What is quasi-recovery and why is it bad? or not?

Quasi-recovery is a term I invented to describe the situation when a patient is no longer actively trying to eat less, lose weight, reach a target shape of some sort but they continue to create sub-clinical levels of energy deficits every day in their bodies.

A patient with an active restrictive eating disorder is not applying any effort to suppress, replace or otherwise turnaround restrictive behaviours. Restrictive behaviours include: eating less than what your body requires, exercising a lot and not eating enough to cover off that exependiture of energy, eating such a restrictive number of foods (clean eating, paleo, vegan, raw...) that there is an energy deficit, or restricting intake for many days with intermittent bouts of reactive eating (and/or possibly purging, abusing laxatives or diuretics, or prescription drugs or alcohol specifically to reduce energy intake).

A patient in quasi-recovery will have reduced the frequency or stopped compensatory behaviours (purging, extreme exertion, laxative abuse etc. etc.). He or she will have also increased food intake. For many non-scientific treatment programs for eating disorders these attributes are actually considered a process of full recovery. The patient is able to restore weight and once that weight is within 85% to 90% of an expected weight, then the patient will be discharged often to an outpatient program to continue "maintaining" that state.

A woman who is attempting to recovery from an eating disorder and who is under the age of 25 and eating 2200 calories a day is in a quasi-recovery state. She will restore weight, but not repair damage. Her metabolism will remain suppressed because there is not enough energy coming in to reverse the energy deficit within her body and repair enough of the damage so that all biological functions can run once again in an optimal state.

A woman under the age of 25 needs at least 3000 calories a day on average to maintain her weight and health. That's a non-ED woman. A woman in recovery under the age of 25 is going to need more than 3000 a day to actually return to an optimal state and enter remission.

The longer that a patient stays at a quasi-recovered state, the more efficient her body will become at shutting down non-essential biological functions to try to minimize the amount of catabolism (destroying cells to release energy into the blood stream) that has to occur to try to make up the energy deficit. Everybody's metabolic efficiency varies, but it is not unusual for a patient (after 20 years in a quasi-recovered state) to find herself gaining weight while eating 1800 calories a day. That is not a sign that she needs to cut back on her energy intake, but rather she needs to up her intake to allow her body to take the brakes off of all the biological functions that have had to be suppressed to keep going under energy deficit circumstances.

Fat is the largest hormone producing organ in the body. It is not a storage unit. Under stress (energy deficits are stressful to our body) stress hormones are released and while they have value for short-term survival, they cause damage when they flow more persistently and over months and years. That your fat organ gets larger when you are under stress is not because you are a lazy fat pig who needs to exercise more and eat less. Your fat organ is having to get larger to produce more hormones to maintain some balance within a skewed metabolic state in the body. In fact, Peter Attia's research suggests that when there are metabolic problems, a body that is able to get fat to respond to that metabolic problem or failure is more likely to survive than a body that cannot get fat under the same circumstance.

For a body to maintain its natural optimal weight set point it has to be at its optimal metabolic state as well. For a patient with an eating disorder, to arrive at that state he or she has to take all the clamps off of eating and intake and rest so that body can not just restore weight, but can actually heal and return to an optimal run rate as well.

There is nothing automatically bad about being in "quasi-recovery". It is a comparatively better state to be in for the body than active restriction. However, physical damage is ongoing and still accumulating unless and until a patient decides to provide enough energy to reverse damage and return to an optimal state.