Weight Gain in Hypothalamic Amenorrhea Recovery
There is no way around the topic of weight gain in Hypothalamic Amenorrhea Recovery. In this post I hope to give you some insights that will make it easier for you to deal with weight gain. I will also explain the so called set point theory. Weight gain is challenging. Especially since the whole outside society is so focused on the opposite. The good thing is you don't have to face weight gain alone. I am here to help you deal with it.
Fat is not bad. Fat is hormone producing tissue
Fat, or adipose tissue is actually not only to be seen as a tissue but as a very important endocrine organ. This means it is an organ that produces hormones. Through the actions of these hormones, adipose tissue plays an important role in the regulation of among others glucose, cholesterol and the metabolism of sex hormones. This is one of the reasons that a too low fat percentage is damaging in females.
Set point theory - your body's happy place
The set point theory states that your body tries to maintain its weight within a preferred (genetically predefined) range by a feedback control mechanism. Please note that I write range and not specific number. This range is believed to be about 5-10 kilos. Just think about height. Or shoe size. It is not like you can drastically change how tall you will grow by fighting where your genes want you to be. The set point is the range where you body feel at its best and functions optimally.
If you go below your set point, your body will respond with slowing down metabolism, sending out hunger cues and do all it can to get you back to your range. At the same time, levels of the hormone leptin (which signals fullness) decrease, while levels of ghrelin (which signals hunger) increase. Throughout evolution, this resistance to weight loss has been helpful in keeping people alive through times of famine or illness.
Analogously, if you are above your set point, your body will response by signalling less hunger and speed up your metabolism.
But I am at a normal BMI, then I wont have to gain any weight?
Please remember, relative energy deficiency occurs at all weights and all BMI:s. For the vast majority, a healthy BMI will not be on the lower spectrum. If you are constantly thinking about food, feeling cold all the time, if you have lost your period, you are most likely below your set point.
So how much weight do I have to gain? What is my set point?
That is the million dollar question. Unfortunately there is no way to know your set point in advance. If you have had a healthy relationship with food and exercise throughout adulthood, this might give you a hunch. If you got stuck in a restrictive behavior in your teens, you will most probably end up on a weight higher than you had before.
The weight you end up at is really up to your body. You have an idea you’re in the right place when you find that you don’t have to work to maintain your size. You follow your hunger cues and do the exercises you enjoy without having to be obsessive, without having to work the rest of your life around either the food or the activity. Your metabolism, appetite, menstruation cycle and digestion are all functioning well without micromanagement.
As soon as I allow myself to eat more I gain weight super fast!
Id like to use the analogy of a sponge that Amalie Lee introduced me to. Think of your body as a super dry sponge that has not been surrounded by water (in case of the body energy) for a long period of time. Once you drown the sponge in water, it will suck up a lot of water at the beginning. But eventually the sponge will be saturated, and the absorption of water will eventually stop. No mater how much water you poor on it.
The same goes for your body. Your body is starved and craving for energy. Once you start to increase your intake, you will inevitability gain weight if you are below your set point. And it is true, at the beginning, you might put on weight fast. But the weight gain will slow down as you go. And it is physiologically impossible to gain X kilos from one day to the next. If this is happening to you, it is water retention that you are experiencing. When your metabolism is ramping up the weight gain will slow down. In my recovery, I put on 3 kilos within the first week of recovery. I was so freaked out! But I trusted in the process and kept going. Then it took me almost 6 months to gain another 4 kilos. And during this time, I increased my intake a lot compared to the first week of recovery.
Sometimes people overshoot the weight after a time of famine. This was also the case for some of the men in the Minnesota Starvation Experiment. In this experiment, thirty-six young men (thoroughly vetted for physical health and mental soundness) were intentionally starved to study the effects starvation has on body and mind (I intent to do a comprehensive post on this experiment in the future). Once put on a recovery diet, many overshot their pre-study weight with about 10 percent +/-. Within two years, they all returned naturally to their pre-study weight without decreasing the amount that they were eating.
So why is overshooting happening? From an evolutionary perspective it it makes perfectly sense for the body to save up some extra after a time of famine. In that case the body will be better prepared for a future period of starvation. Once the body trust that it is in a safe environment (no more restriction), it will eventually return to its happy place.
Will you overshoot? You may. You may not. This is really up to your body. All you have to do is make it trust you by continuously give it the energy it needs. And it will take care of the rest.
I gain all the weight around my belly
This might be true short term. There are two reasons for this. The first being a way your body is trying to keep you safe. It wants to protect the important inner organs located in the abdomen area. It is often seen in patients recovering from an eating disorder. The second reason is that you currently have low levels level of estrogen, which appears to influence where fat is distributed in the body, often low levels of estrogen is associated with lower abdominal weight gain.
Here you need to stay consistent and keep up what you are doing. Once you have regained your period (a sign your body feels safe again) the weight will redistribute.
Some practical advice
Reach our for help
I know the thought of weight gain in Hypothalamic Amenorrhea Recovery sounds unbearable. But you don't have to deal with it alone. Surround yourself with people who truly care for you. Connect with peers. Talk to people who have been through the same. Reach out to me.
Talk to yourself as you would talk to a friend
Sometimes it is hard to treat yourself with respect. So try this mindgame. Start talking to yourself as you would talk to you sister, or a good friend of yours. What would you say to this person if he/she reached out to you struggling in your situation? Most probably you would show compassion, and tell them you love them unconditionally for who they are, not for the way they looks.
Wear clothes that fit
Make sure that you always wear clothes that you feel confident in. This does not mean you have to wear baggy-fit jogging pants all the time (if you don't feel like it of course). But get rid of all clothes that make you feel uncomfortable or does not fit you. Celebrate going out shopping new clothes that fits the new version of you! Try to completely deattach yourself from a certain clothing size. Maybe even try the clothes on without knowing the size.
Focus on function over appearance
Strive after reaching a state where you accept your body for what it is (a vehicle for life, if you will) and focus on what it can do rather than its physical characteristics. The end goal is for you to be able to live without having strong feelings—positive or negative—about your body and its appearance. The most beautiful body is a healthy body. And a healthy body feels safe to ovulate.
Find your own whys and motivation
Try to see the end goal. Is it having a baby? Is it repairing the damage your lifestyle has done to your bones? Is it becoming a better version of yourself? Create a note in your phone where you write down your whys and motivations as they come to you. If you are struggling one day, open the note and read it through. Is weight gain taking you closer to your overall goal? The answer is YES! Here I have collected some of my whys and motivations.
Trust in your body
Your body is doing everything it can to keep you safe and get you through life. It has no interest in transforming you into a big lumps of fat. What is actually happening throughout the wait gain process is a lot of damage repair: your bones, your muscles, your hair, your nails. How amazing is that! Most of the damages are totally reversible. All you have to to is to give your body trust, energy, rest and time.
Clean out your social media feed - hit unfollow or mute
What kind of social media accounts are you following? How diverse are they? How do they make you feel? If you realizes you follow accounts in the name of "health" promoting dieting, excessive exercise and food restriction, hit the unfollow button! If the person is a close friend or family member, at least hit mute. Instead search for accounts that are supporting your heeling. I have collected some awesome accounts in the post here.
Lastly, remember that as you recover from Hypothalamic Amenorrhea, the importance of your body and weight is naturally going to lessen as your life becomes richer, more fun and exciting again.
If you wish for specialized support with body image, I warmly recommend you to connect with Florence Gillet: