Can you recover from bulimia without gaining weight?

by | Jun 28, 2024 | Bulimia | 0 comments

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If you think you may have an eating disorder it is important to seek advice from your GP or health professional. The information in this blog post is intended for information purposes only and is not a substitute for personalised clinical advice. 

Can you recover from bulimia without gaining weight? The fear of weight gain in recovery can be daunting and often keeps people stuck wanting to change but not quite being able to.

So what do we know about weight gain in bulimia recovery? In this blog, we’ll explore the research studies and findings, assess your current weight and pre-bulimia weight, and debunk some myths about bulimia and weight gain.

Whether you or someone you care about is on this challenging journey, understanding these key aspects can provide the clarity and confidence needed to move forward. Join us as we uncover how to reclaim your health and well-being without unnecessary worry, and take the first step towards a balanced and fulfilling life.

weight changes in bulimia recovery

If you start cognitive behavioural therapy for bulimia, the aim will be to keep your weight stable, so long as your weight is within the healthy range. Eating disorder therapists generally define a healthy weight range as a BMI of 20-25.

Research studies have found that, on average, there is minimal change in people’s body weight after bulimia treatment. But this is not the full picture.

First, if you have been avoiding carbohydrates, you will probably see a jump in your weight in the first few weeks of establishing regular eating. This is often related to an improvement in your hydration levels and restoring glucose stores in the body, not fat gain.

Secondly, if your weight is currently below a BMI of 20, it is likely that you will need to gain weight. Studies have found that being below a BMI of 20 is unsustainable for most people without dieting. Dieting is one of the largest causes of binge eating, making it very difficult (or impossible) to recover, and putting people at risk of relapse.

Finaly, for long-term recovery it’s important to understand whether your weight is currently suppressed.

Weight Suppression

Weight suppression is defined as the difference between a person’s highest adult weight and their current weight. For example, a previous highest weight of 90kg and a current weight of 75kg.

One theory is that people who are weight suppressed may develop biological mechanisms that drive them to eat and increase in weight. Exactly how and why this happens is unclear. However, it seems that people who are weight suppressed may experience changes in hormone levels associated with hunger and fullness. Specifically, they have lower levels of leptin, which is thought to signal fullness.

Another theory is that the more weight-suppressed a person is, the more they fear returning to their previous highest weight and engage in strict dieting behaviour to try and prevent this. This dieting behaviour becomes the trigger for binges and keeps the person stuck.

Woman weighing herself

Research Studies and Findings

People with bulimia are more likely than the average person to be weight-suppressed, and studies have found that being weight-suppressed (including the level of weight suppression) is linked with higher levels of relapse.

Despite the fact that there is minimal weight change after bulimia recovery when you look at averages, there are differences when broken down by weight suppression status.

One study found that people who started treatment minimally weight-suppressed tended to lose a small amount of weight over 5 years. Those who were moderately weight-suppressed gained a small amount of weight. Those who were highly weight-suppressed gained a significant amount of weight over a 5-year period.

Furthermore, other studies have found that people who stay significantly weight-suppressed are more likely to continue bingeing and purging. And the more weight-suppressed someone was, the more frequently they were found to binge and purge.

In summary, people who are significantly weight-suppressed appear to need to increase their weight in order to recover, and if they remain weight-suppressed, they are more likely to relapse and continue bingeing and purging.

Assessing Whether You May Need to Gain Weight to Recover from Bulimia

So how to do you know where you can recover from bulimia without gaining weight? Coming to terms with the fact that you may need to gain weight to recover from bulimia can be really hard. Many people I work with tell me they wish they could recover and keep their body weight low.

You might be scared that being weight-suppressed means you will return to your highest weight if you recover. This is not necessarily the case.

In order to get a full picture of your own weight status, consider these factors:

Assessing Your Current Weight Range

What is your current BMI? If you are over 18, you can use this BMI calculator on the NHS website to find out your current weight range.

If your weight is under 20, you will probably need to work towards increasing your weight to a minimally healthy range.

Laptop and calculator representing BMI calculation

Assessing Whether You Are Weight-Suppressed

Next, write down your highest adult weight and subtract your current weight from this. The difference between these two numbers reflects your level of weight suppression.

