Goal BMI for Eating Disorder Treatment Question

So I'm in treatment for an eating disorder (EDNOS restrict/binge cycle with a history of anorexia and bulimia), and I'm not allowed to drop below my goal BMI of 20.

Does anyone know why eating disorder services use BMI 20 as the threshold for underweight, as opposed to BMI 18.5 as used everywhere else? It's pretty frustrating to have to stay at a weight I'm not comfortable with, and to be told I have to gain weight every other week because I've dropped into a BMI that is, frankly, the lower end of normal in conventional medicine.

It isn't only my local ED service, this BMI is used widely across the world as the threshold for a healthy BMI in the eating disorder setting.

Thoughts, reasoning, advice?

Thanks :)

Replies

  • laserturkey
    laserturkey Posts: 1,680 Member
    I imagine it gives you a little room for setbacks, but I'm no expert in the field. I do think part of recovery is doing what your treatment team tells you to do. Follow the rules they set for you. Wanting to justify lowering your BMI by 1.5 sounds like the eating disorder talking.
  • awesomejdad
    awesomejdad Posts: 493 Member
    Well one possible idea is to leave the person a bit of a cushion. Requesting that a person with habitual low weight to maintain a bit of a higher weight would be a good thing. And in the politest way I would suggest to you that your concern over this is a very bad sign in terms of combating your ED. It's OK to be at 20, it's better then 18.5.
  • Jim_Barteck
    Jim_Barteck Posts: 274 Member
    According to this: http://feast-ed.org/TheFacts/SettingTargetWeight.aspx

    The medical folks who are helping with your recovery probably looked at your lifetime height and weight charts to determine where you otherwise would have been if not for the ED altering your growth patterns. Given that you said you had an ED history, there were likely interruptions in your normal body development for which they are now attempting to compensate.
  • Maaike84
    Maaike84 Posts: 211 Member
    I don't know, and considering you are in treatment for a disorder, I think the best thing to do is ask a professional, like your therapist. I'm sure it's part of the programme for a good reason.

    Hazarding a guess though, it could be to do with your frame - there are a lot of factors bmi does not take into account. Me, for instance, I am built in such a way that I'd probably have to chop off a leg to get anywhere near a bmi of 18.5. I have also heard a bmi of 19 to be considered underweight.

    That said, I would like to stress that the main issue here is not the number of 20, but your feeling of discomfort at being at that (healthy) level of BMI. I think that's what your focus should be on moving forward, and if you are unhappy with your therapist's strategy, that's another thing you should discuss with them.

    All the best of luck! :flowerforyou:
  • OldSportOldsport
    OldSportOldsport Posts: 275 Member
    It's to provide a buffer. Aiming at a goal that is precisely one pound or whatever over an 'underweight' number is too close for comfort. It's the obsession with being thin/underweight that caused the problems, asking you to be at what is still the lower end of normal is a way of keeping that in check. You can't trust what you 'feel comfortable with' because you've already proved that your body signals and body image aren't reliable indicators of a healthy weight for you. The very fact that you're still focusing on the BMI numbers and talking about how you feel right at 18.5 but not at 20 is an indicator that you're still in recovery.

    This sounds harsh and it isn't meant to, but the damage done to your body by restriction/severe weight loss is actually also fixed faster if you can gain a little bit more weight than just the bare minimum. There's been a lot of thought and a lot of research into what it is reasonable to ask people with eating disorders to achieve, it's not an arbitrary number - it's an achievable one that you need to push for but will help in itself to measure your recovery. Best of luck!
  • MoosyGoosy
    MoosyGoosy Posts: 44
    I suppose my psychologist would be the best person to ask. I might talk to her about it when I see her friday.
    It just seems really annoying because I don't have a large frame, and the weight I tend to settle at naturally is BMI 21 (and also terrifying of course). So it's hard to keep within that BMI point difference between being terrified at my weight and being "underweight"- I can make that BMI point either way in a week! :(
  • awesomejdad
    awesomejdad Posts: 493 Member
    as was mentioned earlier the problem here is not the exact bmi you want. It's the fact that your even worried about it all. Do what your medical professionals are telling you to do. They are trying to help you overcome your obsession with things like this. The fact that this is bothering you is the ED!
  • EvgeniZyntx
    EvgeniZyntx Posts: 24,208 Member
    "Current goal is a BMI of 18.5" says your profile.

