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One of the most confusing parts of anorexia treatment for patients and families is setting a goal weight. People often imagine that the treatment team selects one exact number that represents recovery and that this number is set at the start and remains fixed.
In practice, we establish an initial goal weight as a first benchmark so we can see how the body responds when consistent nourishment resumes. This early number is not final at all. It is a starting point. And because getting weight restoration right is critically important to treatment outcome, it is worth understanding how initial goal weights are selected, why they are framed the way they are, and how they change over time.
The Initial Threshold
At the start of treatment, it is common for the patient to want clarity about when things will end and what the path ahead will look like. At the same time, the treatment team needs a way to structure the early phase of recovery and ensure that the body is receiving enough nourishment to begin repairing and regulating itself again. Before we can determine what a fully healthy weight will look like for an individual patient, we need a consistent foundation of nutrition that allows the body and mind to stabilize. Setting an initial goal weight gives us a concrete first checkpoint. It provides the patient with a tangible sense of direction, and it gives the treatment team a measurable early indicator of whether the recovery process is beginning to take hold.
A Thoughtful and Collaborative Process
Although general principles guide weight restoration, the nuance of setting a goal weight comes from clinical experience. The process is careful, individualized, and collaborative. Nothing is arbitrary. We draw on multiple sources of information because the goal is to understand an individual’s physiology, development, and history rather than fit them into a generic formula.
We consider growth patterns over time, pubertal stage, bone age when helpful, the degree of weight suppression, muscle loss and deconditioning, vital signs and lab results, hormonal recovery including menstrual function, energy level, the return of hunger cues, increased flexibility around meals, a reduction in eating disorder-driven thoughts and behaviors, emotional regulation, functioning at school and clarity of thinking, sleep patterns, social engagement, and the family’s genetic build.
Parents provide essential historical context and day-to-day observations. Teens share their lived experience and how their bodies feel throughout the process. Clinicians contribute medical and developmental expertise. The initial goal emerges from this shared understanding, and it is revisited as recovery progresses.
Starting With the Floor
Although every person has a natural weight range rather than a fixed number, we usually communicate the initial goal by naming the lowest number within that range. If we believe the early recovery range is 130 to 135, we will say, “Our first target is a minimum of 130.”
Years of clinical experience treating anorexia inform why we take this approach. Patients with anorexia rarely hear ranges as flexible or neutral. They tend to focus intensely on the highest number and interpret it as a limit they must avoid. If we presented 130 to 135, for example, the 135 would quickly become a ceiling the patient believes must not be crossed. Beginning with the minimum helps prevent the common pattern of hovering just below the needed range, slipping under it, and losing progress. We expand the discussion to the full range only when stability is clearly present.
Transparency Whenever Possible
A recurring question in treatment is whether teens should see their weight or even know their goal weights as they are established. In my experience, transparency is usually the healthier approach. It promotes collaboration, reduces secrecy, and helps the teen build tolerance for seeing the number rather than avoiding it. It also helps them connect nourishment with how they feel and function and reinforces trust within the family and treatment team. Telling a teen, “This is your body, and I believe you can handle this. I do not want to keep secrets from you,” can be grounding and empowering.
Many teens manage this well when the process is explained clearly. However, some teens are not ready. If seeing the number leads to restriction, refusal, compulsive behavior, or significant distress, we temporarily conceal it. This is not a punishment. It is a protective step. Weight visibility is reintroduced when the teen has greater internal stability.
While it is both possible and often ideal for people to live without knowing their weight, that is not always realistic for someone recovering from anorexia. It is important to remember that later in recovery and into adulthood, the ability to monitor weight becomes important because even modest unintentional weight loss can trigger the return of anorexia. Older teens eventually need to develop this skill, and occasional check-ins help ensure they remain within a range that supports full health.
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Moving Beyond the Initial Target
Reaching the initial target is one step in a larger process. Once that point is reached, we shift our focus to the full picture of recovery. We look for steady improvements in physical stability, emotional regulation, cognitive flexibility, and eating behavior. We observe whether the eating disorder is loosening its grip. We review medical indicators such as vital signs, lab values, and hormonal normalization. We consider school functioning, social participation, and overall quality of daily life.
If these areas are not yet stable, the initial weight is not sufficient. Many teens need more weight than anyone predicted in order to return to a healthy developmental path. This is not failure. It is physiology. Likewise, if a teen is barely maintaining the lower edge of the expected range, this suggests ongoing vulnerability. In such cases, we adjust the range upward based on what the body is showing us it needs.
Keeping Goal Weight in Perspective
The initial goal weight is exactly what the name suggests. It is a beginning, not a declaration of recovery. It is framed carefully so the eating disorder does not turn it into a ceiling. It is developed collaboratively and revised based on real functioning rather than formulas.
The aim has never been to land on one perfect number. The aim is a body and mind that are nourished, stable, flexible, and able to return to a healthy developmental path.
