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

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alexintx
A friend of mine (who knows my daughter's history) called me this morning because she is worried about her daughter, who just turned 13. She has always been a picky eater, but she has been eating less than usual (she's never hungry) and mom discovered that she has been hiding her school lunches in her room. She us also in the underweight bmi -- which was discovered when they did bmi at school in gym class (grr). Mom says she's always been low weight for height, but never has been underweight before. She also says that she's very bothered about being small and is often picked on about it, which doesn't quite make sense to me - but I know that anorexia can behave in strange ways. I suggested that she see her pediatrician (she has an appointment next week) and, in the mean time, start fixing her plate with an appropriate amount of food and insisting she finish it. Any other ideas? This is different from how things went with my daughter, so I'm not quite sure what other suggestions I should have given.
17yo daughter diagnosed RAN 8/15 after about 5 months of restriction. WR 11/15. Focusing now on intuitive eating and managing anxiety. Hanging onto the roller coaster for dear life!
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atdt31_US
No real suggestion other than she might tread lightly on "insisting" she finish it it if there is extreme pushback (before an AN diagnosis). My d, who is quite underweight (but on her own historic curve and is thought by pros to NOT have an ED) has a net loss of calories upon "insistence" that she finish her plate. So the mom might think about enhancing the meal on the sly as much as possible (canola can be added to MANY things), try to insist she clean her plate, and see what happens. If the child does resist and take in less, it might be premature to implement Magic Plate. For us, Magic Plate/LSUYE was a misstep despite a real need to gain weight but in the absence of an ED. Not to suggest this child is not ED but just cautioning that maybe if "insisting" makes things worse, maybe the mom could enhance with canola, etc until a diagnostic decision has been made and only if ED, then challenge with Insistence in the face of resistance. Being in diagnostic limbo is no fun!
Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth.  UPDATE:  July 2019 diagnosed with PANS. Dr. said likely started first PANS episode at less than 1 or 2 years of age.  On long-term daily prophylactic antibiotics. BMI now about 16 after period of intense refeeding prior to PANS dx,  followed by stagnation as we sort out what is next. FWIW ED-D is a fraternal twin and we have no other kids.
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nmrk
I would encourage her to take her daughter for an evaluation by a professional who has knowledge and experience with eating disorders. This may or may not be her primary care provider. Hiding lunches is very concerning.
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alexintx
atdt31_US wrote:
No real suggestion other than she might tread lightly on "insisting" she finish it it if there is extreme pushback (before an AN diagnosis). My d, who is quite underweight (but on her own historic curve and is thought by pros to NOT have an ED) has a net loss of calories upon "insistence" that she finish her plate. So the mom might think about enhancing the meal on the sly as much as possible (canola can be added to MANY things), try to insist she clean her plate, and see what happens. If the child does resist and take in less, it might be premature to implement Magic Plate. For us, Magic Plate/LSUYE was a misstep despite a real need to gain weight but in the absence of an ED. Not to suggest this child is not ED but just cautioning that maybe if "insisting" makes things worse, maybe the mom could enhance with canola, etc until a diagnostic decision has been made and only if ED, then challenge with Insistence in the face of resistance. Being in diagnostic limbo is no fun!


Thanks for the reply! I see what you're saying about insisting; I just thought it might clarify the diagnosis. If she panics, that will give her the answer!
17yo daughter diagnosed RAN 8/15 after about 5 months of restriction. WR 11/15. Focusing now on intuitive eating and managing anxiety. Hanging onto the roller coaster for dear life!
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alexintx
nmrk wrote:
I would encourage her to take her daughter for an evaluation by a professional who has knowledge and experience with eating disorders. This may or may not be her primary care provider. Hiding lunches is very concerning.


Do you have an idea how to find the right person? We went to our pediatrician, but my daughter had admitted that she was severely restricting, so there was no question. The therapist we have been seeing isn't taking new patients, so I'm not sure what to recommend. I figure she needs medical first for a diagnosis, right?
17yo daughter diagnosed RAN 8/15 after about 5 months of restriction. WR 11/15. Focusing now on intuitive eating and managing anxiety. Hanging onto the roller coaster for dear life!
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Colleen
Does she exhibit other typical symptoms of ED?

Does she avoid eating or have fear/forbidden foods?  We used to suggest that parents try the "pizza test" since pizza seems to be a common fear food.  Put it on the menu and see what happens.  That can apply to anything that might be problematic but shouldn't be, such as ice cream or salad dressing or whatever.  So kind of like your suggestion about serving an appropriate amount of food and seeing what happens.

Finding the right doc is prit'near impossible to know beforehand.  Our d presented with a 20-lb weight loss, low body temp, all her vitals low, bradycardia, etc, and me sitting there telling him how little she was eating--and our beloved ped STILL missed it!!  If your friend takes her d to a doc, she might want to contact the office ahead of time and share her concerns--along with asking the doc to be careful in the messages that he/she might inadvertently give her d.  Many docs offer reassurance that really backfires--"She's fine.  Don't worry.  She'll eat when she's hungry.  All her vitals are in the range of normal" etc.  It sends a strong message to ED (if it is ED) that mom is overreacting.  Have the doctor speak privately to the mom while d waits in the waiting room.