    So are you just looking for reasons to argue against what is in fact a healthy BMI as recommended by your doctor?
  • moonpieto
    moonpieto Posts: 76 Member
    If my goal was a BMI of 18.5 I'd be 5'9" and 125 lbs. I'd look awful. Just saying I figured out what the least I could weigh and be healthy was and that is the calculation. Not going there. Actually I have been that thin before and don't choose to do that anymore. I would say I was not so healthy.
  • MoosyGoosy
    MoosyGoosy Posts: 44
    "Current goal is a BMI of 18.5" says your profile.

    So are you just looking for reasons to argue against what is in fact a healthy BMI as recommended by your doctor?

    Nah, that's an old goal that was only really put there to not freak people out by seeing my actual goal :P
    I'm currently trying to stay over the 20 mark for the most part, because I know it's the best thing I can do for my treatment, career goal, and relationship goals.

    It just bothers me that there seems to be a double standard- heaps of healthy people are BMI 18.5, why can't I be?
  • EvgeniZyntx
    EvgeniZyntx Posts: 24,208 Member
    "Current goal is a BMI of 18.5" says your profile.

    So are you just looking for reasons to argue against what is in fact a healthy BMI as recommended by your doctor?

    Nah, that's an old goal that was only really put there to not freak people out by seeing my actual goal :P
    I'm currently trying to stay over the 20 mark for the most part, because I know it's the best thing I can do for my treatment, career goal, and relationship goals.

    It just bothers me that there seems to be a double standard- heaps of healthy people are BMI 18.5, why can't I be?

    Because with an eating disorder your behavior will bring you under too quickly. Trying to avoid borderline situations. Stay at 20 for a few years and no one will bother you. It's often healthier to have a little more weight, especially if ED has led to issues in the past.

    Eta: you should update your profile to put that 20 there. Show your ED that you own your goal and get comfortable with that - it's likely part of the path....
  • MoosyGoosy
    MoosyGoosy Posts: 44
    "Current goal is a BMI of 18.5" says your profile.

    So are you just looking for reasons to argue against what is in fact a healthy BMI as recommended by your doctor?

    Nah, that's an old goal that was only really put there to not freak people out by seeing my actual goal :P
    I'm currently trying to stay over the 20 mark for the most part, because I know it's the best thing I can do for my treatment, career goal, and relationship goals.

    It just bothers me that there seems to be a double standard- heaps of healthy people are BMI 18.5, why can't I be?

    Because with an eating disorder your behavior will bring you under too quickly. Trying to avoid borderline situations. Stay at 20 for a few years and no one will bother you. It's often healthier to have a little more weight, especially if ED has led to issues in the past.

    Eta: you should update your profile to put that 20 there. Show your ED that you own your goal and get comfortable with that - it's likely part of the path....

    Yeah, I think I'm consider resetting my goal... I just get anxious seeing the number :P
    I'm trying not to count calories anyway, not that it really works out seeing as I already know the calories of everything xD
  • Mischievous_Rascal
    Mischievous_Rascal Posts: 1,791 Member
    "Current goal is a BMI of 18.5" says your profile.

    So are you just looking for reasons to argue against what is in fact a healthy BMI as recommended by your doctor?

    Nah, that's an old goal that was only really put there to not freak people out by seeing my actual goal :P
    I'm currently trying to stay over the 20 mark for the most part, because I know it's the best thing I can do for my treatment, career goal, and relationship goals.

    It just bothers me that there seems to be a double standard- heaps of healthy people are BMI 18.5, why can't I be?

    It's not a double standard, it's a way to get you to a healthy weight, so you can focus on overcoming the ED thinking. A lower BMI for someone without an ED may be considered healthy for them, but health isn't just about weight. It's how you think about that weight, as well. You're on the right track. Please let the professionals helping you know that this is a concern and they'll be right there for you to get you past this feeling. Best of luck!
  • EvgeniZyntx
    EvgeniZyntx Posts: 24,208 Member
    "Current goal is a BMI of 18.5" says your profile.

