Anorexia Recovery and Elevated Nutritional Needs
In anorexia nervosa recovery, a foundational part of the nutrition work is gradually building up to a full eating disorder recovery meal plan and establishing a regular pattern of eating, with balanced meals and snacks spaced consistently throughout the day.
Why We Ease into a Full Meal Plan
When working with families in eating disorder recovery, we certainly do not meet a child on day one and immediately place them on their full and complete recovery meal plan. That would be a quantum leap from where they are currently, often fully engaged in the eating disorder, and could be emotionally overwhelming, physically uncomfortable, and in some cases physically unsafe as well.
Instead, we gradually ease into the full meal plan and supervised meals and snacks over a period of time. This helps reduce the risk of refeeding syndrome by allowing us to increase calories and nutrition as safely as possible.
Taking a gradual approach also helps minimize physical discomfort, particularly digestive symptoms, although some degree of digestive discomfort is common and expected during refeeding. As the body begins receiving adequate nourishment again, the digestive system is re-learning how to process and tolerate the amount of food required for recovery.
Exactly what this process looks like is highly individualized and depends on your child’s unique nutritional, medical, and emotional needs. No two individuals, eating disorders, or families are exactly alike.
You will work closely with me, your registered nutritionist, to gradually guide your child and your family toward a full and personalized recovery meal plan. Together, we will navigate each step of the process, ensuring your family feels informed, supported, and never alone in the work of recovery.
Within the context of what you may think a full day of balanced meals and snacks looks like, this gradual approach may seem unnecessary. However, in anorexia nervosa recovery, significantly more food and nutrition is required to restore health and physical stability than many people can initially conceptualize.
Individuals with anorexia nervosa often become hypermetabolic during weight restoration. As a result, they require a substantially increased caloric intake, along with a broad and varied diet free from food restrictions and food group avoidance. This level of nutrition is necessary not only to support safe refeeding and achieve medical stability, but also to maintain health and sustain recovery after weight restoration.
Understanding Hypermetabolism in Anorexia Recovery
Becoming hypermetabolic means that the individual in anorexia nervosa recovery burns energy at a much higher rate than expected and therefore requires significantly more calories than the average healthy person to gain weight and even to maintain weight.
When someone is sick with anorexia nervosa, they are actively restricting both the amount of food and the types of foods they consume, regardless of whether they have the restricting type or binge/purge type. As a result of this restriction, their metabolism slows down significantly.
With so little food being consumed, the body must ration the limited energy it receives in an attempt to sustain essential bodily functions such as the heart and brain. This is also why individuals with anorexia nervosa often lose their menstrual cycle and experience digestive difficulties.
While we need our hearts to beat in order to stay alive, we do not need to reproduce to survive. And while digestion is important, it does not need to function optimally for the body to conserve energy. The body is simply trying to conserve as much energy as possible in order to survive, and it slows down accordingly.
Once someone begins eating disorder recovery, they will start to gently refeed and integrate more calories and nutrients into their diet. Their metabolism responds to this by speeding up. There is then a period of time, called hypermetabolism, during which the metabolism speeds up much faster than that of the average healthy person.
Because of this, a very large amount of food is often needed to gain even a small amount of weight (more on that shortly!). If someone in anorexia nervosa recovery were to consume what you or I might eat in a day, an amount of food that would be more than adequate for a healthy adult, they would likely continue to lose weight and would not be able to regain physical stability.
This is also why intuitive eating is not appropriate at this stage of eating disorder recovery. There is honestly nothing intuitive about this phase of the process, as the amount of food required to stop weight loss and restore health is not only counterintuitive, but also extremely frightening to the individual in recovery (and sometimes to the family as well, depending on everyone’s relationship with food).
Meal support during this phase of recovery can be incredibly helpful and, in many cases, integral to positive recovery outcomes. If your child is struggling to complete meals and snacks consistently, our Virtual Meal Support services provide real-time guidance and support throughout the refeeding process and beyond.
How Much Food Is Needed for Weight Restoration in Anorexia Recovery?
During weight restoration, individuals with anorexia nervosa often require a substantial caloric surplus to gain even a relatively small amount of weight. This can be surprising to many families, as the amount of food needed to restore health is often far greater than they initially expect.
