Eating disorder recovery is often measured with numbers: weight, BMI, lab results or scores on a questionnaire. But a new review suggests those measures may miss some of the most meaningful parts of healing, including a person’s ability to eat with others, prepare meals, respond to hunger and return to daily life with less fear around food.
The scoping review, published in Eating Disorders: The Journal of Treatment & Prevention, examined 60 studies from five databases across 16 countries between 1990 and 2025. Researchers from the University of Queensland found that nutrition-related recovery in eating disorder treatment is often measured inconsistently and too narrowly, with weight and BMI frequently used as stand-ins for broader changes in eating and nutrition.
Eating disorders are serious, complex mental health conditions that can affect people of any size, age, race or background. They can involve disturbances in thoughts, emotions and behaviors related to food, eating, body weight or body shape. Treatment often requires specialized mental health, medical and nutrition support.
But when nutrition recovery is evaluated mainly through weight or BMI, the researchers said, important signs of progress may be overlooked.
“We found international guidelines lack tools that effectively reflect the complexity of nutrition-focused interventions or dietary changes in eating disorder treatment,” said Lauren Pearson, a Ph.D. candidate in the University of Queensland’s School of Human Movement and Nutrition Sciences.
The review found wide variation in how studies measured nutrition, even when looking at the same diagnosis or treatment setting. In addition to BMI, many studies used psychometric measures, such as questionnaires, to evaluate treatment outcomes. Those tools can be useful, but the researchers said they may not fully capture nutrition-related change.
That matters because eating disorder recovery is not always visible from the outside. A person’s progress might include being able to eat socially again, go out for a meal or snack, celebrate a birthday, choose and prepare an adequate meal, improve concentration, support digestive function or normalize blood tests. For athletes, it might also include better performance and safer fueling.
“This is concerning because when treatment involves a clinician lacking nutritional training – weight and BMI are often used as a proxy for recovery,” Pearson said.
The researchers did not argue that weight and BMI are never relevant. In some cases, weight restoration or medical stabilization can be essential. But the review raises concern about using those measures as the main definition of nutrition recovery, especially when they do not reflect the person’s food behaviors, physical health, social functioning or lived experience.
“Anyone who has sought support knows changes to food, eating and nutrition extend far beyond this and are frustrated when their efforts are reduced to weight or BMI,” Pearson said.
That concern also connects to broader issues around weight stigma and bias in health care. If treatment focuses too heavily on arbitrary weight targets, the researchers said, it could unintentionally reinforce the same fears, rules or rigid thinking that eating disorder treatment is trying to address.
“I’m not saying BMI and weight isn’t important, but it’s not the only piece of the puzzle we need to pay attention to,” Pearson said. “For some people it shouldn’t even be in the puzzle.”
The review does not provide one simple replacement measure. Instead, it points to the need for better tools that can capture the complexity of nutrition recovery across different eating disorder diagnoses, treatment settings and individual needs.
That may mean looking more closely at eating flexibility, food variety, meal adequacy, nutrition-related quality of life, medical markers, digestive health, social eating and the ability to make food decisions without intense distress. It may also mean involving clinicians with nutrition training more consistently in eating disorder care.
For readers, the findings offer a more careful way to think about recovery. Healing from an eating disorder is not just about reaching a number. It is also about rebuilding a safer, more flexible and more sustainable relationship with food, with support from trained professionals who understand the medical, psychological and nutritional pieces of care.
Anyone concerned about an eating disorder in themselves or someone else should seek help early from a qualified health professional or an eating disorder organization. In the United States, the National Alliance for Eating Disorders offers referrals, support groups and resources for people experiencing eating disorders and their loved ones.
This research was supported by an Australian Government Research Training Program Scholarship and The University of Queensland.