    So are you just looking for reasons to argue against what is in fact a healthy BMI as recommended by your doctor?

    Nah, that's an old goal that was only really put there to not freak people out by seeing my actual goal :P
    I'm currently trying to stay over the 20 mark for the most part, because I know it's the best thing I can do for my treatment, career goal, and relationship goals.

    It just bothers me that there seems to be a double standard- heaps of healthy people are BMI 18.5, why can't I be?

    Because with an eating disorder your behavior will bring you under too quickly. Trying to avoid borderline situations. Stay at 20 for a few years and no one will bother you. It's often healthier to have a little more weight, especially if ED has led to issues in the past.

    Eta: you should update your profile to put that 20 there. Show your ED that you own your goal and get comfortable with that - it's likely part of the path....

    Yeah, I think I'm consider resetting my goal... I just get anxious seeing the number :P
    I'm trying not to count calories anyway, not that it really works out seeing as I already know the calories of everything xD

    Managing that anxiety is hard. Sometimes really impossible - but that's also why that number matters. Think of someone that has a fear of heights, how do you show that the fear is gone? You can listen to the person that says "I'm fine, it's gone" or you can climb that ladder, take that flight, live normally in that uncomfortable space. That's what that number is about - stretching into an uncomfortable space until it isn't any more. Someone like me (overweight, no ED) isn't fearful of a BMI of 20 (heck, I'd eat a puppy if I it could get me there) so for me, that number or even lower, doesn't matter - as long as it owns you, you will struggle to accept it, don't you think?
  • delicious_cocktail
    delicious_cocktail Posts: 5,797 Member
    "Current goal is a BMI of 18.5" says your profile.

    So are you just looking for reasons to argue against what is in fact a healthy BMI as recommended by your doctor?

    Nah, that's an old goal that was only really put there to not freak people out by seeing my actual goal :P
    I'm currently trying to stay over the 20 mark for the most part, because I know it's the best thing I can do for my treatment, career goal, and relationship goals.

    It just bothers me that there seems to be a double standard- heaps of healthy people are BMI 18.5, why can't I be?

    Because you have an eating disorder. I'm sure you wouldn't choose to have one, but since you do, you need to put yourself in the care of other people and trust their advice.

    Alcoholics can't drink alcohol. Drug addicts can't do drugs. People in wheelchairs are not good tapdancers. Compulsive liars cannot be trusted.

    Focus on all the things that you can do, and that are within your discretion. In this area, you need to simply trust the professionals who are trying to help you.
  • nancy10272004
    nancy10272004 Posts: 277 Member
    I'm in recovery for an eating disorder and to be honest, I am surprised that anyone is talking about BMI or weight when it seems that you're still very much in your disorder.

    I would talk to your treatment team to ask why they even have you looking at numbers and using them as goals. There should be other measures they use that will be kinder and more helpful to your emotional health.
  • sljohnson1207
    sljohnson1207 Posts: 818 Member
    I'm in recovery for an eating disorder and to be honest, I am surprised that anyone is talking about BMI or weight when it seems that you're still very much in your disorder.

    I would talk to your treatment team to ask why they even have you looking at numbers and using them as goals. There should be other measures they use that will be kinder and more helpful to your emotional health.
    I agree with this. I have eating disorder in my past as well (anorexia, bulimia, laxative abuse, and over-exercising/training). I am healthy now, in fact, overweight. However, I consider myself as cured as can be from my EDs. I don't starve myself, don't binge/purge, and don't over-exercise. Unfortunately years of laxative abuse permanently caused bowel issues for me, and I'm always working on that. I also likely developed dilated cardiomyopathy (enlarged heart with congestive heart failure) during my pregnancy 15 years ago because of malnutrition and all the harm I was causing myself. This heart condition is permanent and makes me at risk of dying young.

    Please, if this treatment center's treatment is causing you to obsess over numbers, any numbers, it may not be the right treatment for you.

    Seek a second opinion ASAP.

