This post challenges the very common narrative in our modern Westernised culture that restrictive eating disorders are at their core driven by a fear of weight gain. I don't believe that the driving force behind a restrictive eating disorder is fear of weight gain, although I am not denying that many people with restrictive eating disorders do have a deep seated belief that they are scared to gain weight and if that is you, then I am not discrediting how real it is for you. But I would argue that if I could magic away your fear of gaining weight and being bigger, you would still struggle intensely with eating enough, resting and abstaining from other energy deficit creating behaviours to allow yourself to fully recover from an energy deficit state.
I do understand though that this is a challenge to the way you might have thought about eating disorders or the things you have been taught about eating disorders for years and you might have some resistance to this idea that fear of weight gain is not the primary force to the eating disorder. I would just ask that you read on with an open mind as I explain more about what I do think drives eating disorders and why I believe that we need to change the narrative about fear of weight gain with restrictive eating disorders, in order to better understand this complex addictive state and thereby be better able to ensure people with eating disorders receive more meaningful help and support.
What are Restrictive Eating Disorders (my theory)?
Restrictive eating disorders are an incredibly powerful addiction to energy deficit (see this post). This makes any behaviours or food restriction that lead your body into a state of energy deficit highly rewarding and in themselves addictive.
The predisposition to develop an addiction to energy deficit comes from an evolutionary and once much-needed survival-based response to flee a famine situation (see this post).
The ancestors from whom the predisposition to the eating disorder evolved were not affected by fears about weight gain. They were driven to avoid energy intake so that they could leave the scarce environment they were in and move to an area in which there was much greater food availability. This was to secure their own survival and that of their family members.
These facts should lead us to question the validity of today’s pervasive cultural belief that restrictive eating disorders stem from a powerful fear of weight gain.
Over the past year, as a result of the research I undertook in writing my book, Addicted to Energy Deficit, I developed an insight into eating disorders that now makes absolute sense to me. It fits both with my own experience of having a restrictive eating disorder and my observations from working with countless others. I no longer believe the narrative that eating disorders are due to a fear of gaining weight. Instead, this is a powerful story that we have all been led to believe for three key reasons:
We live in a culture that idolises weight loss.
As a result of this culture, many people with restrictive eating disorders do have a strong aversion to the thought of gaining weight.
The seemingly irrational and dangerous behaviours that people with eating disorders are so driven to has been a puzzle to experts for a long time. The fear of weight gain theory has been a convenient conclusion to draw.
If Restrictive Eating Disorders Are Not a Fear of Weight Gain, What Drives Them?
As stated above, restrictive eating disorders are an addiction to the body being in a state of energy deficit, so the state of energy deficit creates a very high and addictive internal reward response. Any behaviours that create energy deficit, which will also result in weight loss, become highly addictive in and of themselves. When your body is in a state of energy deficit, it is by definition below the weight at which it needs to be to function optimally. Therefore, to overcome the eating disorder, returning to a state of energy balance necessitates weight gain.
When you are driven to pursue sometimes dangerous and extreme behaviours that create energy deficit and to resist anything that might lead to energy surplus and weight gain, it’s understandable that the natural conclusion has become I am scared to gain weight. However, this is an oversimplified conclusion and doesn’t fit with the experience of all people with restrictive eating disorders. It was never an explanation that met with my experiences. In recent years, I’ve also worked with several people for whom fear of being in a bigger body plays no or only a tiny part in their eating disorder experience. Yet they too are just as compelled to remain in a state of energy deficit which keeps their weight low.
Throughout history, wherever restrictive eating disorders have been observed within cultures in which there is no societal pressure to be thin, the explanations attributed to the commonly observed starvation behaviours differ. In these cases, a fear of weight gain is not considered to play any part, yet the symptoms of the restrictive eating disorders seen are the same.
As humans, we like a narrative for why something makes us feel the way we do. The fact that stopping eating disordered behaviours leads to weight gain—and people experience strong resistance to doing so—has resulted in a fear of weight gain story that seems credible, but it’s not quite that simple.
The truth is, when a person attempts to stop any addiction to a behaviour or substance, the powerful symptoms of resistance are the same. They just come with a different narrative.
The Fear is Real
A restrictive eating disorder causes a powerful anxiety-based resistance to doing anything that could promote energy balance or surplus. Restoring energy balance leads to weight gain, and so this anxiety response has been mislabelled as a fear of weight gain. However, the true cause of this resistance is that behaviours that lead your body away from your drug of energy deficit create intense withdrawal symptoms and cravings for that energy deficit fix. These withdrawal symptoms are intense, painful and incredibly hard to tolerate. The two main withdrawal symptoms you will experience when you abstain from your 'drug' of energy deficit, will be anxiety and fear, arising from the brain's amygdala or flight-flight centre.
The primal and brain-based fear reactions you can experience when you are overcoming a restrictive eating disorder—which can be powerful at maintaining it—do not arise from a fear of weight gain. It’s a reaction that any person with a strong addiction to anything will experience when not able to pursue their usual fix.
