically. Could she substitute almond milk for cow’s milk?

No.

Tears.

Good. They’re not messing around. She’s going to get better.

Fast forward six months, and my daughter hit the target weight. We’d followed the meal plan to the letter and it had worked. She had been steadily putting on weight. Some days, she told me, she barely thought about food any more. So her brain was healing too, it seemed.

But as we neared that target weight, her behaviour changed again. She became angrier, more aggressive, less willing to eat from the plan. All she talked about was being allowed to come off the meal plan—which would happen when she reached her target weight—and it was that idea that kept her going.

I guess that should have been a big red flag.

A few times I had mentioned to the therapist that I felt the target weight was too low, but they didn’t want to change it. And how could we change it now? To move the goalposts would be devastating for my daughter. All she wanted was to reach that weight and come off the meal plan. To be free.

But of course, that’s the last thing she would be.

My daughter hit the target weight, and we all started to eat a little more normally, not tied to the meal plan as we had been, although I was still careful to see that my daughter was properly nourished.

But she was still agitated around meals. She didn’t want to eat what I cooked. Couldn’t I substitute this ingredient for another? Why was I treating her like a child? She wanted to prepare her own meals. I didn’t know what she liked.

Tears. Screaming. Rage.

And so it went on.

This became difficult to fight. My daughter was 17 by then. Almost an adult.

You’re treating me like a child. It’s humiliating.

We spoke to the therapist about my daughter’s request to have more control over her food. Her reaction was surprising.

“Well, perhaps she could start preparing some meals again and learn to be more independent—take responsibility for her eating.”

I knew instinctively that this was wrong, but I was worn out from fighting. And I still thought that the treatment team knew what they were doing. More importantly, it was too late. Permission had been given. I didn’t feel that there was anything we could do.

I was the sort of mum who never gave in. Ever. When my kids were toddlers, I was firm but fair. If I said no, I meant it. I didn’t wobble. There was no negotiating. And most of the time it worked. Everyone knew where they stood, and ours was, usually, a pretty harmonious household.

Eating disorders are a bit like toddlers. You cannot negotiate with them. And if you negotiate about food with a person who has an eating disorder, you’re negotiating with the eating disorder itself. I learnt this the hard way.

I suppose in a way we were lucky. My daughter didn’t suffer a sudden, dangerous relapse in that her weight didn’t plummet. She gradually started cooking for herself, making her own packed lunch, eating the things she wanted to eat. She has hovered around her target weight ever since.

And never recovered from anorexia.

Because recovery is not the same as weight gain. Recovery is not living with obsessive thoughts around food every day. Recovery is not always thinking about your next meal. Recovery is being able to enjoy a meal out with family. Recovery is not counting calories. Recovery is not obsessively exercising.

Recovery is not crying over a yogurt.

Just because someone doesn’t look dangerously thin doesn’t mean they aren’t battling with this mental illness every waking minute. My daughter was discharged from eating disorder services when she left home to start university. But, six years on, she has still not recovered from anorexia.

I’m not sure now that I believe in target weights at all. I mean, nobody tells my body what its correct weight should be. It just is what it needs to be. I eat what I like and my body figures it out. The human body is clever like that. In fact, so is the body of every living creature on this planet. Nutrition is nowhere near as complicated as we make it.

There is a lot of discussion these days about overshoot—aiming for a weight higher than your previous healthy weight. This seems like a sensible idea to me. If you look at the results of the Minnesota Starvation Experiment (the only scientific study into human starvation), volunteers who had been deliberately been put through a period of malnutrition all went beyond their previous weight when they were allowed to eat freely again. In the end, when their bodies were fully recovered, their weight returned to the level it had started at. As I said, the body knows what it’s doing.

So it may be safe to err on the side of caution and aim for a weight that’s a little higher than the starting point so that the malnourished organs, including the brain, can fully repair themselves. But I wonder if there should be a target weight at all. Why not let the body just do its thing? Eat until your mental state shifts. People who have recovered say this happens eventually, when the body is restored to health, when it has recovered from being in a state of malnutrition. But it does take time, and other work will probably be needed to challenge some of the thoughts and behaviours that have become entrenched. Hopefully good treatment providers will be found to guide the person with anorexia through recovery, and there are resources that can help with recovery here. But I would be wary of a target weight, particularly if it is set too low.

So eat until you can eat without thinking about what you’re eating. Without planning your next meal. Without worrying about a meal out with friends. Without spending hours figuring out how to avoid a family get-together. Without crying over a yogurt.

Food is medicine.

Eat until you’re better.

And then keep eating.