On Goals and Metrics
For as much as we wish things were never about the scale, it can be a helpful relapse prevention and monitoring tool. It definitely was for us. Dealing with restrictive anorexia,
we were able to identify, in someone at full adult height and 18, a weight that coincided with a huge, positive cognitive shift. In fact, she herself identified it as "the number that set me free" - a moment etched in my psyche in a way that I feel the promise of that proclamation still and have been lucky to see that promise fulfilled. One of the ways the promise was fulfilled was by having a hard stop on dipping below that healthy brain and intake weight.
I have been asked recently to define what I mean when I say, in support forum comments, that contracts and treatment goals should include metrics, so here is that post and video.
Weight and intake are likely to be metabolic factors in all eating disorders, and full nutritional rehabilitation is a cornerstone of recovery. Weight suppression below a body's set point (and natural set points cover the entire range of body sizes) can drive illness severity and duration and prevent full recovery (which I define as at a personally healthy weight and intake level, free of all behaviors, and largely free of thoughts). For some people with eating disorders, and especially early in recovery before it's fully solidified, some focus on the number can be helpful.
Just as my daughter self-identified a major shift in her cognition (at a higher weight than growth charts indicated would be necessary), parents and clinicians can often identify this as well. For me, if you are lucky enough to have a straightforward indicator like this, it makes sense to use it.
When families and clinicians are preparing young adults to go to college, travel, etc. they often arrange for support in the form of clinical visits (therapist, dietitian, etc.) and assume this is a plan for relapse prevention. I argue that it is a plan in need of a metric - a way to measure the success of the plan? Therapy and dietitian visits are not the end goal - they are simply the means to the end goal of getting/staying in recovery.
One objective measure for some is weight - and in that case, I advise being explicit about what the number is (even if your child doesn't want to know numbers, you can use a thumbs up or down approach to let them know where they stand and a team member can be the one who knows the exact number).
In addition to a specific metric, you also need a clear plan for what happens if the metric isn't met. Without that, it's simply an exercise in monitoring decline.
Between these two plans, which one sounds most likely to have the outcome of keeping your child in recovery?
X must attend 1 therapy appointment each week and1 dietitian appointment every 2 weeks
X must maintain a minimum weight of Z pounds
X must be weighed every two weeks at the student health center and the number reported to Y team lead
if X's weight is within 5 pounds under Z pounds, X has two weeks to return weight to Z pounds
if X's weight is 6 pounds under Z pounds, X must withdraw from school for the semester and return home as a higher level of support and oversight is needed to sustain recovery
If you are wondering how you know all these metrics when your child is over 18, that's another post and video - stay tuned!