Weight Restoration and Anorexia: Dealing with Anxiety

There is a terrible irony that people being treated for anorexia nervosa have to face: the last bit of weight restoration is the absolute hardest.

When people have put on about 90 to 95 percent of their ideal body weight, suddenly their anxiety skyrockets. This occurs just as their sex hormones (primarily estrogen and testosterone) start to stabilize.

This is the moment when my patients in anorexia treatment often tell me “Great! Thank you very much for your help! I think I’ve reached just the right weight and it’s time for me to complete my treatment here!” The thought of any additional weight gain seems impossible and completely intolerable.

Patients imagine that if they feel this bad now, just think how much worse they will feel after they complete their weight restoration. As troubling as this may be, these tend to be common signs of anorexia recovery.

While anxiety is not unfamiliar to these individuals, the anxiety related to the impact of recovery can feel unbearable. However, with proper clinical support, you can learn how to manage it.

Why does anxiety increase with weight restoration?

Here’s what we know: people with anorexia nervosa who do not complete full weight restoration are less likely to achieve and maintain recovery from their eating disorders.

In fact, this is the time they need the most support from their treatment teams. This is also very often when insurance companies decide that it’s time to withdraw coverage.

And here’s the most remarkable thing: This critically high level of anxiety improves dramatically when the individual does restore to a healthy body weight.

You read that correctly: once the individual achieves a healthy body weight, their anxiety improves.

If I hadn’t seen it happen so many times myself, I wouldn’t feel so confident when counseling my patients and their families on how important it is to continue right through the tremendous anxiety. In fact, it is almost magical to watch it happen. You can see the phenomenon clearly in this graph below. [Data from Dr. Craig Johnson, personal communication]


Trace the anxiety trend (the red line) as it drops during the first part of the weight restoration. Watch how anxiety spikes sharply as the patient reaches 90 percent of expected body weight, only to drop off again after reaching 100 percent of goal weight.

While this graph is very informative, nothing can convey this experience as beautifully as the words of someone who has lived it.

One of my patients very recently went through this experience and offered to share her experience with us here:

Dealing with anxiety and anorexia

When someone with anorexia is asked to gain a large amount of weight in a short amount of time, you could say there is a bit of anxiety. You’re basically given an ultimatum: You can face a huge fear all day, every day. Or you can wither away until you’re literally nothing.

I chose to face my fear. 

It came with tears. A lot of them. In the car on the way home. In the shower. In bed. Pretty much everywhere.

As I packed the pounds on it only got worse. It reached its pinnacle when I hit 90 percent of my weight goal.

One more forced bite meant one more unwanted pound, which meant one more intrusive thought. “Sit with the feelings,” they said. “They will pass,” they said. But it felt never-ending. I felt hopeless. I felt frustrated. I felt lost. I couldn’t trust myself. My eating disorder couldn’t trust my treatment team.

It was the worst kind of battle. It was a fight with myself. My gut and my heart told me keep going. That the more I complied with my meal plan the faster I would reach my goal weight and not have to be scared any more.

But my head told me that one extra bite would mean at least ten extra pounds. That these people didn’t know the real me, and therefore, they were just trying to make me gain weight. I felt as if I shouldn’t look in a mirror because then I would see the extra cushion that had reached places it had never been before.

But I felt as if I should look in the mirror because this is my body, and I had to trick myself into believing that this is one thing I would need to learn to accept. I was in a constant conflict; my head, my heart, my values and my eating disorder were all fighting for control. The thoughts kept coming. The tears kept flowing. The bites were still being taken. The number on the scale was increasing, inching closer to a weight that I said I would never reach.

During this period, I was presented with factual information meant to convince me that I just had to persist past this point — that my ability to think logically would return when I reached my goal weight. In turn, I would be able to cope when my emotions, my thoughts, and my life became overwhelming.

Every day I struggled to find the energy and the hope to keep going.

Then, almost overnight, I didn’t need to fight anymore. The thoughts still came, but they flowed out as quickly as they had intruded. I could actually sit with the feelings because they really did pass and they gradually became less and less. Logic started to return. The fight became more one-sided. And I was winning. The bites were less forced, and the bites now meant energy. I had energy to walk, energy to laugh, energy to breathe and energy to persist — despite the pain, the anxiety and the fear.

I had energy to exist.

Managing anxiety and weight restoration in anorexia treatment

If you are in the process of gaining weight in anorexia recovery, or are a loved one supporting someone going through it, please remember two things:

  1. The intense anxiety that you are experiencing at this point is the very worst it will be.
  2. The anxiety you feel now will get better; struggling through this part is absolutely necessary to achieve and maintain a full recovery from your eating disorder.

We encourage you to turn towards your support system during this difficult phase and let them help you through – it really does get easier.

Written by Dr. Anna Vinter, adult psychiatrist

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This page was updated and clinically reviewed by Allison Chase, PhD, CEDS-S, regional clinical director at Eating Recovery Center on June 16, 2023.

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