F.E.A.S.T's Around The Dinner Table forum

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Pyohaesoo
I just went for a weigh in at the Doctors office, and d has gained 1.2kg since Monday. (Up 5.5kg In 4weeks, eating now 2000-2500 kcal) The doctor said he’s alarmed at this rate of weight gain and that it is not normal. He wants to reduce d’s calories. Is that the right thing to do? I have told him that d is down with a cold so it may be the cause of water retention too, but he said that there’s no relation to that. What should I do?
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melstevUK
Hmmmm.  If she is not protesting too much I would continue.  However, if she has a petite frame then maybe she can be re-fed successfully initially on less.  My own d was someone who put on weight easily on less calories than many others.  Thanks goodness as I could never have managed to get her to eat 4000 calories.  In general in the UK - don't know about other countries - 0.5 kg is accepted as a good amount to put on weekly in an outpatient setting, and up to a kilo in an IP setting.  
Personally I think you would be wise to stick with the current regime - unless she is recovering from a dangerously low weight and bmi.  

Clearly we cannot offer medical advice, but if her heart and blood pressure are fine, then it would appear that she is coping with this weight gain and I would continue.  
If you decide to lower her intake - make sure she doesn't realise what is happening.  Otherwise the illness will see a loophole and take advantage and you could then find yourself in a situation faced with complete resistance around eating after the reduction.  
Believe you can and you're halfway there.
Theodore Roosevelt.
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Pyohaesoo
Thank you. I’ll give her the same intake for another week before deciding and checking progress. Just curious, if she ends up maintaining on 2000-2500 calories do I need to increase it further? 
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tina72
I would try to do that. I am quite sure that it is no "real" weight gain at this intake but fluids as you also thought. Are you sure she was not water loading and has no weights in her pokets?

If she gains steadily on that intake you do not need to increase it further. There are some patients that gain on a low intake. You might need to increase it later when her metabolism increases. Gaining on that intake now does not need to mean that it will be enough in three months. Weight gain is a secret service thing, we had all three versions (no gain, loss and weight gain) on exactly the same intake in one months.

In case it IS real weight gain, that would be great as it would get her to WR quite fast. It is evidence based that a quick WR has better outcome. As long as there is no risk for refeeding syndrom (and that is very rare and normally only at the start of refeeding) you cannot do anything wrong with quick weight gain I think. Many professionals still think it is better to do it slowly and to let them "get used to the new weight". That only lengthens the pain. You would not do chemotherapy slowly to not frighten the cancer...
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
What do you mean there is no real weight gain at this intake? Does it mean that it is not enough for real weight gain? I thought that there should be some extent of real weight since it has already been one month. Should I increase it to make real weight gain faster? 
Shes not water loading as I follow her to the bathroom and make sure she does not try anything funny. 
I am quite unsure as right after the weigh in today, when we got home she had bowel movement and lost a kg (I weighed her on my own and had already left the Doctors office) So there’s a net gain of 0.2kg. 
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tina72
Sorry, maybe I used the wrong words. I mean that:
At the beginning of refeeding many patients are quite dried out. My d "gained" 1,5 kg in the first week in hospital but it was not fat gain but only water that was put in the body cells again. So this was no "real" weight but only water in her body. Next week with same intake she lost weight again. Do you understand what I mean? Sorry, english is not my mother tongue...

So with the body movement after that appointment your question is answered I think.
She gained only 0,2 kg. That is the "real" weight gain. The rest was just digested food that has stayed in her stomach. So in that case, you might need to increase intake but I would also give it a try another week to see what the real weight gain is. If she has bowel movement around the same time each day make the next weighing appointment after this time if possible. For example in the afternoon if she goes to to toilet in the mornings normally.

Think about giving the doctor that information so he can change the weight in his paper and will not try to stop you from increasing if needed...
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
Thank you for clarifying. I understand where you’re coming from. However, my d is in her fourth week of refeeding so why is there no fat gain yet? Am I feeding her too few calories? 
Is the 0.2kg also just water retention or actual fat? If it isn’t actual fat I’m looking to increase her calories more... 
Yes I have just informed the doctor and he said that I can maintain at the current calories. I am still confused as to how to know if the calories are enough as I don’t know whether my d is gaining fat or just water. 
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tina72
To be honest, some few patients gain on that low intake but it is rare.
So if there is only 0,2 kg real weight gain (it may be fat gain) then there are normally 3 possible reasons:
1) exercising
2) purging
3) not enough intake
So if you are on the low side of intake (you are with 2000-2500, most parents here needed more than 3000) and you can exclude 1 and 2 it is very probable that you need to increase intake to see 500-1000 g a week real weight gain which would be ideal.

