The Complexities of Finding a “Goal Weight” in Pediatric Eating Disorder Recovery: Why It’s Not Just About the Number on the Scale
One of the most common — and most misunderstood — parts of treating eating disorders in children and adolescents is the idea of a “goal weight.” Parents, teens, and even some providers may ask:
“What should their target weight be?”
“When will they be ‘done’ gaining?”
“Are we aiming for a number, or something more?”
The answer? It’s complicated — and for good reason. Let’s break down why identifying a goal weight in pediatric eating disorders isn’t straightforward, and why weight is only one piece of the recovery puzzle.
Why Weight Matters in Treatment
For kids and teens with restrictive eating disorders (like anorexia nervosa, ARFID, or OSFED), restoring weight is often a life-saving step. Medical complications like bradycardia, hypotension, loss of menses, or growth delays can emerge quickly when the body doesn’t get enough energy to grow.
✅ Reaching a safe, individualized weight can help:
Normalize vital signs and labs
Restore brain function and emotion regulation
Support puberty and development
Restart menstruation (a key marker of health in girls)
Reduce intrusive eating disorder thoughts
But goal weight is not a fixed number, especially in growing bodies.
⚠️ Why Goal Weight Is Tricky in Pediatrics
1. Growth and development are still in motion
Unlike adults, kids and teens are supposed to be gaining weight every year. A "goal weight" that is appropriate for a 12-year-old may be far too low just 6 months later.
📈 Healthy growth means upward movement — in both weight and height.
2. Past weights aren’t always reliable
Many patients were already restricting for months (or years) before diagnosis — so their “baseline” weight may be artificially low.
A teen may have dropped percentiles before anyone noticed
Children with ARFID may have been under-eating for years
Hormonal suppression (loss of periods) may have occurred at a “normal” weight
This means goal weights must be restorative, not just reflective of past data.
3. Puberty is a major factor
Recovery requires restoring not just body weight, but also hormonal function, especially for teens. In girls, this means returning to menstruation; in all genders, it includes:
Healthy bone development
Cognitive maturity
Sexual development
⛔ Weight suppression during puberty can cause long-term health issues — even if BMI looks “normal.”
So How Do Clinicians Estimate Goal Weight?
Eating disorder specialists use a mix of tools, including:
Growth charts (CDC/WHO curves for weight and height)
Mid-parental height estimates
Pubertal status (e.g. menstrual history)
Bone age (if needed)
Vital signs (resting heart rate, blood pressure)
Mental status (reduction in ED thoughts)
Behavioral signs (reduction in rituals or rigidity)
The true goal isn’t just a number — it’s full medical, nutritional, psychological, and developmental restoration.
Weight Restoration ≠ Recovery
Even once a child reaches their “goal weight,” they may still be:
Obsessive about food, exercise, or body image
Struggling with anxiety, depression, or trauma
Stuck in rituals or rules
Avoiding social eating or feared foods
Incomplete in pubertal development
That’s why full recovery requires time, therapy, and continued support, even after weight is restored.
Supporting Parents: Common Questions
“My child looks healthy — why do they need to keep gaining?”
Weight appearance can be deceiving. Recovery weight often lies in the higher percentiles to account for prior suppression and ongoing growth.
“Isn’t a higher weight unhealthy?”
Not at all. For many pediatric ED patients, higher weight is healing. The risks of underweight or suppressed growth far outweigh concerns about temporary “overshooting.”
“When will they stop gaining?”
When the body is fully nourished, growth is on track, puberty is complete, and the brain has the fuel it needs — the body will settle. This takes time and trust.
Final Thought
In pediatric eating disorder recovery, “goal weight” is not a finish line — it’s a milestone. It’s one part of a much larger picture that includes:
Emotional health
Cognitive freedom
Medical stability
Social connection
Long-term resilience
So rather than asking, “What’s the goal weight?”, a better question might be:
“What does a fully nourished, fully alive child look and feel like?”
Need Support?
We specialize in evidence-based, weight-inclusive eating disorder care for children, teens, and young adults — including FBT and ARFID treatment.
