You're listening to Food is Food, the podcast that will support you to ditch diet culture, break free from food rules, and debunk nutrition misinformation. I'm your host, Talia Chiquelli, specialist eating disorder dietitian and founder of the TC Nutrition Clinic. If you would like to learn more about our one-to-one nutrition support and group program, or download your free portioning guide, head to www.taliachely.com. Each week we will cover topics that delve deeper into nutrition, intuitive eating, psychology, diet culture, and the consequences of under-eating. Our relationship with food is so complex and is influenced by our thoughts, emotions, and life experiences. Which is why healing from disordered eating is about more than just food. Welcome back to Food Is Food. Hello, hello. Thank you so much for joining in today. And to be honest, in general, I am just so grateful for your support. So I just wanted to take a moment to thank you because on the guest episodes, I don't really have as much of an opportunity to actually sort of speak more directly to you. So I just wanted to say thank you so much for every listen, every message you've sent me on Instagram or email. I honestly love receiving them. If you ever want to place a comment on Spotify or YouTube, like I am all for that. So I just want to say thank you from the bottom of my heart again for listening, for being here, and for supporting me on this podcasting journey. Anywho, today I had originally planned to answer one of the most common questions I received when I was planning for season one of the podcast. So I had put out the feelers to the community via my newsletter and received a ton of questions and topics that people wanted to cover. But the most common question or theme or topic that came up was what is a healthy weight? Now, I originally wanted to answer that question for you in today's episode. However, it is a really big topic. And in order to answer it, I really would need to cover several topics on overshoot theory, set point theory, BMI, sustainable weight gain, and weight monitoring practices, because I all think that they have a part to play in answering that umbrella question of what is a healthy weight. So today I'm just going to focus on overshoot theory, covering what it is and why it's necessary in order to return to a healthy weight for you. I will cover the other topics in future episodes across this season and also the next. And for most people who need to work through nutritional rehabilitation and weight restoration, so either if they are weight suppressed or they have lost a significant amount of weight, understandably the thought of changes to their body and the number on the scale can be associated with a lot of fear and anxiety. So we know that with an eating disorder or with disordered eating, there are going to be many barriers which present themselves, which get in the way of someone restoring to their natural weight quickly, or in what I say, like a sort of expected time frame, if someone was malnourished and needing to restore weight versus someone who is malnourished with an eating disorder and/or disordered eating and needing to restore weight. So we know that those barriers are fear, anxiety, beliefs about what happens when weight changes. So it's a really common fear that people will talk about with me, which is my weight is never going to stop. It's going to be exponential. And that is tied into maybe what they see in terms of body shape and size across the world and the stigma that's associated with being in a larger body. So we know that there are a lot of barriers that stop people in recovery to getting to the weight that they need to be in order to be healthy, joyous human beings. So if we can put that to the side, what we know of overshoot is that for someone who is malnourished or weight suppressed and is able to go through that process of weight restoration naturally, what we would see is that for some people, body weight or more specifically, body fat, would need to increase above the level before the weight loss occurred. And then what we know is that fat percentage and weight gradually drops back to the pre-weight loss level, generally within a year or so. So this is what we mean by overshoot. It is the biological process of body fat percentage going above what it was before weight loss occurred, and body weight increasing alongside that in order for the body to restore both body fat and muscle mass, and then it gradually drops back to where it needs to be. So this process of overshoot is required, and why that is or how it happens and the mechanisms behind it is what I want to talk to you about next. So when people regain weight, their body uses energy from their fat stores first as a way to protect muscle mass, remembering that muscle is our heart, our digestive system, our lungs, our kidney, our liver. So fat loss usually occurs first, and then the body will start to break down muscle and convert that protein into amino acids into energy for the body to use. So when we regain weight, therefore a person needs to restore both muscle and fat mass. So what's really important to understand is that when someone is going through the weight restoration process, just because their body