by Insook Jeon, M.S., R.D.
Patients entering treatment for anorexia sometimes resist getting help from what they perceive as various authority figures such as doctors, psychiatrists, and nutritionists trying to make them fat and gain weight. This is partly in response to some of the screening and evaluation methods used with eating disorder patients, especially the widely used height and weight charts from MetLife or the USDA.
For example, a 20 year old woman might enter treatment at 5′ 5″ and weighing 80 pounds, which corresponds to a Body Mass Index (BMI) of 13.3. The standard BMI chart range for this age is between 19 and 26, or between 114 to 159 pounds, with a 50th percentile target of 130 pounds. It would be difficult for most anorexic patients to contemplate gaining 34 pounds, not to mention 50 pounds at the outset of their treatment program.
One response to the perception of “unrealistic” goals set by treatment programs can be that patients will actually work diligently at gaining weight as quickly as possible, in order to be declared “cured” and thus “escape” from their treatment program, free to resume their old behavior. It is not uncommon to see some women who have gone in and out of treatment facilities with this pattern.
Rather than trying to force a struggle with an overwhelming increase in weight, I often ask new clients, “What weight do you think you manage without hating yourself?” This helps us set a “safe” goal that we can work towards together, and allowing a focus on recovery through changes in nutrition, behavior, and attitudes, rather than a focus on weight gain. By the time the initial goal is achieved, we are ready to set a secondary goal, building on the improved health and behaviors, and progressing toward levels that seemed unattainable at the beginning.
Link: Interactive age-adjusted BMI calculator (Baylor University)