Eighty-five per cent of what?

Setting target weight is, in my opinion, fundamental to eating disorder recovery. Set too low, it consigns a patient to permanent illness as the brain marinates in stress hormones and not enough nutrients. Set and not adjusted as height and maturity progress is a recipe for relapse. Set and not adjusted after patient is recovered and finds a metabolic level that is naturally maintained: a tightrope of torture. Set too high.... well, that never happens. (The irrational terror of an anorexic or bulimic about an average weight is only slightly greater than that of those around him or her - it is sad.)

Another issue is psychological: if you set a range, most people will choose the lowest number - even people without an eating disorder history. But the body has its own ideas: the body has its own natural metabolic rate and it healthily and beautifully changes over the day, over the month, over years. In our family we call that the boa constrictor effect: the illness cinches in more securely every time you exhale.

And after malnutrition we know that there is a natural progression of caution, then wild cravings, and up to a year of settling down to intuitive eating. Brain chemistry and metabolism take far longer to recover than simple body weight, but of course the body composition has to normalize first.

Most maddening, to me, is that we define the illness with the 'less than 85%' term but we have no real definition of RECOVERY. Of HEALTH. I wish we didn't settle for anything less than 100%, and I rail at the idea that those between 85.01% and 99.99% are 'not in danger.' That's ridiculous. That is exactly when most of the distress, and the bingeing and purging, require the most attention.

It is a myth that there is one common standard, a scientific way to set weight goals that everyone is using. "There is considerable variance across studies in the determination of the AN weight cut-off."

Eighty-five per cent of what?

"The citation of the 85% criterion creates a sense of false consensus."

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  1. I've always hated this percentage, because it means nothing. Numbers really mean nothing, in a way. I've been in recovery for two years, and although I'm still thin, no one would say I look anorexic anymore. Even still, I haven't had a period in four years. No doctor knows how to bring it on, and they have no answers. Sure, I look, and mostly feel healthy, but continuing not to menstruate (at age 25) is certainly not something I'm happy about!

  2. This will seem very simplistic, but the science on this is pretty good: maybe your target weight is too low?

    How one looks, of course, is meaningless. But numbers do matter when you are looking at an individual's health. Numbers like body composition, hormone levels, metabolism.

    Have you had body composition analysis and hormone testing? And if you aren't functioning fully at this weight, why not go higher?

  3. The 85% point has always been a sticking point with me... when you hit 86%, are you then okay? You are suddenly classified as having ED-NOS and not AN... which is (unjustly) often not taken as seriously. But really... what really changes over that one percentage point? Nothing.

    Just to play devil's advocate, though... don't you think that there is a need for some number or percentage for diagnostic criteria? Don't you think it has some value as in ED screening? And also... in terms of diagnosis... it also gives some indication of treatment protocol. Certain physical (and emotional/mental) issues are associated with low body weight, which make the weight criteria a value piece of the diagnosis.

    I don't think that 85% is by any means a magic number (especially in terms of recovery), but I see why there is some numerical line.

    And in regards to the amenorrhea... Some recent research has shown that it may actually be more related to disordered eating rather than low body weight. It's possible for your body to be at a healthy weight but still functioning in a conservation mode. Have you had a progesterone test or an MRI to rule out hypothalamic amenorrhea?

    Great post, Laura.

  4. Good point, Grey: weight is an indicator of nutrition, but not a direct view.

    The numbers do matter, but they are very individual, and they should be 100% of what the person needs, not one point less.

  5. I hate this percentage too - I always used it as a goal, and suddenly when I hit it, THEN people started worrying

  6. I wish my "team" had never given me a goal weight. It was based on my previously healthy, normal weight. In the process of recovery I have gone *over* that weight hitting the heightest weight of my life (I'm an adult.) I've never been this shape or size or weight before and knowing that I went over what they said was a normal, healthy weight for me is just killing me. Now they tell me it's "normal" to go somewhat over goal weight/set point until the metabolism recovers ugh. I hate the 85% for a different reason - because I went *over* it! I wish they'd never given me a goal weight. It's hard enough to reach a "goal weight" let alone go over it. I would have been better off never hearing a goal weight.


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