weight might have returned to quote unquote normal or the weight at which a person was before they started to lose weight, what we know is that fat mass restores quicker, and that's a survival response. So the body wants to have that preference of backup fat stores rather than continuing to break down muscle if there was another famine or period of starvation. So that's just how we have evolved over the many, many years in terms of survival. So the human body will restore fat mass quicker, protect all those internal organs, and be the better option in terms of energy stores if another famine occurs. So because fat mass is restored quicker, we still need to ensure that both fat mass and muscle mass are caught up back to that healthy percentage of which the body was pre-undereating. And that's why overshoot occurs. So it's because fat mass restores quicker. So therefore, in order to get to that baseline, if you've got fat mass sort of happening and restoring quicker the muscle mass, you need to for the fat mass to continue in order for the muscle mass to return to normal, and then the body fat percentage can settle back to where it was. If you're watching on YouTube, you'll see my hands are sort of giving a demonstration there. So this is what we saw in the Minnesota Starvation Experiment. So I have previously recorded an episode on the Minnesota Starvation Experiment where we saw that the men's weight returned or it was a little bit higher than the pre-experiment weight. However, their muscle mass was still significantly reduced. So in the study, we saw that in order for the men to achieve a healthy muscle mass or for their muscle mass to return to the pre-experiment percentage, the men underwent body weight overshoot, in which they restored and kept restoring body fat until their muscle mass had returned to a healthy level. So the degree of fat overshoot does differ on an individual level. And what we know from the Minnesota Stimmation Experiment and more recent studies is that generally the leaner the individual, the greater amount of overshoot occurs, and that's purely down to the percentage of body fat lost compared to body weight versus being in a larger body where the percentage is generally less. So the percentage of body fat before weight loss occurs is one of the biggest predictors in terms of the variability in overshoot that occurs depending on body size. Now, what we also know from the Minnesota Starvation Experiment and more recent studies and what I see in clinic is the concept of compensatory hyperphagia. So again, I spoke about this in the solar episode when I spoke about the Minnesota Starvation Experiment. So we know that compensatory hyperphagia, so the increase in hunger levels that we see alongside the nutritional rehabilitation process is driven by the need to restore both fat mass and muscle mass, in addition to meeting overall energy requirements. What this means, in summary, I guess, is that a person will continue to experience high levels of hunger until both their fat mass and muscle mass have been restored. And so if overshoot is required for that, then someone will remain hungry until their body has gone through that overshoot process. Now there's also some evidence to suggest that the extent of prior food deprivation will influence the degree of overshoot and compensatory hypophagia. So, for example, a short-term reduction in body fat will likely result in less overshoot required compared to if someone has been chronically fat depleted. This is why we also see with repeated and chronic episodes of weight cycling, so where people go through periods of losing significant amounts of weight, regaining weight, then going through another cycle of losing weight, regaining, losing weight, regaining, we can see that a person's body fat percentage might gradually increase. And this is going to be tied to a future episode that I will do on set point theory, where we can see that over time, people that engage in chronic weight cycling, losing gaining weight, their set point can move in the upwards trajectory because of that change in the physiology in terms of body fat percentage and muscle mass. One of the common questions that I get asked, or one of the fears or confusion that people have, is around where does the weight regain happen? So usually the weight gain and the body fat increases around the abdomen and the face. Of course, these are the areas where diet culture sort of having the thin ideals in our society, we place a very high value on having a flat stomach and a thinner face. So these are the areas where people often don't want their body shape or size to change. However, biologically, this is where all of your important organs are: your brain, your heart, your digestive system, all of your other organs, sex organs, digestive, everything is really between like our sort of forehead and our hips. So it is a protective survival response. Now, in saying that, what we know is that when someone sort of goes through the overshoot that they need to, the body fat will redistribute and the body will use that energy. So I just want to reinforce that because during that overshoot nutritional rehabilitation sort of process, you may have a higher amount of body fat percentage