Last month, we did a deep dive into eating disorder treatment and recovery. Now, we want to take a closer look at why recovery is more than weight restoration.

Case Study: Eating Disorder Recovery

For this case study, the patient is 5 feet, 4 inches and 120 pounds, making her a healthy weight for her height. When she came into the office, she expected to hear that she was fully recovered based on the scale alone. However, her metabolic testing and body composition analysis showed otherwise. 

To start, disordered eating behaviors are still present, including:

• a restricted intake of 1,000 to 1,400 calories per day

• purging two to four times a month, depending on how often she eats something she considers “bad”

• overexercising, spending two to three hours at the gym in an effort to meet a “calories burned” requirement

Now, let’s look at her test results. Her metabolic rate is only 1,154 calories per day, notably lower than the anticipated 1,475 calories per day. This issue occurs when you don’t consume enough calories and your body compensates for the lack of fuel by bringing down your metabolic rate. Her protein metabolism is 9.7 percent above normal, meaning her body is burning more lean mass than it should. So, even though her weight on the scale appears to be restored, her body is still undernourished and not functioning properly.

Supporting these results, her body composition analysis showed a lean mass of 78.8 pounds — 11 pounds below where it should be. It’s important to note that your muscle mass plays a significant role when it comes to your overall health. When your number is this low, we start to see issues like low bone density, (osteopenia and osteoporosis), poor immunity, and poor longevity. 

Next Steps to Reach Recovery

Based on her continued habits, metabolic testing, and body composition analysis, we know that her health is not where it should be, despite her weight now being in a normal range for her height. “Recovery is more than just a number on a scale,” nutritionist Elaina Efird, RDN, CD, CEDRD, CSSD explains. “Yes, weight is important, especially when someone is severely underweight; we need to restore it. But at the same time, behaviors and what’s happening inside your body are most important for full recovery.”

As we mentioned above, her body is compensating for being under-fueled and burning too much lean mass for energy. In order to correct these issues and reach full recovery and optimal health, this individual will actually need to gain weight. She needs to consume more calories each day in order to restore her lost muscle mass and appropriately adjust her metabolic rate.

If you’re a clinician interested in learning more about this topic, check out this presentation by The Kahm Clinic founder Annika Kahm, MS, titled There Is More to Recovery Than a Number on the Scale. 

To talk to a professional about eating disorder diagnosis, treatment, and recovery, please reach out to our staff or schedule an appointment at The Kahm Clinic.