By Emily Boring
I wish I’d been given a higher weight goal at the start of recovery.
If you’d told me five years ago that I’d someday write that sentence, I would have laughed in disbelief.
Like most patients with restrictive eating disorders, my recovery from anorexia was marked by fear, anxiety, and resistance to the very idea of weight gain. My personal mantra—reinforced by many doctors and dietitians—was, “Gain as little as possible to restore basic physical function.”
In the years since my recovery (2015-18, the majority of my time in college), numerous studies and articles have addressed the nuances of target weights in illuminating, empowering ways. Some points of emerging consensus:
- Set a weight minimum, not a maximum. A wide range is better than a single number.
- Focus on “state, not weight”: a person’s mental and emotional wellbeing are just as vital as physical markers when measuring recovery.
- Weight goals must be highly individualized, cognizant of a patient’s lifetime growth curves, family history, body type, and size-inclusive definitions of “health.”
- In present treatment, weight goals are consistently set too low for full psychological recovery. The farther below their ideal body weight a patient remains, the greater the risk of relapse.
Each time I read these articles, I find myself deeply moved, torn between tears of frustration, gratitude, and determination.
Frustration about the years that I lingered at the minimum BMI threshold, trying to will my way to recovery without the physical foundation.
Gratitude that eventually, thanks to articles, blogs, and better-informed providers, I broke through years of stasis and finally gained the weight my body needs.
Determination to ensure that no one stays trapped in limbo like I did, resigned to a life of mental anguish in a partly-recovered body, when science and personal experience repeatedly show that full recovery may lie only a few extra pounds away.
My goal isn’t to summarize the current recommendations on target weight ranges, which others (Eva Musby, Jennifer Gaudiani, Julie O’Toole) do excellently. Instead, I want to speak to the inner experience of this topic—to show how and why I’ve changed from someone who insisted on gaining the bare minimum, to someone who advocates with total certainty, “When in doubt, set a higher target weight.” I write from my firsthand experience of four things:
- The immense cost, physical and psychological, of staying at a weight too low for my body;
2. The unparalleled freedom, joy, and sustainability I find when I let my body settle in its own unique range;
3. The narrow but paradigm-changing margin—just a handful of pounds, in many cases— that separates one state from the other;
4. And the vital role that parents play in inviting their loved one across this threshold, helping build bodies equipped to sustain a life of freedom rather than fear.
When I’m recovered—eating consistently, moving for pleasure, maintaining the weight range that’s right for my body—I live in a different world than when I was ill. I like to think about it through a simple visual: a hill-and-valley diagram, with a little ball—me—travelling in between.
On the right side of the diagram, there’s the valley of full recovery. In this world, I feel comfortable in my body. I look in the mirror and observe the changes between my appearance now and my appearance in illness, and I greet this difference as a symbol of life and strength. I listen to cravings. I have no trouble cooking independently, traveling, going out for meals, eating desserts. All of the signals of my body—my cues for hunger, rest, or movement, my mental state and thought-patterns—are in tune with the goal of maintaining this healthy equilibrium. The valley of recovery is vivid and constant, a self-sustaining, holistic worldview.
On the left side of the diagram—the valley of the eating disorder—the rules are completely different. In this state of energy deficit (long-term or short term, dramatic weight loss or not), I experience a basic distrust of my body, a rigidity that makes me regard any changes in weight, diet, or routine with paralyzing fear. I can’t trust my body’s signals, because my sensations of hunger and fullness, distorted by malnutrition, paradoxically push me to restrict even more. I’m unable to recognize the danger of what I’m doing; restriction feels comfortable, anxiety-quelling, habitual. This isn’t a choice or a weakness. It’s a biological fact, a result of the physiological and metabolic changes (genetically based) that happen to a brain and body when you take in less energy than you need.
But here’s the tricky part, and the crucial thing to remember. A person in a state of energy deficit experiences their illness as the real, true, logically consistent way of things. From the valley of the eating disorder, anorexia’s biological and mental distortions feel just as “natural” and compelling to me as the healthy instincts that form my recovered world. And from the vantage point of illness, I can barely remember, much less act on, my recovered-world values. It’s impossible to sit in the valley of anorexia, inhabiting an underweight body, and truly envision or desire the valley of health on the other side.
