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qwpo10

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Reply with quote  #1 
Our daughter was discharged from The Priory a month ago after a 4 month stay on a section. Because she is almost 18 she was discharged with the intention that she would independently eat, and we are incredibly relieved that she is weight restored, and managing to create and stick to an appropriate meal plan which seems to be maintaining her weight. I eat with her for around half her meals, but am out at work for the rest.

BUT we have some major concerns - she is only able to do this by counting every calorie. This takes up loads of time, and also causes great stress for her. On occasions she has eaten something extra and been wracked with guilt afterwards. It also really limits her lifestyle. She is off school this year but hoping to go back in September for her final a level year, and I'm not sure how she will manage the calorie counting then. She says she does it because otherwise she would be tempted to eat too little, and we do believe this. She has also said that she wants to get away from doing it but it isn't clear how she will. She is very resistant to our Influence and we don't want to undermine her efforts by trying to take control. I have suggested that she has just one component of her diet unmeasured to start, and gradually increases with time. She is not prepared to do that.

Is it ok to leave it to time and weight restoration in the expectation that relaxing the rules will get easier and she I'll be able to do it herself? Or is it likely to become more entrenched with time? If she is genuinely doing it to avoid eating too little is it going to cause harm by changing too soon? Do we need to be actively trying to get her to change? Does anyone have any suggestions as to how we can tackle it? Or any experience of doing so themselves?

Another issue is that she is refusing to engage with the EDS, so essentially we are doing this alone.
Foodsupport_AUS

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Reply with quote  #2 
It is great that she is managing to stick to some sort of meal plan, it does show that she is really trying to do this and is aware that weight loss is going to send things backwards.  Her reliance on a measuring and meal plan however is setting things up for being entrenched in the longer run. Normal eating does not rely on measuring and monitoring everything that goes in, and if she is going for recovery then ideally she shouldn't be doing this either. 

Is she having any other support? Sometimes getting those people to look at suggestions for how she can change things may be better than coming from family. Other options are working on the motivational interviewing techniques. For example asking about her anxiety with respect to the preparation, asking if she can see if this will cause issues down the track with study, asking her to come up with solutions for how things could be changed. It is a subtle difference but her coming up with her own solutions will give her a better outcome than if you suggest it.

I suspect she may also be at a safe weight but not truly weight restored. 

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D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
Torie

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Reply with quote  #3 
Quote:
Originally Posted by Foodsupport_AUS
I suspect she may also be at a safe weight but not truly weight restored. 


That's what I was thinking. xx

-Torie

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"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
tina72

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Reply with quote  #4 
Hi,
calorie counting and especially not to be able to eat more than there is on the meal plan is ED behaviour. So if ED behaviour is left, I would think she is not truly WR, too.
She says she does it because she wants not to eat too less, that is great, but is she able to eat something extra? A little sweet, a piece of chocolate, a slice of cheese snacked out of the fridge? If not, she is definitivly still restricting, on a higher level for sure, but still restricting.
What other "rules" are left? What about fear food? Sweets? Cake? Pizza?

Another problem with calorie counting is that once they have learned all these calories they cannot forget them. We have that problem, too, my d says although she tries not to think about it (and she really eats extras and has not much fear food left) every time she sees something to eat the caloric information pops up in her mind without control. I hope brain recovery will solve that.

What I experience additionally is that my d has lost her trust in choosing the right amount during refeeding. She trusts on me to put the right amount on her plate but she has problems to do it herself (only with lunch or dinner when there is a warm meal). We try to help her with the plate : 3 rule. One third is for meat, one third is for vegetable and the rest third for potatoes or rice or noodles. We try to ask her to plate for us so her brain can re-learn what a normal amount is. Maybe that is worth a try?
Tina72
Mamaroo

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Reply with quote  #5 
Hi, my d was refed on ensures, so she knew exactly how many calories she was consuming. When we switched to food, I had to calculate the calories to ensure she was getting the same amount. I found that counting calories wasn't really that accurate, no more or less than just eyeballing an amount on the plate. We follow Tina's plate when plating food. Obviously my children will have larger servings than I do, but I spread my serving, so it looks the same amount [wink].

To help my d during the transition from counting every single calorie to just guessing the size of the meal, we divided the meals and snacks into three sizes, small, medium and large. So for a 3000 kcal daily mealplan a small would be 60-100 kcal, medium would be 120-200 kcal and large would be 250-350 kcal. Then she new she needed a large meal for breakfast, lunch and dinner and a medium snack for morning tea, afternoon tea and supper. In addition large=2 x medium = 4 x small. Instead of having a large breakfast, she could have a medium breakfast, but then have to include either a medium snack or two small snacks. I would also show her what a small and medium size snack would look like. I still plate the 3 main meals, so that she can get used to how a large size meal looks. I know this is still counting, but it is an interim step before going to intuitive eating. My d doesn't have a lot of hunger cues, so I still have to help her choosing snacks.

Eventually, the aim it to be able to eat without thinking about the amount of calories in it.

Good luck!

 

__________________
D became obsessed with exercise at age 9. Started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. She is back to her old happy self and can eat anything put in front of her. Now working on intuitive eating.
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