Why is my child gaining weight in eating disorder recovery?

If your child is in eating disorder recovery, you may be noticing they are gaining weight. Sometimes you are prepared and even desperately want this. If your child has been dangerously weight suppressed, then, of course, you want them to gain weight. But for many parents who have kids in recovery, there comes a time when they worry their child is now “swinging the other way” or “going too far” in recovery.

That’s what happened to Kari and Ian. Their daughter Bailey is in recovery for anorexia. After hospitalization, she went into residential treatment. She did well, and Kari and Ian implemented Family-Based Treatment (FBT) while Bailey gradually stepped down from full residential to lower levels of care.

“I read all these stories about kids not recovering, so I feel really lucky that it seems like the treatment worked really well for Bailey,” says Kari. “But the truth is that now I’m a bit worried. Bailey’s weight has passed the point of where she was before the eating disorder. Her doctor seems a little concerned, but her therapist and nutritionist assure me that this is how it should be. I’m pretty confused and just want to do the right thing.”

Restriction and eating disorders

Almost all eating disorders begin with dietary restriction. A child can be anywhere on the weight spectrum when they start the cycle of an eating disorder. Due to a cascade of physiological factors, the restriction can beget more restriction. For many others, it leads to a restrict-binge cycle. Either way, the body and brain are not receiving the nutrition they need to maintain “homeostasis” or a steady weight.

Once in the cycle of most eating disorders, the person may become increasingly food- and weight-oriented. They find themselves thinking about eating or not eating many times per day. They may plan exactly how to avoid eating or what to eat next. Rules and restrictions take over their lives, leaving little room for anything else.

Most eating disorders begin with a diet. Whether your child remains in the restrictive phase (anorexia), or cycle between restrict-binge (binge eating disorder) or restrict-binge-purge (bulimia), restriction is a core behavior. 

Multi-layered disorders

While this is happening, most* bodies respond by slowing down the metabolism to meet the unstable access to food. The body does not like weight loss or unstable food supplies, so it triggers a famine response in which the body becomes extremely efficient with every nutrient and calorie it receives. This is why most efforts to lose weight result in regain, often with some extra pounds to protect against the next famine.

*In people with anorexia, their bodies may go into hyper-metabolism, which can remain a symptom for many months following weight restoration.

Why is my child gaining weight?

This effect can also happen with an eating disorder. Even after recovery, the body can continue to run slowly and hold onto calories and nutrition in an attempt to avoid the deadly impact of famine. Many people accept that they carry extra pounds in eating disorder recovery simply because their eating disorder triggered their body’s famine response.

While this can be challenging in our anti-fat society, it’s a necessary part of recovery for many people.

If your child is gaining weight during recovery from an eating disorder, it is because weight gain is a natural and physiological natural response to the restriction they endured. Your child’s weight during recovery may fluctuate wildly as the body recovers a new state of homeostasis.

How much weight will my child gain during recovery?

Weight gain during recovery depends on how big of a factor weight was in your child’s eating disorder, how long your child has struggled with an eating disorder, his or her individual metabolism, the total weight lost and gained throughout the eating disorder, the number of weight cycles, and more. These factors will combine to make each recovery journey unique.

Because most eating disorders involve restriction, recovery often includes weight gain. Recovering bodies need to return to a natural weight and will likely add pounds in response to the restriction endured during the eating disorder. It is impossible to estimate your child’s recovered weight, especially since it may take years for your child’s body to settle into a new “normal.”

What you must know is that once recovered, no number on the scale will ever measure your child’s health. Full recovery from the eating disorder, not body weight, will dictate your child’s health and the likelihood of a successful, meaningful, and joyful life.

It can be uncomfortable

The good news is that your child’s weight, with proper eating disorder treatment, will eventually stabilize. The bad news is that your child’s new weight may make you uncomfortable. This is why you need to work on your own biases about body weight and food restriction.

• Do you believe low body weight is a sign of health?
• Do you believe that your child can only be happy and successful in life if his or her body meets a narrow societal standard of body size?

These are the questions that Kari and Ian had to consider as Bailey gained weight.

“Our primary goal, of course, is for her to be mentally healthy,” says Kari. “Of course, we don’t want the eating disorder coming back, so we’re going to be vigilant about not allowing restriction and dieting anymore. We’ve gotten rid of all our diet foods and are careful about how we talk about food and weight now. But the truth is that we still struggle with the idea of gaining weight. I guess it was just so ingrained in us, as kids of the 80s, that thin is best. I’ve been watching my weight my whole life. This is a major shift for us.”

This makes so much sense. Weight gain is a challenging issue in our society. When a family faces an eating disorder, our cultural weight biases become critically important. We have to evaluate how and where they seep into our beliefs and thoughts and work to overturn them.

That’s what Kari and Ian are working on now. “I can see that we still have a lot of work to do about our own weight biases,” says Kari. “We’re working to understand weight science and accept our own bodies and Bailey’s. It’s not easy, but her life and health are worth it to us!”

Is it ever too much?

Now that you understand that weight gain is a natural and healthy part of eating disorder recovery let’s just consider if there is such a thing as “too much.” I believe that most of the time weight gain makes sense during recovery, but since an eating disorder can swing between restriction and binge eating, weight gain can sometimes (not always!) be a sign of an ongoing eating disorder.

Unless your child’s doctor is an eating disorder specialist, I take any concerns they have about weight gain with a grain of salt. Unfortunately, our healthcare system has a lot of weight stigma, and most doctors don’t understand eating disorders. On the other hand, I would do a quick check-in with your child’s dietitian and therapist.

What I would ask the dietitian:

• Are you still focusing on a weight gain goal?
• Is the current weight gain unexpected?
• Are we on track to guiding our child toward an Intuitive Eating approach?
• Do you have any concerns about my child’s weight gain?

What I would ask the therapist:

• Do you see signs of reduced or increased food obsession and compulsion?
• Do you believe my child is still actively in an eating disorder?
• What skills are you teaching that we can reinforce at home to support recovery?

Kari and Ian took these questions to Bailey’s therapist and nutritionist, and they felt greatly relieved. “Both of them explained in detail the signs of recovery that they were observing and what they were still looking for,” says Kari. “They were confident that Bailey’s weight would even out over time and that any gain at this point is not a sign of a new or different eating disorder. I feel so relieved, but we still have work to do on our own feelings about her recovered body. I know this is for us to work on and has nothing to do with her. So we’re working on it!”

For privacy, names and identifying details have been changed in this article.

See Our Eating Disorder Treatment Guide For Parents