What does all of this have to do with target weight goals? Nearly everything. I’ve found that the single most important variable—the safeguard that separates the valley of recovery from the valley of illness—is maintaining the weight range that’s right for me.
I didn’t realize this the first time through recovery. The process of finally reaching my body’s ideal weight zone—helped by an expert dietitian—was slow and painstaking. I couldn’t fully appreciate the mental and biological improvement as it was taking place. Instead, I learned about the value of staying in this higher weight zone later, through an experience of partial relapse.
Some months ago, a perfect storm of factors—pressure from grad school, a move across the country, anxiety about covid-19—caused me to slip into patterns I thought I’d long left behind. A skipped snack here, a few extra miles of running there—nothing drastic, nothing intentional, just enough to fall subtly short of my energy needs. Before I realized it, one lost pound became several, and I slowly slipped out of the range where my body likes to stay.
Luckily, I caught it quickly. Because I’d spent years in full recovery, I was able to notice something which, in earlier stages of healing, I couldn’t access: the striking difference in quality of life between illness and health. I became hyper-attuned to the incremental ways that my body and mind alter as my weight drops lower. A few pounds in, it suddenly felt more comfortable to be hungry than full. A meal that seemed normal two weeks ago looked huge and daunting. I couldn’t focus; my brain spun with calorie counts and exercise plans. When I’m in energy balance, I wake up every morning eager for breakfast. During my relapse, I wasn’t even interested in food. When I did eat, I got full quickly, and the sensation sent my mind in guilty spirals that seemed impossible to ignore.
In short, within a few weeks of inadvertent weight loss, my body and mind slipped back to the valley of the eating disorder. The change was all-or-nothing. In this alternate state, anorexia’s rules dominated, leaving no room for the hard-earned values of my recovered world. And the central factor behind this shift in worldviews? A BMI point or two in the wrong direction. Merely a handful of crucial, life-changing pounds.
I’m not the only one who’s had this experience. Many caregivers, describing a loved one’s descent into illness, marvel, “It was like a switch had been flipped.” Parents describe watching their children, flexible and boisterous one day, turn unrecognizably rigid and withdrawn within just a few weeks of undereating. Recent genetic science supports the notion of a “metabolic tipping point”—a critical threshold of energy intake and body weight—below which, for people with certain genes, the biological pull of restriction becomes nearly impossible to avoid. My experience of relapse, on the heels of a strong and long-held recovery, showed me just how dramatic and out-of-control this tipping point can feel.
This experience profoundly shaped my philosophy of target weight goals. It altered the advice I give to the parents and teenagers I mentor, and the practices I put in place to maintain my own recovery.
First, I realized just how impossible it is to fully recover at a weight too low for one’s body—and how often professionals inadvertently give weight goals that condemn a patient to settle for less than full health. I don’t like using numbers (everyone’s recovering body is different), but I’ll do so loosely here, to make a point.
When I first showed up for treatment in college, doctors and dietitians gave me a BMI goal of X—a single number, right on the lowest edge of “health.” When I reached that goal, life felt slightly better; my vital signs improved, my symptoms faded, I ate a little more. But now that I know my true metabolic threshold—now that I’ve felt, through my experience of relapse, the precise weight at which my eating-disorder-world melds into my recovered one—I see just how far off that first weight goal really was. For my body (like most bodies), a BMI of X falls squarely on the wrong side of the hill-and-valley diagram. For as long as I stayed there, I was fighting an uphill battle against my own biology, unable to see or desire true health. Continued weight gain—to X+2 BMI points, at the bare minimum—was the missing ingredient that put full recovery in the realm of possibility.
Second, I see the importance of treating target weight as an iterative experiment, constantly asking whether the fullest holistic recovery has been reached. The low goal a doctor first gave stuck with me. It became a static ceiling, an absolute maximum, a number I used to resignedly accept how things were. “The scale says I’m technically healthy—clearly, I don’t need to eat any more,” I reasoned. The illusion that I’d “arrived” at recovery, then, kept me from seeking the help (professionals trained in eating disorders) and the changes (flexibility around food groups, less exercise, a shift to more intuitive eating) that I needed to experience the benefits of recovery with pleasure and pride. How much easier it would have been if my goal weight were flexible from the outset, wide enough to accommodate the vast range of choices and bodies that constitute “health”!