on your abdomen and your face. It does not mean that you are fat or that you need to stop restoration. It is a sign that your body is going through that nutritional rehabilitation process and it is super normal and it needs to happen. That's like most important. So once muscle mass has been restored, mass and body fat percentage will gradually normalize for that person. The other common question that I get is around the macronutrient spread of a person's diet. So for example, in order to restore fat, do I need to eat fat? In order to build muscle, do I need to eat protein containing foods? Now it's really important to know that when we eat particular foods, it doesn't just go to a certain body system. So for example, every time we eat protein, that doesn't just go to our muscles. Every time we eat fat, it doesn't just go into fat storage. It's used for hundreds of other different processes. So although having a balanced diet and having a good mix of protein, fats, carbohydrates, and fiber is really important. What we know is that from a purely survival biological response to undernutrition is that what is most important is energy, total energy, giving your body the energy it needs to reverse the metabolic down regulation and to restore and rebuild muscle and fat tissues. So the exact split of carb protein fat is not as important as the human body getting enough energy. I just wanted to share that with you as well. So when we think about why is overshoot important and why is it necessary, I just want to reinforce some of the key points when we're thinking about overshoot and nutritional rehabilitation. So when we think about overshoot, it is 100% necessary for some people in order to complete nutritional rehabilitation and therefore fully recover from an eating disorder or disordered eating. So if you have restored some weight, we know that it can be really common, and this is due to anxiety and fears, that a person may reach a quote unquote healthy BMI or a previously healthy weight. And a lot of this might be generated around really unhelpful BMI categories in terms of BMI of 18.5 or 20, where someone might restore to that and then think, okay, done, I can stop restoring now. However, if you are still experiencing hunger, if you are still experiencing food preoccupation, i.e., you're thinking about food all the time, and you are still experiencing eating disorder cognitions, and I might also add to this other markers such as abnormal biochemistry. Is your cholesterol still elevated? Is your liver function still elevated? Are your white cell count, is that still low? Is your T3 thyroid marker still low? These are all signs that the body is still in a malnourished state. So the fact is that if you're experiencing any or all of those things, that you most likely need to continue to restore weight. And if there is a part of you that's super resistant to that idea of restoring weight further or your body weight or shape changing further, that's probably a sign that eating disorder cognitions are there. And it's a sign that you need to continue to focus on that nutritional rehabilitation and allow your body to do what it needs to. So overshoot is also important to build any evidence against those eating disorder cognitions that your body weight will continue to rise. Often the fear is that there will be no endpoint. So I'm here to tell you there will be an endpoint. However, it is only when both fat mass and muscle mass are restored that body weight can settle where it needs to be. And also just to provide that reassurance is that I have never in the 10 years that I've worked in eating disorders seen a person's body weight continue to rise, let alone in an exponential way. There is always an endpoint. Always. Because otherwise, if you think about, like again, if we put, like I asked at the beginning, if we put eating disorder to the side and we just think of a malnourished, undernourished person needing to restore the weight that they've lost, the likelihood is that you wouldn't be thinking the same thing, that their body weight would continue to gain and gain and gain. So that's where again we know, just in that sort of a statement or reflection or observation, that there's an eating disorder self and healthy self driving these two different cognitions. So on that topic, overshoot is required to reverse those eating disorder cognitions, give your brain the signals that both your fat mass and muscle mass have restored. The other point that I wanted to make just to reinforce, I've already sort of mentioned it, but in terms of that compensatory hyperphagia, so the feeling of being hungry all the time, overshoot is likely going to be needed because compensatory hyperphagia is driven by signaling from both the fat mass and fat-free mass in your body. Therefore, you know, as a result, you will continue to be hungry until both fat and fat-free mass are restored. Now, where I can maybe hear if you have an eating disorder and are listening, your eating disorder, sort of growing in strength here, is that you might be thinking, well, I don't experience hunger, so therefore it must mean that I am weight restored. We have to remember that when people, the human bodies, are undernourished, a side effect of