What To Do When The Weight Comes Back

I get asked all the time: will the “extra weight” come off her stomach or his face?  Many people are appalled to hear that parents whose child was starved and wasted could become focused on worrying that “they might have gained a little too much weight”.  But it happens all the time. We talk and talk about weight re-distribution to families, but it’s hard.

I am grateful, therefore, for an article that appeared in the September 2014 issue of the journal Nutrients titled Anorexia Nervosa and Body Fat Distribution: A systematic Review.

Their abstracted findings are bold and direct, and I am going to summarize them here as they correspond so well to what we have seen over the years:

  1. during the course of anorexia nervosa adolescent females lose more central body fat, while adult females lose more peripheral fat

  2. partial weight restoration leads to greater fat mass deposition in the trunk region than other parts of the body

  3. after short term weight restoration, whether partial or complete, adults show a central adiposity phenotype with respect to healthy, age-matched controls

  4. central fat distribution is associated with increased insulin resistance, but does not adversely affect eating disorder psychopathology

  5. the abnormal fat distribution seems to normalize after long-term maintenance of complete weight restoration

Translation?

Partial weight restoration will give us weight gain in the middle of the body (“stomach”/abdomen), just where we don’t want it and where it’s metabolically least advantageous (i.e. increased insulin resistance) but if we persist into the realm of long-term weight restoration, it will normalize.  Further, you shouldn’t keep the patient/child at a weight under full restoration out of fear of central weight gain because such restoration “may adversely affect their psychological recovery”.

We nearly always have to wade through the waters of increased anxiety as weight begins to go up in order to reach the shores of normal cognitive and psycho-social functioning.  It turns out that you cannot “console” their eating disorder by keeping weight suppressed below the healthy threshold for that child.  The eating disorder will not be placated: there is no weight low enough for that.