Is It Safe to Lose Weight if You've Had an Eating Disorder?
This question seems to come up pretty frequently. It usually comes in one of these forms:
I'm in recovery from an eating disorder. Will it ever be safe for me to lose weight in the future?
I have a pretty bad binge eating problem and I'm overweight. Can I focus on weight loss?
I used to have an eating disorder. Would it be smart for me to try and lose weight now?
This is a tough question to answer, but there are some simple guidelines to go by when doing so. I'm hoping that what I leave for you here will answer this question concisely and help you understand how weight loss fits into this whole story.
Restricting versus binge eating
The first important distinction to make when discussing weight loss in the context of EDs is the type of ED you have/had. While there are of course multiple different types of EDs (BED, NES, AN [and its subtypes], BN, OSFED, ARFID, Atypical Anorexia, Atypical Bulimia, Pica, Orthorexia, Exercise Bulimia, etc.), we can broadly divide this conversation into two main categories (Restricting and Binge Eating), because depending on which of these you fall under, there will be a different answer to this question.
For the purposes of this conversation, we can define these two categories as such:
Restricting: The hallmark feature of your ED is a heavily restrictive mindset and restrictive behaviors. This restriction has to do with purposeful weight loss (i.e. food fear without a desire to lose weight might not fall under this category perfectly).
Ex. Anorexia Nervosa (restrict type and purge type), Exercise Bulimia (otherwise known as Anorexia Athletica), Avoidant/Restrictive Food Intake Disorder (otherwise known as ARFID), and potentially Bulimia Nervosa (if there is a strongly restrictive component to your BN experience).
Binge eating: Any ED that consists of any appreciable amounts of binge eating, or overeating, episodes. The binge eating feature of your ED, under this category, is more pronounced than any restrictive practices.
Ex. Binge Eating Syndrome, Night Eating Syndrome, and potentially Bulimia Nervosa (if you are in a larger body or if the binge element of your ED is more prominent than the purge element).
Weight loss in restrictive EDs
Though neither category has a necessarily "easy" answer to this question, we can much more definitively say for restrictive EDs that no, it is not safe to lose weight. However, the truth is a bit more nuanced than this.
With anyone in the throes of their restrictive ED, especially if they have not begun the path to recovery yet, there is simply no way to embark on a weight loss diet safely. Plain and simple. Going on a diet designed to facilitate weight loss way too closely resembles any restrictive behaviors you could be engaging in, and all it does is worsen any symptoms you are experiencing.
But what about for anyone who is long since recovered from their ED? This is where things are less black and white. In theory, if you have totally healed your relationship with food and love for your body, you should be able to begin a specifically targeted weight loss effort without it being harmful psychologically or physically, right? Well, no, not so right.
The sad truth about eating disorders is that they stay with you. Even if you have learned to manage them and notice and name the Ed voice without necessarily acting on urges and thoughts, it will still always be there in the back of your mind. Going on a weight loss diet will too easily recruit this side of you and use it as inspiration to delve into progressively more pathological behaviors.
In fact, a weight loss diet by definition assumes that there is something "wrong" with your body right now and that you should not trust your body's own cues for hunger and fullness. All of this flies directly in the face of the important lessons taught in recovery: love your body unconditionally, trust your body, learn to love food.
This does not mean you will never look differently than you do now. In fact, and we will get into this in the next section, your body will learn to "normalize" its weight over time. This happens when we learn to eat when we're hungry and stop when we're full, and when we learn how to see food differently (not as a reward or punishment, but as an enjoyable part of life that serves to satisfy important biological drives).
Weight loss in binge eating EDs
So with our conversation on weight loss in restrictive EDs out of the way, what about those eating disorders marked by binge eating and overeating episodes? This brings us into another realm of discussion and necessitates a conversation about the concept of "normalizing" body weight.
To be sure, minus some rare genetic conditions that chances are astronomically low anyone reading this actually suffers from, the human body does not want to be overweight or underweight. What this means is that our brains are our friends. They want us to reach a homeostatic body weight that is conducive to proper metabolic health and that does not require too much energy to regulate (i.e. overweight) or protect (i.e. underweight). But to allow the brain to work this way, we have to do something for it in return, namely abide by its natural cues to seek out food and, alternatively, to stop eating when we're full.
Where problems come about is when we start straying from these natural cues. This happens when we...