Finally, I believe that an adequate “weight buffer” is an indispensable ingredient for sustained recovery. My relapse taught me that for my own body, the difference between health and illness can be quite a narrow margin, just a handful of pounds. The simplest solution? Don’t live so close to the boundary. Pick a weight that gives me some room for error, so that even through small perturbations—travel, stress, a stomach bug—I stay in the recovered zone.
Once upon a time, I would have seen this buffer as unwelcome and unnecessary. (“Why go above the bare minimum? No one is forcing you!” anorexia liked to claim). Now, I have evidence to talk back. I’ve witnessed how discouraging it feels to re-enter the valley of illness, how wonderful recovery feels by contrast, and how difficult it is to fight your way back from relapse to health. I don’t want to spend my life re-living this struggle; I’d rather stand firmly in the valley of recovery. A few extra pounds in the right direction—unnoticeable to an outsider, but vital for my body—seems a small price to pay.
Not everyone likes to hear this. At the suggestion of a higher weight goal, I’ve heard parents protest, “My child is already anxious enough! If they can’t accept their body at its current weight, how on Earth will they feel if they have to gain more?” I hear the weariness and discouragement (so natural—recovery is a marathon!), and the well-meaning desire to avoid further pain.
To these worries, I say: remember the hill-and-valley diagram. Of course your child fears weight gain! They’re still in the valley of anorexia, subject to mental and physical symptoms that only re-nourishment can assuage! A person’s resistance to reaching a higher weight is strong evidence that that’s exactly what they need to do. For what it’s worth, I can say with total certainty that when (and only when) someone reaches their own recovered valley, the anxiety quiets, fades, and all but disappears. Weight gain unlocks a mindset that’s literally unimaginable until you arrive there. I couldn’t have foreseen it (and neither could my parents or my dietitian, in those months of rage and resentment and anxiety and distrust), but it’s true. Today, I have nothing but gratitude for those who pushed me to take this more difficult route.
I write this to parents deliberately, because I see a profound invitation. You are the people who know your children best, who understand the gap between where they are now and the vision you hold for their future. You are the voices in the doctors’ and dietitians’ offices, in conference rooms and online forums, who are willing to push past the weight stigma that colors current treatment and advocate for individualized, inclusive definitions of health.
Trust your intuition. Refuse to settle for the bare minimum. Don’t let anyone convince you that recovery is one-size-fits all, or that health can be measured by a single pre-determined number on a scale.
I’m not a parent, but I know how it feels to see someone you care for trapped in stasis, unable to envision a life of greater pleasure or peace. I look at the teenagers I mentor— young people who are creative, sensitive, compassionate, and driven, whose challenges have wrought incredible maturity and depth—and I see extraordinary potential. I see their roadblocks and anxieties, yes—challenges I vividly remember. But I also see what they can’t quite glimpse yet: the radical freedom that’s waiting just around the corner, a few BMI points away. I think, “What would happen if you let your weight climb just a little bit higher? What new thresholds of liberation and joy and confidence could you unlock?”
Consider it this way. The cost of weight gain is fleeting—a couple weeks or months of effort and anxiety, as you push past anorexia’s fears. The cost of never achieving full recovery is long-term, tragic, and profound. A few weeks of discomfort, or a lifetime stuck in limbo? Weight gain isn’t easy (believe me, I’ve been there), but I know which option I’ll always choose.
Full recovery is possible—the return of your loved one, with all their pre-illness energy, their humor, hobbies, passions, and character traits (and many more markers of growth and selfhood that this journey of healing invites). If this hasn’t yet happened, consider that the thing that must yield is not your hope for full recovery, but the static, narrow number your loved one has been given, which may not be quite what their unique body needs to thrive.
Emily Boring is a writer and scientist from Corvallis, Oregon. A graduate of Yale University (’18), she earned her Masters of Science (’20) in marine ecology and genetics at Oregon State. Since recovering from anorexia nervosa during college, she has become an active speaker, writer, and one-on-one mentor. Her writing has appeared on the F.E.A.S.T. blog, Recovery Warriors and The Mighty. She is currently pursuing her Master’s of Divinity at Yale, focusing especially on religion and literature. She hopes to write and teach at the intersection of science and spirituality, using this shared language to help others through processes of healing. You can reach her at [email protected].