The other brain system that contributes to elevated anxiety with an eating disorder is the dopamine system (see this post). As a result of the addiction, your brain has developed a dopamine deficit that creates an internal state of anxiety and depression when you are not engaged in the eating disorder behaviours. Not engaging in your usual behaviours creates high levels of anxiety, which can also feel like fear or panic. The only way to reduce this inner anxiety in the long term is by stopping the behaviours and allowing your brain to reprogram. This naturally means weight gain, and so in reality weight gain can be a key factor in alleviating your current chronically anxious state.
Many people who go through the process of overcoming an eating disorder and restoring their natural body weight believe they won’t tolerate the weight gain. However, as they progress through the process, they are amazed to discover that their fears about weight gain diminish despite being bigger than they have been in years, possibly ever. This is due to the dopamine deficit returning to a level balance. The underlying anxiety, which has been mislabelled as concerns about weight gain, has diminished because dopamine levels are restored to a level that will allow the person to feel calm, even when they are no longer engaging in the eating disorder.
Avoidance Reinforces Fear
When you have an eating disorder, you might experience an instant fear-based reaction when you attempt to eat a food that is outside your usual level of restriction, such as a burger. This fear reaction arises because eating that burger is not engaging in your addiction. In fact, it could be said eating the burger is the same as abstaining from your usual habit of restriction, which is your drug. This pushes your limbic system and amygdala into life with an intense fear-based panic response because your brain needs its fix. Your baseline brain is programmed to recognise fear and what’s caused it. Therefore, your brain registers the cause of this reaction (the burger) and wires it in as a threat that should be avoided in future. This part of your brain doesn't understand that this fear is irrational. As far as it's concerned, there was fear and so there must have been genuine danger. This leads to increasing levels of fear at even the thought of eating a burger and active future avoidance of such a situation.
The same scenario can occur with anything you have attempted to face that would compromise your state of energy deficit. If you have avoided high-density foods, certain food types, resting or other behaviours that can lead to an energy surplus, your brain will have labelled them as potentially dangerous. As a result, your brain will now create a powerful fear response when you encounter them (and to be fair to your brain, it thinks it is protecting you by doing this!).
It’s Time to Change the Narrative
Many people develop restrictive eating disorders because of dieting behaviours that created an initial energy deficit, triggering their genetic susceptibility. This initial drive to lose weight has been coupled with our powerful diet culture that leaves your vulnerable self believing it would be 'wrong' to gain weight. This is a very strong belief system that can make it even harder to make the necessary changes to overcome the eating disorder. But these beliefs and fears alone are not the powerful driving force to the eating disorder.
Perhaps changing your internal narrative will help.
You are not as afraid of weight gain as you believe. The deep anxiety you experience arising from the eating disorder and the panic that can come when you attempt to overcome it are not stemming from fears of weight gain alone. They arise from a deeply embedded addiction that creates overwhelming withdrawal symptoms of fear and anxiety. These symptoms are so strong, they can feel impossible to tolerate. Have compassion for yourself in relation to this. If overcoming symptoms such as these was easy, then people would overcome eating disorders and other addictions with a lot more ease and much higher success rates than they do.
The Fear of Weight Gain Belief Can Become Self-Fulfilling
At the end of the day, continuing to believe the fear of weight gain narrative can be harmful.
Beliefs too often become self-fulfilling prophecies. For example, I believe I have no confidence, so I act like someone with no confidence, or I believe that I’m scared of gaining weight, and so I act like someone who is scared of gaining weight. These beliefs become your identity, and this identity then disempowers you and lessens your ability to change. This reinforces the belief, and it becomes a vicious and self-fulfilling cycle.
I don’t think you are scared of gaining weight, not to the level you believe yourself to be. Once you stop acting like you are and start working through the difficult process of abstaining from the eating disordered behaviours— decisively pursuing behaviours that take you away from energy deficit, even though they will result in weight gain—you will also finally realise that this is something you can indeed cope with.
And for our wider eating disorder community, the belief that is now so widespread that restrictive eating disorders are a fear of weight gain is also having more damaging consequences on individuals who have powerful eating disorders but just can't identify with this narrative. Individuals are being denied treatment by eating disorder 'specialists' because they don't identify with having a fear of weight gain and their brain has an alternative narrative for why they can't let themselves emerge from energy deficit.
This fear of weight gain narrative is also perpetuating stereotypes that eating disorders are about a need to be thin, driven by diet culture and an elevated level of vanity in the individual, which is just not the case and something that also then creates more confusion in the wider world about what eating disorders really are.
It is time that we all change how we talk about eating disorders, so that those of you with eating disorders can better understand what is happening in your own brain and why it is happening. This will empower you to find ways to make the necessary changes and changing the narrative will also enable treatment programs and specialist centres to begin to provide more meaningful help, support and understanding. Wider change takes time but it starts with each one of us.
**For more information on eating disorders and how to overcome one, please don't miss my newly available books,
And,
The information for this post was largely taken from Addicted to Energy Deficit.
If you like to listen, as well as (or instead of read!) then this blog post is the transcript of a podcast episode which you will find on my podcast series,
available on this website, all mainstream podcast platforms and on YouTube.