Go on a specific diet (thereby letting some diet book or diet guru tell you when to eat and not to eat, effectively ignoring the brain's signals)
Let body hatred and thinness-admiration guide us (self-hatred leads to increased stress, poor decision making, and a furthering of the restrict-binge cycle that digs us into a deeper hole)
Use drugs to suppress (or stimulate) hunger
Purge excessively (this not only scars the GI tract but also disturbs the enteric nervous system, which houses a lot of hormones and neurotransmitters directly and indirectly linked to appetite and even weight regulation)
Binge eat (eating that ignores the brain's sent signals to stop eating and pushes us past the point of physical fullness, into the realm of actual physical pain)
So, as you can see, any efforts to bypass the body's natural hunger and satiety cues will inevitably fail us at every level. As such, imposing external rules regarding calorie restriction or carb omission or anything of the sort will only worsen the problem. This is all to say that a weight loss diet will be counterproductive, but a productive diet will usually lead to weight loss. It's that second part that is important: just as they say a watched pot never boils, a watched brain never induces weight loss (well, not never, but you get the picture).
Weight loss will naturally happen in overweight individuals upon following a diet that eliminates everything in the aforementioned bulleted list: externally imposed diet rules, body hatred (which falls under the umbrella term of Cognitive Dietary Restraint), hunger suppressors (or stimulators), and disordered behaviors like purging and bingeing.
So, is it safe for those with binge-eating EDs to lose weight? Yes. But is it safe (or effective) for them to aim to lose weight? No, most definitely not.
Is it safe for anyone to lose weight?
This brings us to one point you might be left wondering... If all the factors in that bulleted list are ineffective for the purposes of weight loss and actually make it less likely to happen, what implications does that hold for anyone who has never dealt with an eating disorder? Well, these rules are just as true for them as they are for anyone else.
The reality is, diets specifically tailored to weight loss (which encourage unnatural dietary rules and restrictions) are not effective, and usually not even safe, for anyone, but this is even more so the case with anyone who has a propensity to engage in disordered eating and exercising behaviors.
The entire concept of "weight loss" has been taken and bastardized by a multi-billion dollar a year industry that learned the sick trick of teaching people to hate their bodies so that they would buy their products. It's a never-ending cycle of self-hatred, a dangerous yet enticing solution being offered, a subsequent worsening of trust of our own bodies, and then a return to that enticing solution. In other words, it looks like this:
Media (and the diet industry in particular) inundates you with images of lean, flawless models. Plus social media is filled to the brim with people's best pictures and highlights they like to show the world.
We see this and assume "there must be something wrong with me."
We turn to the solution being offered at every corner: "Come try the new ThisIsLiterallyAReiterationofEverySingleDiet Diet! You'll lose 15 pounds in the first week!"
After anywhere from 3 days to 4 weeks, we realize eating in this unnatural way is not sustainable.
We inevitably give in to our body's commands for us to eat something that actually tastes good, or just not always follow every single externally imposed diet rule.
We feel guilty for eating that muffin and, in an effort to get a quick reward and feeling good again, we load up on all the foods we've been restricting for the past 3 to 28 days.
The binge eating leads to weight gain.
The weight gain leads to "there must be something wrong with me."
We turn to the solution being offered at every corner: "Have you put on weight recently? Shred it off with the new ThisIsThatLastDietExceptWeChangedOneFoodRule Diet! This time you'll lose 16 pounds in the first week!"
And so the cycle goes...
Okay, okay, so externally imposed dietary rules and restrictions don't work. Weight loss diets in general are dangerous roads to go down. But then what is the answer, other than the relatively empty sentiment of eating when you're hungry and stopping when you're full?
The answer is a dedicated period of taking care of yourself, restoring your relationship with food, learning to love the body you're in, conquering specific food anxieties, and making sure to have fun throughout the process.
All of this is covered in great detail, in a step-by-step, day-by-day fashion in my upcoming book 100 Days of Food Freedom: A 100-Day Journey to Self-Discovery, Freedom from Dieting, and Recovery from Your Eating Disorder.
If you want early access to the book, updates on it, and a cheaper price, make sure to sign up for the presale list. This is a product I've poured my heart into, and the entire book is based on science and experience, so you can trust that it will work for you.
If you have any questions or comments after reading this, feel free to contact me!