My daughter is in the refeeding process, and is doing very well. She’s gained about half the weight she lost. Her treatment provider, who specializes in the Maudsley approach, says she will probably have to gain all her lost weight back, plus a few pounds.
How do we determine how much she will need to gain? She was never fat by any standard, but she was near the top of the healthy range for the height/weight charts. But right now she is happy with her body, she is back within the healthy weight range as defined by all of the height/weight charts, and she is having menstrual cramps, though has not started menstruating yet.
Does she really need to gain all of the weight back plus some, in order to not relapse? I'm afraid that by pushing her to be at the top of her weight range again, she is actually MORE likely to relapse, or else have other body hatred issues.
Angela Celio Doyle, PhD responds:
First, here’s a little background on what to take into account when considering a goal weight range. First is the adolescent’s previous percentiles on growth charts prior to the onset of the eating disorder. If you have access to the growth charts that your child’s pediatrician would have logged at their annual visits, get a copy of these to bring to your treatment team. If your child has always been in the 45th percentile for BMI, for instance, and then dropped to the 10th percentile, you can be fairly confident that your child should return to the 45th percentile.
Second, if your adolescent is a female, the weight at which she is able to regularly menstruate is a very helpful indicator (which is why treatment teams aren’t fond of the use of oral contraceptives since they “mask” this sign of health with an artificially-induced period).
Finally, parental body types can be useful to consider. If both parents have always been a bit stockier or quite slender throughout their lives, then this might suggest a body type to expect for their adolescent.
So, to more specifically answer your question, I would suggest looking at the history of your adolescent’s weight and BMI percentiles over the years with your therapist and your physician. Has she always been in the upper range of healthy weights? Or had it increased just prior to the eating disorder? I would rely on the general trend of her percentiles pre-eating disorder. Once her period returns, that does not signify an end to weight restoration, as she will probably need to put on a bit more weight to sustain her period on a regular basis. Finally, you are wise to look to signs of body satisfaction – this, along with less rigid views towards eating, increased cooperation with provided meals, and overall reduction in eating disordered thinking all mark progress towards a healthy weight.
A couple of other things to consider: it is important to aim for a range rather than a specific number. Also, this range can cause some difficulty with some adolescents in that they will aim for the lowest number in the range and not want to go above, especially if specific goal weight ranges are discussed too early on in treatment. This is something to discuss with your Maudsley therapist. Second, because adolescents are in the midst of growing, goal weight ranges are a “moving target”. With each passing year (and with any height increases), the goal weight range will shift upwards. Again, another reason to resist speaking about specific goal weight ranges too early in treatment, since it might change during treatment!