Why weight restoration in eating disorder treatment must come first - and why I agree with Dr Julie O'Toole on the fact

In her last blog post for 2016, Dr Julie O'Toole of the Oregon-based Kartini Clinic reminds us 'Why Weight Restoration in Eating Disorder Treatment Must Come First' and why this fact isn't exactly rocket science - yet many people continue to overlook it. As she says: So why the heck do people seem so impervious to the message that without weight restoration you get nothing? And I do mean nothing: no physical recovery AND no psychological recovery. Remember: psychological recovery is about the brain. The brain is an organ of the body; like all other organs it needs fuel to replace broken or used-up cells, and for functioning cells to communicate with each other. Starvation is as bad for children and for any other living thing. This takes no great leap of intellect: you can’t become psychologically normal in a state of malnutrition. You don’t (or shouldn't) need access to all “latest science” to know this. What happens when you starve any other mammal? Think about it. Why the resistance to this simple message?


When I first came across eating disorder treatment models such as FBT (Family Based Treatment) which insist on weight gain first and foremost, it made sense to me.

But it didn't seem to make sense to our treatment team who put the weight issue to one side while focusing on the talking treatment for my son's escalating eating disorder.

As I've said time and time again, this led to a serious clash as the eating disorder treatment model I wanted for my son (weight restoration first, mind second) was diametrically opposed to the eating disorder treatment model they wanted for my son (whatever that was, I never did find out).

And because they were the professionals, I began to doubt myself. Maybe they were right. After all they had years of experience of mental health treatment and, presumably, eating disorders. What did I know? I was only a mum...

Also, because Ben didn't look too bad, they weren't interested in getting him back to the weight he was before the eating disorder struck when he was a healthy, muscular strapping lad. I remember them once saying that they could tell that Ben was genetically slim by looking at me, his mum. 

What!!! I wanted to yell. My slim physique is entirely fake; it takes a constant diet to keep it like this! (Proven by the fact that ever since Ben's eating disorder I have been stones heavier...)

When a young person has lost as much weight as Ben lost before he ended up at CAMHS it's essential to get his weight back up to where it was before.

Fact.

End of story.

To argue that they could tell Ben was a naturally thin boy by looking at my physique was wrong on every count. To argue that Ben's mental functioning and volatility was there as a result of co-morbid issues like depression was also wrong. Ben's behaviour was a textbook case of how young people can act when an eating disorder is raging. I read about carbon-copy behaviour every day on the Around The Dinner Table forum for parents of young people with eating disorders.

I like to think that if Ben were in front of the eating disorders treatment team today they would do it differently. If they haven't done so already, the Powers That Be plan to roll out FBT for adolescents with eating disorders in our city.

Thank goodness.