There isn’t enough evidence yet to give definite answers on how to categorize levels of weight suppression in relation to bulimia recovery outcomes. However, the bigger the discrepancy, the more likely it is that weight suppression may be preventing you from being able to recover fully.

Many people with bulimia are overweight before they developed an eating disorder. Gaining weight doesn’t necessarily mean you will return to your highest weight. But it might be necessary to increase your weight enough so that you can eat in response to your hunger and fullness signals.

Assessing your emotional reaction to weight gain

The final, and perhaps most important, area to consider is your emotional reaction to the prospect of weight gain.

Being very concerned about body size is one of the key maintaining factors for bulimia. The more concerned you are about body weight, the more likely you are to engage in weight controlling behaviours and these put you at risk of bingeing.

Allowing yourself to gain some weight is an important psychological shift. It involves taking a step away from body weight being very important and allows you to step towards the things in your life that you truly value.

How do you feel about the idea of gaining weight? Does it fill you with dread or is it something you can come to accept in order to get your life back? If you feel extremely worried about weight gain, it might be a signal that it’s time to work on your body image and sense of identity outside of body size and shape.

You might find it helpful to take a look at this guide to increasing motivation to recover from bulimia.

Woman looking in the mirror smiling

Debunking Myths about Weight Gain in Bulimia Recovery

To deal with the fear of gaining weight we also need to clear up some common myths about bulimia and recovery. Myths can make people more anxious and stop them from getting better, so it’s important to know the truth.

Purging Doesn’t Work Very Well

One myth is that vomiting helps control weight. But research shows that vomiting doesn’t get rid of many calories (between 30-50%). The body absorbs most calories before purging can happen.

Laxatives are even less effective, providing virtually no removal of calories but risking significant health complications.

Since purging is ineffective, this helps explain why many people with bulimia are in the healthy weight range or overweight. Increasing what you eat earlier in the day will reduce your likelihood of bingeing and likely reduce the overall amount of calories consumed.

The Benefits of Regular Eating

Another myth is that eating regular, balanced meals will always cause weight gain. Actually, eating regular meals is important for recovery. It helps keep your metabolism normal, stabilizes blood sugar levels, and reduces binge-eating episodes. Following a meal plan can help your body start to trust that it will get the food it needs, which reduces the urge to binge and purge.

Table with selection of people eating a meal

Recovering from bulimia without gaining weight is a complex issue. Weight gain can happen during recovery, but it’s not always the case. By debunking myths, understanding the importance of regular eating, and working closely with healthcare professionals, you can recover in a way that feels safe and manageable. The main goal is to be healthy and well, focusing on nourishing the body and mind rather than controlling weight.

References

Butryn, M. L., Lowe, M. R., Safer, D. L., & Agras, W. S. (2006). Weight suppression is a robust predictor of outcome in the cognitive-behavioral treatment of bulimia nervosa. Journal of abnormal psychology115(1), 62.

Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.

Fairburn CG, Welch SL, Doll HA, Davis BA, O’Connor ME. Risk factors for bulimia nervosa: A community-based case-control study. Archives of General Psychiatry. 1997;54:509–517

Herzog, D. B., Thomas, J. G., Kass, A. E., Eddy, K. T., Franko, D. L., & Lowe, M. R. (2010). Weight suppression predicts weight change over 5 years in bulimia nervosa. Psychiatry research177(3), 330-334.

Juarascio, A., Lantz, E. L., Muratore, A. F., & Lowe, M. R. (2018). Addressing weight suppression to improve treatment outcome for bulimia nervosa. Cognitive and behavioral practice25(3), 391-401

Lowe, M. R., Berner, L. A., Swanson, S. A., Clark, V. L., Eddy, K. T., Franko, D. L., … & Herzog, D. B. (2011). Weight suppression predicts time to remission from bulimia nervosa. Journal of consulting and clinical psychology79(6), 772.

About

Welcome. I'm Dr Jenny Davis, a Clinical Psychologist with a special interest in eating disorders. I'm passionate about helping people recover and build a healthy relationship with food. 

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