One of the thorniest issues in eating disorder treatment is the notion of goal weight. Almost everyone in treatment wants to know what weight they’re supposed to be. The problem with this question is that it presumes the brain can and will tell the body what an appropriate weight is. This, however, is essentially untrue. When a person is healthy, the body finds the weight it needs to be.
For a person with Anorexia, the way the brain tries to control weight is through behaviors. Good treatment therefore means stopping the brain from trying to make the body do what the brain wants to. In eating disorder treatment, a client must learn to trust their body.
Goal weight is determined by your body, and is what your weight will be when you eat a healthy diet, stimulated by hunger, ending with fullness, over a period of time while engaged in an activity level that is healthy for you. The eating disorder has a very hard time believing this. This is one of the reasons a behavioral method of treatment is effective when other methods of treatment have failed. With all of this in mind, doctors and therapists use the term “goal weight” to mean many different things.
Primary care physicians are likely to use the term goal weight to define a weight where medical function (i.e.: heart, kidneys, endocrine system, bones) are functioning normally. This means that a person’s blood pressure and pulse will improve, their kidneys will function, they will experience a return of menses, and they will be on their way to reversing bone loss.
Dietitians may determine goal weight based on notions of ideal body weight from weight charts or previous body weights. Dietitians who specialize in eating disorders are more likely to understand what a goal weight is from an eating disorder perspective than those who primarily work with obesity or diabetes.
Eating disorder therapists and specialists versed in the current literature on Anorexia will determine goal weight based on research which demonstrates that the more weight a client gains during treatment and is able to maintain post-treatment, the less likely they are to relapse (Kaplan, Walsh, Olmsted, Attia, Carter, Devlin, Pike, Woodside, Rockert, Roberto, & Parides, 2009).
Any one of the treatment members discussed above may use criteria described for another. Centers using a multi-disciplinary treatment approach will form a team that consults from all of those mentioned above to best determine what a client’s goal weight might be.
The bottom line is this: no one knows what you’re “supposed to” weigh and no one can predict what you will weigh. Many doctors and therapists will be able to provide numerical guide posts along your way to healing, but no one will be able to tell you what your body truly needs to weigh. There are too many variables and every person is different. Ultimately, the goal is health and happiness.
Kaplan, A. S., Walsh, B. T., Olmsted, M., Attia, E.,Carter, J. C., Devlin, M. J., Pike, K. M., Woodside, B., Rockert, W., Roberto, C. A., & Parides, M. (2009). The slippery slope: Prediction of successful weight maintenance in anorexia nervosa. Psychological Medicine, 39, 1037-1045.
Next week: Therapy fails patients, patients don't fail therapy
Contributions by Sarah Emerman