Experts say, "Recovery weight must be individualized" • Eva Musby

Individualized target weight versus one-size-fits-all: quotes from experts

This page is all about useful quotes!

Regaining weight to meet the body's needs (that includes the brain!) is necessary for eating disorder recovery.

And nobody should have their treatment end prematurely on the basis that they have reached some calculated target weight.

I'm going to give you quotes from eating disorder experts, all recommending that if a goal weight is estimated for your child, it must be individualized. Personalised. Tailor-made. It should not be a one-size-fits-all number, churned out by a calculator, based on a statistical population.

The quotes on this page will help you move away from a one-size-fits-all goal like 'median BMI' or '50th centile BMI' or '100% weight-for-height'. They urge you to take into account a person's growth history, using a growth chart.

That will be a huge improvement. Like a weather forecast, we're getting closer, and predictions made from a growth chart still leave us with some uncertainty If your child was given a goal weight (and there are pros and cons to that) then it needs to be regularly revised in light of their physical and mental state.

Or to give you an analogy, when you're choosing a shoe for your child, you try various models for a good fit. You'll know the shoe must be at least as large as those you bought a year ago. You'll be observing as your child tries a few shoes on. For everyday shoes, you won't let fashion dictate your choices: you know the shoe must fit.

Middle-size-fits-all and a fashionable shape don't work for feet, and they don't work for recovery weight either.

What the experts say on target weight: individualized, not statistical

I'm distressed by how many people are still being told the target weight is "100 percent weight-for height" or "50th percentile BMI" or "median BMI".

As I explain here, statistically those numbers means that half of patients are getting target weights that are too low, which means they are highly likely to stay ill.

So here I've gathered quotes from professional organizations, as well as from esteemed researchers and clinicians, several of whom are central to the training of thousands of eating disorder clinicians. I hope that these help change practices among clinicians, and help inform parents.

Here's what the experts are saying about goal weight

"Individually determined target weights should be established as part of the initial treatment plan.[…]

In adolescents, target weight will be adjusted upward to correspond to increases in the patient’s height.[…] During a period of growth, the target weight should be reassessed every 3–6 months
The American Psychiatric Association (APA) Practice Guideline 2023 Page 33

'Treatment goal weight should take into account premorbid trajectories for height, weight and body mass index; age at pubertal onset; and current pubertal stage"
Position Paper of the Society for Adolescent Health and Medicine (USA) (2016)

"Target weights should be individualized"
James Lock, co-author of the FBT treatment manual, personal communication

"Yes, it is better when considering weight to take into account their weight history"
Ivan Eisler, Maudsley's Child and Adolescent Eating Disorders Service, personal communication

Cease this madness! BMI is not an accurate measure of a healthy state.
Julie O'Toole,
Chief Medical Officer of Kartini Clinic, in 'The misuse of BMI in diagnosis of pediatric eating disorders'

"Contrary to the promises of diet companies and the ideology of the war on fat, not every individual will place neatly into the 'average' weight category based on age and height."
Lauren Muhlheim in 'When your teen has an eating disorder'

"There is no one right size that fits all when it comes to healthy weight after anorexia nervosa. Thus anyone who uses an equation (such as a BMI or ideal body weight calculator) or simplifies this complicated situation is relying on tools that are inadequate."
Dr Jennifer Gaudiani, internist and expert on the medical complications of eating disorders, in 'Weight goals in anorexia nervosa treatment'

"A person’s healthy weight is highly individual to their genetics, their medical history, their experiences with food and dieting/caloric restriction throughout their life, and their body’s unique responses to inadequate fueling and to nutritional rehabilitation."
Dr Jennifer Gaudiani, internist and expert on the medical complications of eating disorders, in 'Weight goals in anorexia nervosa treatment'

"The idea that […] everyone should be at medium BMI – that is just not the case and not appropriate"
Daniel Le Grange, co-author of the FBT treatment manual, in this webinar

"In young individuals, a “biologically appropriate weight” is associated with normal historical development. In adults, a “biologically appropriate weight” is where weight settles when enough food is consumed to attain all required nutrients, and the person is physically and emotionally satisfied."
AED Guidebook for Nutrition Treatment of Eating Disorders (2020)

"For adolescents and young adults and adults, we are really trying to think about their lifetime growth trajectory and not just some standard norm, off a chart. So we're looking at their growth patterns throughout their own lives, considering what pubertal stage they're at, considering if catchup height is needed"
Rebecka Peebles, FEAST of Knowledge conference 2024

"Goal weights typically take into account patient’s height, age, premorbid growth curve percentiles for height and weight, prior growth trajectory, growth potential, pubertal stage, anthropometric measurements and other physiological factors"
Faust et al (2013) 'Resumption of menses in anorexia nervosa during a course of family-based treatment'

" Individualized attention, especially to premorbid weights, heights, body mass index percentiles, and paediatric growth charts, is essential."
Norris et al (2018) 'Determining treatment goal weights for children and adolescents with anorexia nervosa'

"Such methods [using median BMI] are unlikely to gauge the extent of weight recovery needed for individuals whose baseline weight was higher or lower than average, which may not only lead to partial recovery for these individuals."
Lebow et al (2017) 'Is there clinical consensus in defining weight restoration for adolescents with anorexia nervosa?'

"Treatment goal weight for a particular patient cannot simply be read off the charts on the basis of normative population data. Put another way, treatment goal weight is not necessarily the same as the weight associated with median BMI."
Golden et al (2015) 'Update on the Medical Management of Eating Disorders in Adolescents'

"Professionals also use growth curves to establish target weights for recovery. Research shows that these curves, when available, are more accurate than using population averages to determine an individual's treatment goal weight."
Lauren Muhlheim in 'When your teen has an eating disorder'

"In most cases, [a growth curve] allows a clinician to easily estimate a patient’s healthy body weight and provides a number that is specific to the individual patient based upon their previous growth parameters, rather than on the population average for age (i.e. the 50th percentile).
Harrison et al 2013 'Growth curves in short supply'