The Problematic Use of Weight as a Metric in Eating Disorder Recovery

By Ali Fields

As an Eating Disorder Survivor, I feel compelled to use my voice. When I was sick, my eating disorder often muzzled my voice and tried to gaslight me into believing I didn’t matter and didn’t deserve recovery. Sometimes it felt like eating disorder treatment providers were working with my eating disorder to keep me silent and sick.

I am sure it wasn’t/isn’t intentional, but we cannot continue to ignore the harm caused by the prevalent use of weight as a metric in eating disorder recovery. Specifically, weight is often used as a metric to monitor the re-nourishment process. What I call the re-nourishment process is also often referred to as “weight restoration.”

The term “weight restoration” is an oversimplification and highly triggering description of the healing process of re-nourishing a malnourished body. For those in ED recovery, whether it’s binge eating disorder (the most prevalent eating disorder), bulimia, AFRID, OSFED or anorexia, body re-nourishment is essential to the recovery process. Nourishment comes in many forms (i.e. spiritual, emotional, relational, etc.); for the purpose of this article, I am specifically referring to the nourishment food provides our mind and body.

Stable and sustained nourishment are vital to eating disorder recovery. For the past two years, I have sustained a full recovery (I identify as Recovered*). I understand the foundation of my status as Recovered rests in keeping my brain and body nourished. Nourishment is important because being Recovered, like being in recovery, requires a tremendous amount of renewable mental and physical energy.

I recognize the vital importance of the re-nourishment process. I also acknowledge how easy it is to monitor weight (via a scale) or assess someone’s physical appearance to gauge whether someone is gaining or losing weight. But at what cost? Using weight as a recovery metric is like serving alcohol at an AA meeting. It is, at best, counterintuitive and, at worst, acutely harmful.

We cannot ignore our culture’s pervasive weight bias which manifests as systemic fatphobia. People in larger bodies are pathologized, dehumanized and viciously oppressed every single day. This deeply ingrained weight bias and the toxic fear of fat it created, turned an inanimate object–a scale–into a weapon of psychological destruction. By forcing clients to step on a scale before, during, or after an appointment, providers inflict trauma, which acts as a barrier to healing.

Scale trauma is real. It is the eruption of stress and anxiety that occurs before, during, and/or after stepping on a scale. The stress and anxiety can be so consuming it overwhelms one’s ability to cope (read more about scale trauma Every time a client steps on a scale, whether they know the number or not, the client experiences trauma.

The use of weight as a metric also breeds distrust and judgment between patient and clinician. Clinician’s can use a client’s weight to determine if the client is complying with treatment. In some cases, losing, or not gaining weight, is a sign of non-compliance. In others, failure to lose weight is a sign of non-compliance. Clients show up to see the person they’ve entrusted to help them heal, feeling defensive and ashamed. I’ve heard far too many stories from friends who were reprimanded or threatened by their clinician, dietician, or medical provider by saying such things as, “I won’t treat you anymore if you don’t gain (or lose) weight!”

Finally, weight is an unreliable metric. People can gain weight and still be malnourished. That was certainly my experience. It is also super easy to “game” the system. I won’t go into this for obvious reasons, but if a client is more focused on “tricking” the scale to avoid getting “busted” then he/she is not about working on recovery. This is a problem. It was me for almost three decades. I worked so hard to fool the scale and my doctors and it never got me anywhere other than deeper into the eating disorder.

During my recovery, weight was never used as a metric to track my re-nourishment process. In fact, my therapist and I rarely, if ever, spoke of my weight. I am proud to say I haven’t stepped on a scale in over three years. My therapist and I knew recovery wasn’t linear, so we focused on the Phases of Recovery and/or Levels of Motivation listed in Carolyn Costin and Gwen Schubert Grabb’s phenomenal book, The 8 Keys to Recovery From an Eating Disorder (pgs. 14-16 and 20 – 22). I would sometimes start our session by talking about what phase of recovery I was in that day and my level of motivation.

Because I didn’t have to worry about exposure to weight stigma, scale trauma, or judgment in therapy, I showed up to therapy every week and spoke whatever my truth was that day. Some days I was a mess of eating disorder thoughts, others I was empowered and determined.  My therapist made me feel safe, trusted, and respected. Between each session I thought, I wrote, I challenged behaviors and belief systems. I failed, I fell, I relapsed. I also got up, showed up, made progress, kept moving and made my way through to Recovered.

*I started capitalizing Recovered during my recovery as a sign of respect. I continue to capitalize it because I know how hard I worked to reach Recovered.