Normally a steady weight gain of 500-1000 g for some weeks is not only water and you will see it on her body and face when the fat gain starts. You can also make sure she gains fat when you make sure 30% of calories come from fat (that means in your case at the moment 800 calories or 80 g should be fat in her intake). And when you control her fluids intake also. They should drink 1,5 - 2 l a day but not much more.
To get there you can increase intake slowly about 300 calories every 3-4 days and check weight until you see the steady weight gain that is recommended.
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
I see. I’m assuming that the intake is not enough for her considering that she’s 165cm/5’5. I’ll try to increase it slowly and add more fats. Does fats help her gain fat faster for the same calories as other foods? 
May I know why she can’t drink too much water? From what I know she drinks about 2+ litres a day
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tina72
The fats help her brain recover faster. The brain runs on fat. It is its fuel. Fat and glucose (sugars). WHO recommends a daily intake of 30% fats at least for everyone.

To drink too much is not healthy and can be an ED behaviour. If it is only slightly above 2 liters and it is hot there you do not need to be concerned. Try to find out if there is a "rule" behind it. Some MUST drink before every meal. Some use fluids not to feel hungry and fill the stomach. When it is ED behaviour it needs to be tackled. Not easy to find out unless it is extreme.

Here it helped to make it a rule that with meals and snacks no water is allowed, only fluids with calories like juice, milk, shakes.
Water was only allowed in between meals. That decreased her fluid intake rapidly 🙂.

If she drinks more than 3-4 l a day or big amounts at a time that can be really dangerous, especially for the kidneys.
https://www.medicalnewstoday.com/articles/318619.php
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
She only drinks about 2-3 litres a day (mostly closer to 2 litres) and it’s around 33 degrees here, which is relatively hot and humid, so I Guess it’s fine. She doesn’t always drink before meals but mostly drinks in the morning, I’m not sure why. I rarely see her drink water after 3pm.
i see, I’ll make sure she gets to eat more fats.
actually, when she was first discharged (2weeks ago), I noticed that she has gained some fat around her thighs and stomach and was quite happy with the efficient progress. However, those fats seemed to have disappeared now even though she has not lost the weight, and In fact gained even more since discharge. Is there an explanation for this?
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tina72
So the drinking seems fine, no need to be concerned.
It is normal that you see the fat gain more at first (often at the face or the belly) and then is distributes over the whole body with time.

"She doesn’t always drink before meals but mostly drinks in the morning, I’m not sure why. I rarely see her drink water after 3pm."
Some drink to not feel hungry. Maybe try to add more food in the morning and see if that helps.
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
I have also read in many websites that it is normal for people in anorexia recovery to feel extreme hunger and they should follow that hunger in order to increase their metabolism. However, my d seems satisfied on 2000-2500 calories a day and tells me she’s hungry at normal times (regular meals and sometimes snacks). What does this mean? 
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tina72
All is possible: Some experience extreme hunger. Some normal. Some like my d have nearly no hunger cues at all and need to eat when it is time to eat. Did your d say "I am hungry"?
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
Yes she does say she’s hungry usually around the same times everyday... which I believe are normal people cues. Does this mean that her hunger cues are returning to normal? Im really grateful if that if happening!
Should I try letting her follow her hunger cues for 1-2 days? If it’s not working I’ll return to the meal plan? Since the ultimate goal is eating normally, would that be a good decision?
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sk8r31
It's still early days, and I would continue with the meal plan as you are doing.  It can take some time to get back to a normal routine and to follow hunger cues.  You are doing great.  Hang in there!
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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Pyohaesoo
I see. I’ll stick to the meal plan then. When will I be able to tell that she’s ready to follow her own cues? Am I supposed to look for an indicator?
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tina72
If she is asking for seconds and still hungry after a meal I would give in to that. It is a great sign if she says she is hungry.
Basically I would follow the MP as a minimum but if she wants to eat more, why not? If it is not leading to binging you can do nothing wrong I think if you give her more.
Keep feeding. There is light at the end of the tunnel.
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Ellesmum
Really, don’t rush,  you’re clearly doing a grand job so far, I’d just keep feeding her as you are, let her have more as she needs it. 

Who is this doctor who is so alarmed at someone with an eating disorder gaining weight? 
I’m unclear how old your child is, did I miss that information?  Mine had extreme hunger early on which kind of helped kick start her recovery but she’s had several episodes since, some last a day some a few days and I figure she needs the extra boost at these times so I’m happy to indulge the need for ice cream etc. 
Ellesmum
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Pyohaesoo
Thank you. I’m glad to hear that I’m doing fine. I was worried that I’m not supporting her well enough. 
I have always felt that the doctor didn’t have enough/good knowledge on treating eds as he thinks quite differently and I’m not sure whether I am able to trust him...
my child is 17, and has no extreme hunger.. she still says she feels bloated. Is hunger related to bloated ness? Will she feel hungrier if her digestion improves? As of now, her hunger easily brings her to consume 2000-2500 calories.
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Ellesmum
The bloated feeling is totally normal, my d still complains of it sometimes seven months on of refeeding,  she also gets constipated but that’s easing a bit now.  

If you feel you cant trust the doctor there’s a reason for that, it’s unfortunate that we can’t always trust the professionals we see but ED is a complicated illness, and needs very skilled people to help us and probably most important people willing to listen and keep learning otherwise great damage can be done. 
Ellesmum
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