Insights from Part Two of Monte Nido’s Goal Weight Setting Webinar
On February 12th, 2025, Monte Nido Vice President of Adolescent Medicine Rebecka Peebles, MD, FAAP, DABOM, and Monte Nido Vice President of Nutrition Services Nathalia Trees, MS, RD, CEDS-C presented “Are We Aiming High Enough? Part Two: Goal Weight Setting for Adults,” as an addition to their talk last fall about goal weight setting for adolescents.
Existing Methods for Setting Goal Weights in Adults and Why We Need a New One
- The Hamwi equation became very popular because it’s quick to calculate and easy to remember. However, it comes with a lot of weight bias, is not research based, significantly underestimates ideal weights, not was not developed with eating disorders in mind.
- Ideal body weight (IBW) dates back to over 150 years and was defined as the weight associated with the greatest life expectancy for given height, despite the research during that same era repeatedly revealing either no significance or inverse relationship between obesity and mortality
- Body mass index (BMI) is traced back to a Belgian astronomer and mathematician, Adolphe Quetelet, who collected data on men’s heights and weights at various ages to determine the “average man” IBW and BMI do not account for body composition, age, ethnicity, other comorbidities, body diversity, psychological wellness
- Ultimately, there is no simple math equation or number in a chart can predict a person’s health outcome.
Exploring New Methods for the Importance of Weight Restoration
Recent evidence demonstrates cognitive recovery happens at higher weights, but we need a method of setting goal weights that works for all eating disorders and is standardized for all providers to rely on (Accurso, et al, 2020). An inadequate goal weight can lead to chronic relapse, especially if there are recommendations of lower goal weights. Weight restoration is necessary for physiological and psychological recovery (Accurso, 2014) and is the single biggest protective factor against relapse. Rapid weight gain is associated with normalization and maintenance of weight and recovery from eating disorder psychopathology (Doyle, 2010, Le Grange, 2014; Madden, 2015: Le Grange, 2014)
Weight Bias and Stigma in Healthcare
Eating disorders can happen at all sizes and are life-threatening illnesses. People in larger bodies are less likely to receive higher levels of care despite equal severity. Early diagnosis is highly correlated with improved outcomes, but diagnosis is frequently delayed in higher weight percentiles. Even if a person in a larger body has lost enough weight to be in the underweight category, they may be celebrated instead of flagged for medical attention. It’s important to remember that weight is not a behavior or a disease. Weight stigma can cause patients to avoid health visits and be treated differently than those in smaller bodies. The comorbidities that are often associated with higher weight can also occur in smaller bodies - weight is not the deciding factor in an individual’s overall health.
Setting Goal Weights in Eating Disorder Treatment for Adults
When it comes to setting goal weights for adults, look at previous weight history, and avoid weight bias and weight suppression. Unlike adolescents, adults rely on self-reporting, which can present challenges in accuracy. Try to assess where client’s body prior to their eating disorder and calculate that based on current height, which isn’t expected to change for adults. A larger weight range allows for flexibility in restoration, as this isn’t an exact science. Be transparent with the client about this process and hold space for feelings that may come up.
Explore Monte Nido’s Prior and Upcoming Webinars
At Monte Nido, we value a culture of learning and invite our network of professionals to our Continuing Education Webinar Series. Check out our comprehensive CE webinar page where you can see our 2025 schedule of expert-led sessions covering the latest research and innovative treatment strategies designed to enhance your practice and support your professional development.
Learn more about our upcoming CE webinars.
Accurso EC, Sim L, Muhlheim L, Lebow J. Parents know best: Caregiver perspectives on eating disorder recovery. Int J Eat Disord. 2020 Aug;53(8):1252-1260. doi: 10.1002/eat.23200. Epub 2019 Nov 19. PMID: 31743480; PMCID: PMC7269124.
Accurso, E. C., Ciao, A. C., Fitzsimmons-Craft, E. E., Lock, J. D., & Le Grange, D. (2014). Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa. Behavior Research and Therapy. 56, 1-6. doi: 10.1016/j.brat.2014.02.006
Garber, A. K., Cheng, J., Accurso, E. C., Adams, S. H., Buckelew, S. M., Kapphahn, C. J., Kreiter, A., Le Grange, D., Machen, V. I., Moscicki, A.-B., Saffran, K., Sy, A. F., Wilson, L., & Golden, N. H. (2019). Weight loss and illness severity in adolescents with atypical anorexia nervosa. Pediatrics. 2019 144 (6): e20192339. doi: 10.1542/peds.2019-2339
Pai, M.P. Paloucek, F.P. The origin of the “ideal” body weight equations
Ann Pharmacother, 2000; 34:1066-1069
Humphreys S. The unethical use of BMI in contemporary general practice. Br J Gen Pract. 2010 Sep;60(578):696-7
Pray R, Riskin S. The History and Faults of the Body Mass Index and Where to Look Next: A Literature Review. Cureus. 2023 Nov 3; 15(11)
Peebles, R., Lesser, A., Park, C. C., Heckert, K., Timko, C. A., Lantzouni, E., Liebman, R., & Weaver, L. (2017). Outcomes of an inpatient medical nutritional rehabilitation protocol in children and adolescents with eating disorders. Journal of Eating Disorders, 5(1), 7. https://doi.org/10.1186/s40337-017-0134-6
Peebles, R., & Sieke, E. H. (2019). Medical Complications of Eating Disorders in Youth. Child and Adolescent Psychiatric Clinics of North America, 28(4), 593–615.
