One main focus of eating disorder thoughts is weight. It feels like a huge success to seemingly master weight with disordered behaviors, restricting, binging, purging, laxatives, etc. The positive feedback weight loss elicits is often intoxicating and only fuels the eating disorder thoughts. Just when someone starts to question the symptoms, that person finds herself trapped between the possibility of recovery and the terror of gaining weight.
Treatment programs and clinicians often focus too much energy on weight for many reasons. Insurance companies limit treatment after weight normalization as a way to keep down costs. The pressure of patients to focus on weight can be hard for treatment providers to resist. And weight provides a concrete, if limited, measure of improvement, something otherwise difficult to quantify.
The focus on weight in treatment only strengthens the eating disorder because weight gain feels most terrifying to someone in recovery. Losing the false sense of security that the eating disorder provides with weight is an enormous change in identity.
Recovery needs to put weight in context. The number on the scale is only one marker of improvement in health and quality of life. Medically, heart rate, blood pressure, improved organ function, normalized brain function and increased energy all are signs of improved health. Similarly, a broadened personal life through work, family and friends represents changes only possible with improved health.
If weight becomes a battle between recovery and the illness, the illness always wins. Treatment needs to minimize the value of weight and refocus instead on health and living a full life. There is so much more to being in this world than the number on a scale.
The fact that women sick with a disease receive so many compliments for a core part of an eating disorder is a sad comment on modern day living.