Determining Ideal Weight In Adolescent Eating Disorder Treatment 
Ideal body weight is a very sensitive subject in treatment not only for the adolescent, but for the entire family. There tends to be a lot of questions and concerns about how the ideal body weight is determined. The biggest concern for the adolescent is that the ideal body weight will be set too high.

When a family arrives at Walden’s Adolescent Intensive Outpatient Program (IOP), a request is made to the child’s primary care providers for growth charts extending as far back as possible. Once the clinician receives the charts, they look to see which growth curve the adolescent has been on for the majority of their life and will set the ideal body weight based off that information. In adolescent IOP we do not use the average (50th percentile) for the child’s age and height since we rarely come across adolescents who have been on the 50th percentile their whole life. If an adolescent has always hovered around the 60th percentile for weight over their lifespan, but fell to the 45th percentile during their eating disorder, they would be set back to the 60th percentile where their body naturally falls.

There are cases when adolescents have been overweight for the majority of their lives and it would not make sense to set their ideal body weight back to where they were before. We tell clients that while it is unhealthy to be under your ideal body weight we know it is not healthy to be overweight. In these cases there are other factors that play a role in setting ideal weight. The factors that are considered include: height, stature, labs, vitals, period, and thoughts around food and shape. When an adolescent is not at their ideal body weight labs will most likely come back abnormal in some way. Vitals may be off, whether it is an abnormally high or low heart rate or orthostatic signs – a drop in blood pressure from sitting to standing which indicates that the heart is working harder than normal. Many females who are underweight may have stopped menstruating or in some cases the eating disorder started at a young age and the adolescent never began menstruating at all.

As someone gets closer to their ideal body weight their thoughts around food shift. The rigid thoughts around food decrease and flexible eating will begin to increase. Eating foods that were once deemed “bad” or “scary” will become easier to eat. Not simple by any means, but the amount of fighting around meal time will decrease. There will be a decrease in eating disorder behaviors, such as cutting food into small pieces, taking small bites, wiping excess sauce or oils off foods, and mixing foods.

In this level of care adolescents are shown their weight and are told their ideal body weight. One of the goals in adolescent IOP is weight restoration along with normalized eating. Having the adolescent know their ideal body weight has proven to be helpful so small bench marks can be set, such as incentives to hit a certain weight. It is also important to explain to the younger clients that many of them are not done growing yet so as they restore weight they may begin to grow. This means if they grow their ideal weight will need to be raised as well. Additionally, as their height increases they will continue to follow the weight curve on their chart.

About the author: 

Michelle Felton is the lead clinician of the Adolescent Intensive Outpatient Program for Walden Behavioral Care in Waltham, MA. She earned her bachelor’s degree in Psychology from Keene State College and her master’s degree in Community Mental Health from Argosy University in Phoenix, AZ. Michelle’s professional interest include the treatment of eating disorders in adolescents, athletes, and families.