The process of normalizing eating is often referred to as “eating with training wheels”. The individual has to learn what normal eating is and that dieting (which would include behaviour like avoiding foods and counting fat, grams, or calories) is not consistent with the goals of achieving health and well-being.
Some individuals with eating disorders have never had normal eating patterns in their lives. It may be helpful for an individual to be in contact with a dietitian or nutritionist who has expertise in the treatment of eating disorders. In other words, contact with a dietitian who won't prescribe a weight-reducing or restrictive diet. This contact is helpful in guiding the individual into normal eating in an understanding, respectful manner.
It is also important that individuals with eating disorders learn about weight regulation and the effects of starvation on thinking, feeling, and behaviour, and the effects of purging on the body. As the person begins to normalize her eating, she will begin to recognize how normal eating has helped her concentrate, increased her energy levels, and improved her thinking patterns, moods, and her sleep.
Weight gain may, initially, cause extreme distress to the individual. It is best that individuals with eating disorders weigh themselves in the therapist's or doctor's rooms rather than at home. In that way, the person can be helped to understand the relationship between weight gain and the other emotional, social and physical changes she is experiencing, and helped to accept or at least tolerate the weight gain and understand that it will level off.
Individuals with eating disorders can expect to gain weight at the outset of normalizing their eating, but the gaining will level off as their bodies make a metabolic adjustment to the higher intake of calories. Many individuals hold the faulty belief that if they eat, they will become morbidly obese. This is an example of the dichotomous thinking patterns characteristic of individuals struggling with an eating disorder; they find it difficult to accept that there is the middle ground of a healthy weight for them.
As the underweight individual approaches a healthy weight, sex hormones will return to normal levels and women will reach their menstrual threshold where menstruation resumes. At this point the individual will be going through something akin to adolescence once more, with changes in hormonal levels. It is important to help individuals understand the effects of changing hormone levels on mood so that they aren’t frightened or discouraged.