Exactly how much food is required varies widely from person to person. Every individual is different, and no two eating disorders or recovery journeys are exactly alike.
Some of the factors that influence caloric needs include physical activity (while exercise is not recommended during the refeeding phase, some individuals may continue to move excessively through secret exercise, pacing, standing, fidgeting, or other forms of constant movement), differences in metabolic efficiency, health and weight history, age, and thermoregulation.
Working together in our nutrition for eating disorder recovery sessions, we will determine the amount of nutrition your child requires to restore health and physical stability. We then very gradually build up to that full amount over time, allowing us to do so as safely as possible while also more accurately identifying the level of nutrition needed to support complete recovery.
I share this to emphasize that yes, your child will need to eat more than you, and no, this is not too much food (a question we get asked ALL the time!) but rather exactly what they need to get well and stay well.
They must treat their meal plan like their medication.
What you need nutritionally and what they need nutritionally will look different. What they need to eat to be healthy will also look different from their siblings and peers. This is very challenging for them (and perhaps the family) to comprehend, but imperative, as anything less than what they need will result in a drop in body weight and health.
Does the Amount of Food Stay the Same Throughout Refeeding?
This is another challenging aspect of the initial refeeding phase of anorexia nervosa recovery. Most individuals will need to continue increasing the amount of food and nutrition they are consuming in order to maintain a steady rate of weight gain, even after weight restoration has begun.
This is one of the reasons why we, or your healthcare team, continue to monitor weight closely throughout this phase of recovery (learn more about why we recommend blind weigh-ins here).
We continue to monitor and adjust the amount of food and nutrition at regular intervals throughout this refeeding phase of eating disorder recovery, managing not only the individual's physical health and weight, but also their mental health, as this stage of the work is often extremely difficult and, quite honestly, terrifying for the person in recovery.
Can We Reduce the Amount of Food Once My Child Reaches a Healthy Weight?
Once your child has achieved weight restoration and they are physically healthy again, you all may feel eager to reduce calories to what most perceive as a “normal” amount of food (put intentionally in quotations, as the honest truth is no two bodies are alike and everyone will need a different amount of food and nutrition to be healthy, regardless of what is perceived as normal or average).
This is a difficult time, however, because your child is still physically quite vulnerable and reducing food too soon after weight restoration may result in a quick and/or steady drop in weight (and health) even after a year or more of working to regain weight and health in recovery.
Their bodies are still quite energy inefficient at this stage of the recovery process and as such they will still require an increase in nutrition to maintain the weight that they (and you all) have worked so hard to restore.
This is one of the reasons why relapse rates can be high in anorexia nervosa recovery. Recovery is not simply a matter of restoring weight and then abruptly ending treatment.
Instead, support is gradually tapered over time. Just as we carefully build up nutrition, meal support, coaching, and family support during the early stages of recovery, we also thoughtfully reduce support as the individual and family become more confident and stable.
Going slowly is important not only at the beginning of recovery, when someone is easing into a full meal plan and the refeeding process, but also at the later stages of recovery, as they begin to step back into a full and healthy life.
This gradual transition creates space for the family to practice managing more meals independently, for the individual in recovery to make increasing numbers of food choices based on health rather than the eating disorder, and for everyone to navigate the inevitable challenges that arise as life expands again. This may include returning to school or work, rebuilding social relationships, traveling, and balancing the demands of everyday life while continuing to prioritize health and recovery.
My motto in eating disorder recovery is:
The slower you go, the faster you get there.
I know that everyone wants recovery to happen as quickly as possible, but there is no race. Healing takes time, and eating disorder recovery is far more complex than simply restoring food intake and body weight, though nutrition is the essential foundation upon which all other recovery work is built.
After all, an eating disorder is a mental health condition.
The nutrition needs involved in anorexia nervosa recovery can feel overwhelming, but you do not have to navigate this process alone.
We offer specialized nutrition counseling and Virtual Meal Support to help individuals and families safely move through refeeding, weight restoration, and the ongoing work of recovery.
If you would like to learn more about how we may be able to support your family, we invite you to book a complimentary discovery call.