    And best wishes to you in recovering............from the bottom of my heart.
  • MoosyGoosy
    MoosyGoosy Posts: 44
    I'm in recovery for an eating disorder and to be honest, I am surprised that anyone is talking about BMI or weight when it seems that you're still very much in your disorder.

    I would talk to your treatment team to ask why they even have you looking at numbers and using them as goals. There should be other measures they use that will be kinder and more helpful to your emotional health.

    It isn't really that much of a focus, it's more helping me stay out of the underweight zone so I can think properly for treatment and university.

    I'm in New Zealand, my treatment centre is a publicly funded service, so even if I wanted to get a second opinion, I wouldn't because I'd have to pay!

    My treatment really suits me, they are very evidence based and I get to see a clinical psychologist (as opposed to a therapist). To be honest, I'm always going to be number obsessed anyway.
  • jancie84
    jancie84 Posts: 83 Member
    Just remember....your health is what makes you beautiful not the scale number! Surround yourself with positive people, find things (not food related) that make you happy! Try to focus on eating healthy- protein, vegetables, fruits.

    I'm sure you've been given meal plans before...but found these online! Eating healthy is hard....it's a lot of food! But, you need those nutrients!



    Sample Eating Disorder Recovery Meal Plan 1

    7:30am
    Banana
    ½ cup or 1 serving Cereal
    1 cup Milk (dairy, soy, almond, etc)
    10:00am
    Protein shake or ½ cup cottage cheese w/pineapple
    12:30pm
    Turkey sandwich with slice of cheese on 2 slices whole wheat bread
    Carrots and celery w/low fat ranch dressing
    3:00pm
    1 serving crackers, pretzels or popcorn
    6:00pm
    Grilled chicken breast
    1 cup broccoli
    1 cup noodles w/1 T butter
    1 cup milk or soy milk
    8:30pm
    1 cup yogurt w/1 medium apple
    Sample Eating Disorder Recovery Meal Plan 2

    7am
    1 slice toast
    1 scrambled egg with mushrooms
    1 medium apple
    10am
    1 oz cheese with 1 serving wheat crackers
    12:30pm
    2 slices whole wheat bread with roasted turkey, 1 slice cheese & mustard
    1 cup salad with vinegar or 2 T low fat dressing
    3pm
    ¼ cup trail mix (raisins, nuts, dried fruit, etc)
    6pm
    Baked salmon with 1 cup broccoli, ½ cup pasta, 1 T butter
    1 cup low fat milk or soy milk
    8:30pm
    1 cup yogurt with 2 T peanut butter
    Sample Eating Disorder Recovery Meal Plan 3

    7-9am
    1 cup yogurt
    ½ cup bran flakes
    9:30-11:30am
    1 slice whole wheat bread with hard boiled egg and tomato slices
    11:30am-1:30pm
    Peanut butter and jelly sandwich
    Tossed salad with almonds and 2 T low fat dressing
    1:30-3:30pm
    ½ cup cottage cheese with fruit
    5-5:30pm
    Veggie burger (make sure has 14 grams protein or more) on whole wheat bun with 1 slice cheese
    1 cup steamed broccoli or vegetable
    1 cup milk or soy milk
    7-8pm
    1 serving wheat crackers with 2 T peanut butter
  • Momjogger
    Momjogger Posts: 750 Member
    Have faith that the people who are treating you know what is best. Unfortunately you cannot count on your own perceptions right now as you are recovering. I am so happy for you that you are taking your health seriously and caring for yourself. Now just try to trust and believe that you are on the right path.
  • Just remember....your health is what makes you beautiful not the scale number! Surround yourself with positive people, find things (not food related) that make you happy! Try to focus on eating healthy- protein, vegetables, fruits.

    I'm sure you've been given meal plans before...but found these online! Eating healthy is hard....it's a lot of food! But, you need those nutrients!

    Thanks for the food ideas :) I might have a look at the plans, I really need to increase the variety of food I eat- I basically live off coffee, white bread, and tinned beetroot, with lots of chocolate mug cakes to stop my weight dropping too low xP

    I'm suuuper picky :P