What to Do If Your Child Is Not Gaining Enough Weight in Eating Disorder Recovery
If your child is not gaining enough weight despite treatment efforts, it’s important to identify barriers, adjust the recovery plan, and seek additional medical and nutritional support. Below is a step-by-step guide to help parents navigate this challenge.
Identify Possible Reasons for Slow Weight Gain
Common Causes & Solutions:
Potential Reason
Signs to Look For
What to Do
Not Eating Enough Calories
Eating smaller portions, avoiding calorie-dense foods
Increase portion sizes, add calorie boosters (nut butters, oils, cheese, smoothies)
Fear of Weight Gain
Anxiety after meals, body-checking behaviors
Work with a therapist on body image concerns
Hidden Restriction
Skipping snacks, making excuses, avoiding fats
Supervise meals/snacks, reinforce structured eating
Overexercising
Exercising outside of agreed limits, walking excessively
Set exercise boundaries, focus on gentle movement
Digestive Issues
Complaints of bloating, nausea, slow digestion
Offer smaller, frequent meals, consult a GI specialist
Metabolic Adaptation
Body adjusting to past restriction
Increase calorie intake in small increments
Medical Conditions
Fatigue, low energy, unintentional weight loss
Rule out thyroid issues, gut disorders, or metabolic conditions with a doctor
Key Takeaway: If weight gain is stalled for more than two weeks, adjustments are needed.
Adjust Nutritional Strategies for Weight Gain
· Increase Energy Density Without Increasing Volume
o Add healthy fats: Avocados, nuts, nut butters, olive oil, cheese
o Enhance meals: Cook with extra butter, whole milk, cream, sauces
o Use high-calorie drinks: Whole milk, smoothies, Ensure/Boost, homemade protein shakes
· Increase Meal Frequency
o Instead of 3 meals + 2 snacks, try 3 meals + 3-4 snacks
o Offer bedtime snacks (full-fat yogurt, peanut butter toast, granola).
· Ensure Full Nutrient Coverage
o Protein: Lean meats, eggs, dairy, legumes, tofu
o Carbohydrates: Whole grains, pasta, potatoes, oats
o Fats: Full-fat dairy, oils, nuts, seeds
· Avoid:
o "Low-fat" or "diet" foods—these don’t provide enough energy
o Filling up on low-calorie foods (raw vegetables, water-heavy fruits)
Address Fear of Weight Gain & Food Anxiety
· Reframe weight gain as positive:
o “Your body needs energy to heal and grow strong.”
o “This is about feeling better and having more energy for the things you love.”
· Encourage a non-judgmental approach to food:
o Avoid labeling foods as “good” or “bad.”
o Remind them that all foods provide nourishment.
· Incorporate Therapy Support:
o Work with a therapist specializing in eating disorders (CBT-E, FBT).
o Use exposure therapy for fear foods in small, manageable steps.
· Key Takeaway: Mental barriers can slow physical recovery, so emotional support is crucial.
Monitor Weight Trends & Seek Medical Support
· Track Weight in a Low-Stress Way
o Weigh-ins should be supervised by a doctor, dietitian, or at-home in a non-judgmental manner
o Look for trends, not day-to-day changes.
· When to Seek Urgent Medical Help:
o If your child is losing weight instead of gaining
o If they experience fainting, dizziness, or extreme fatigue
o If their BMI is dangerously low (<3rd percentile for age)
· A doctor may recommend:
o Bloodwork to check for malnutrition-related deficiencies (iron, vitamin D, thyroid function)
o NG feeding or hospitalization in severe cases to ensure weight restoration.
Create a Supportive Environment for Recovery
· Model positive eating behaviors
· Make mealtimes relaxed and structured
· Celebrate non-scale victories (increased energy, better mood, improved sleep)
· Encourage them to express food fears without judgment
Disclaimer: This information is intended for educational purposes and should not replace professional medical advice. If you or someone you know is in crisis or needs immediate help, please contact a healthcare professional or crisis intervention service immediately.
