How can I gain weight with an eating disorder?

Dear Slim,

It sounds as though you are interested in recovering from your eating disorder, but aren't receiving the guidance and help that would benefit you. Does your health care provider know that you have an eating disorder? What about your family? If you are dealing with recovery on your own, it would greatly benefit you to seek out support from experienced professionals that your family or others might help you find (other resources are listed at the end of this answer).

Gaining weight without resolving the underlying issues is not a cure. Weight gain can help alleviate some of the medical complications that are caused by malnutrition and being severely underweight. However, one of the difficult parts about weight gain during eating disorder treatment is that as a person increases his or her food intake, his or her metabolism increases, requiring even more calories. This is further complicated by the fact that eating disordered persons need more calories to gain weight than non-eating disordered, underweight individuals. This could be due to the fact that a person's metabolic rate is depressed in anorexia, and so is the thermic effect of food (the amount of calories being burned during the digestive process). As anorexic persons get well, and eat more, both their metabolism and thermic effect of food increase, raising their caloric needs. Levels of growth hormone, leptin, and other hormones are also lower in eating disordered people and become more normalized during recovery, which may also contribute to changes in calorie needs. The same disproportionate rise in metabolic rate to body weight is not seen in non-eating disordered individuals.

In order to gain weight, you need to follow a schedule of steadily increasing your calorie intake until you reach a level that is appropriate for you. Since you are 15 and possibly still growing, you may need to account for this factor as well. Weight gain (termed "re-feeding") is a process that often requires help and guidance. Your calorie needs for weight gain need to be assessed by a registered dietitian specializing in eating disorders. They can help you gain weight at an appropriate rate for you. Many factors are considered when developing re-feeding plans. Some of these include your current medical status, body frame, weight history, current food intake, and eating patterns, just to name a few. In addition, on-going nutrition counseling can help you to understand and cope with the changes that happen to your body as you succeed in gaining weight.

You mentioned that you are not really in treatment. Are you seeing only your medical doctor, or are you seeing other health care professionals, too? It is well documented that the most effective treatment for eating disorders is to work with a multidisciplinary team consisting of a medical provider, psychologist, and nutritionist. Gaining weight is not the only answer. Dealing with the problems that are central to the eating disorder is vital for recovery. A therapist experienced with eating disorders can help you with this. Learning how to eat properly and handling issues around food can be addressed with a qualified nutritionist. If your current treatment doesn't include all three areas of care, you may want to consider it. You can find more help at the National Eating Disorders Association, and find a team of specialists.

You can also talk to a health care provider or local hospital, who may be able to refer someone to a registered dietitian and therapist or a treatment center that can assist her/him. If they are unable, here are some resources to help a person find these resources in their area:

• Academy of Nutrition and Dietetics
• National Association of Anorexia Nervosa and Associated Disorders
• Eating Disorder Referral and Information Center