that is that metabolic processes slow down. The hypothalamus, the control center in our brain, it has a little nap. It go, you know, it goes into the battery-saving mode, it conserves energy. And one of the hypothalamus's jobs is to help with the regulation of appetite, so hunger and fullness cues. So if you are under a healthy weight, you may be experiencing hunger suppression. So you may not be feeling hunger as a result of that. It does not mean that you are necessarily at a healthy weight for you. So the danger of not allowing your body to go through this very important physiological process of overshoot, and this is quite a direct statement, but the danger of it is that you won't reach full recovery. Now, again, knowing how eating disorder cognitions work, you might be thinking, well, my period has come back, I have more energy, my digestion is so much better. And these are all fantastic, and you should be so proud of getting to a point that you are noticing these signs of your body returning back to a joyous, nourished state. However, if your body is still coming out of low battery mode and those metabolic processes are suppressed, especially if you can't see it, we know that without that adequate nutrition and without your body composition returning to a healthy level, that is going to keep you stuck in quasi recovery. And that's a really dangerous place to be because your eating disorder cognitions can very strongly give you signs that you don't have to keep going. However, this is where I'd really encourage you to listen to what your treatment team is saying and look at the other evidence around you. In summary, when we think about overshoot, there's a couple of key points that I want you to remember if we're separating eating disorder recovery from someone without an eating disorder that need to go through weight restoration and overshoot. So the first is to remember that an ideal, natural, biological, healthy body weight varies between individuals. Please, please do not force your weight to stop at your previously healthy weight because this can keep you stuck in that quasi or partial recovery. It's also really important to not use BMI as a fact or sole indicator, or necessarily an indicator, really, because of the fact that not many people are naturally going to fall at the lower end of the BMI categorical normal healthy weight. Most humans are going to be above that. So that's really important to remember. Some other important parts of your story when you think about overshoot and returning to a healthy weight for you is that if your eating disorder developed as a child or in adolescence, a lot of people don't have weight data from that time. And so therefore, we want to be really mindful of how the eating disorder cognitions might try to get you to remember a certain body shape or size as an adolescent and that be the goal. However, your adult body is very different to your adolescent body. So the only solution, really, to see what your adult healthy weight is, is to wait and see what happens and allow that process to happen and for your body to settle where it needs to. And also in summary, just to reinforce the message that those metabolic processes, so the physical and psychological side effects of under-eating of a body being in low battery mode, and you can hear or listen back to the episode on the starvation study and also the episode with Jennifer Gordiani on the concept of sick enough, is that metabolic processes are not going to return to normal until you have restored both your fat mass and your muscle mass. And remembering that when you are metabolically suppressed, so those metabolic processes are turned down, your body is conserving energy. So this is why we say that when people return to a healthy weight, those metabolic processes ramp up, which is why the amount of food that you need in order to support nutritional rehabilitation is likely going to be very similar to the amount of food that you're going to need to sustain a good relationship with food and a good amount of nutritional well-being. So that's something else that I see people get really caught out in is this thought process around food being taken away from me once I return to a healthy weight for me. The reality is it doesn't work like that. So I just wanted to share that as one final sort of reminder and message to reinforce around this idea of overshoot. Please let me know if you have any questions either in the comments or I'm very happy for you to send me an email and I will note them all down and hopefully answer them in the future episodes around set point theory, BMI, weight monitoring sort of practices, and ultimately answering your question of what is a healthy weight. Thank you so much for tuning in today, and I look forward to being in your ears next week. Thank you for tuning in to Food Is Food. If you found the episode nourishing, hit subscribe so you don't miss our weekly episodes. And just before we wrap up, a little reminder that the discussions in each episode are for informational purposes and don't replace individualized advice. Because every recovery journey is so unique. Please consult your healthcare provider for support. That's all for today. Stay nourished and see you next time.