Have your friend look through some of the FEAST family guides, especially Puzzling Symptoms.  Maybe she could take that to the doctor when she goes?  Another important document to take with is the AED guidelines for treating EDs.  This will give the doc some tests to run, including orthostatic heart rate and blood pressure.  Don't put too much stock in labs, which can come back normal even when the sufferer is gravely ill.

We can't diagnose here, but if your friend is worried, there's probably something wrong.  I'm a strong believer in moms.
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
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alexintx
Colleen wrote:
Does she exhibit other typical symptoms of ED?

Does she avoid eating or have fear/forbidden foods?  We used to suggest that parents try the "pizza test" since pizza seems to be a common fear food.  Put it on the menu and see what happens.  That can apply to anything that might be problematic but shouldn't be, such as ice cream or salad dressing or whatever.  So kind of like your suggestion about serving an appropriate amount of food and seeing what happens.

Finding the right doc is prit'near impossible to know beforehand.  Our d presented with a 20-lb weight loss, low body temp, all her vitals low, bradycardia, etc, and me sitting there telling him how little she was eating--and our beloved ped STILL missed it!!  If your friend takes her d to a doc, she might want to contact the office ahead of time and share her concerns--along with asking the doc to be careful in the messages that he/she might inadvertently give her d.  Many docs offer reassurance that really backfires--"She's fine.  Don't worry.  She'll eat when she's hungry.  All her vitals are in the range of normal" etc.  It sends a strong message to ED (if it is ED) that mom is overreacting.  Have the doctor speak privately to the mom while d waits in the waiting room.

Have your friend look through some of the FEAST family guides, especially Puzzling Symptoms.  Maybe she could take that to the doctor when she goes?  Another important document to take with is the AED guidelines for treating EDs.  This will give the doc some tests to run, including orthostatic heart rate and blood pressure.  Don't put too much stock in labs, which can come back normal even when the sufferer is gravely ill.

We can't diagnose here, but if your friend is worried, there's probably something wrong.  I'm a strong believer in moms.


My daughter suggested the pizza test too! I asked if she seemed to be narrowing her diet or being picky about things she'd ordinarily eat, and my friend said she hadn't noticed. It sounds like it's more about portion restriction.

I did suggest that she call the ped ahead of time, but that's a good idea about talking to mom privately.

Thank you for all the suggestions. I'll pass it along!
17yo daughter diagnosed RAN 8/15 after about 5 months of restriction. WR 11/15. Focusing now on intuitive eating and managing anxiety. Hanging onto the roller coaster for dear life!
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Trytrytry
Can I ask why insisting on eating might be a bad idea? Or am I missing something. I know adolescents are moody and she might not be happy but you can't cause an ED, but a diet can be the trigger, sorry I might be missing something.
she could be dieting like lots of teens do, doesn't mean it will become an ed, that is up to genetics. I don't know how many of us have the genes and lots of teens diet and don't get an ed. I imagine the dr will stay 'wait and see' - or I could be cynical. But her mum is concerned so there must be some behaviour to make her worried.
In families who have experienced ed, I think it is easy to see disordered eating everywhere as that is what we know. But then again stepping in early can make life easier.

Then there is the whole can of worms about whether you can prevent an ED?
I want a realistic dr and team, not someone who says what I want to hear and not a 'touchy feely nice' dr that doesn't have success.
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alexintx
Trytrytry wrote:
Can I ask why insisting on eating might be a bad idea? Or am I missing something. I know adolescents are moody and she might not be happy but you can't cause an ED, but a diet can be the trigger, sorry I might be missing something.
she could be dieting like lots of teens do, doesn't mean it will become an ed, that is up to genetics. I don't know how many of us have the genes and lots of teens diet and don't get an ed. I imagine the dr will stay 'wait and see' - or I could be cynical. But her mum is concerned so there must be some behaviour to make her worried.
In families who have experienced ed, I think it is easy to see disordered eating everywhere as that is what we know. But then again stepping in early can make life easier.

Then there is the whole can of worms about whether you can prevent an ED?


I took the post above it mean to tread lightly until the anorexia diagnosis, so you don't start the battle before you are prepared. And, instead, get calories in other ways.. My thought was that if she tried to insist, she could probably know based on her d's reaction what she's dealing with.
17yo daughter diagnosed RAN 8/15 after about 5 months of restriction. WR 11/15. Focusing now on intuitive eating and managing anxiety. Hanging onto the roller coaster for dear life!
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expat_mom
Just a thought, please ignore if utterly useless! If there is a quality (evidence based) ED treatment facility anywhere within reasonable distance from your friend, it might be worth a call to see if they can offer the name of a physician who truly understands eating disorders. They may or may not be able to do this, but in my experience the best referrals come from professionals in the field. (Nothing lost by trying, anyway!). As we all know here, the right help can make all the difference in the world.

Either way your friend and her family will be in my prayers. It's always sad to think of another family having to face this illness, but you will clearly be an invaluable support whatever the diagnosis. Warmest wishes.

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Foodsupport_AUS
Another thought for your friend would be to go to this site FEEDYOURINSTINCT . This site is a new initiative by CENTRE FOR EXCELLENCE IN EATING DISORDERS in Australia. It is designed to help parents establish a diagnosis and to get early help. Your friend could fill in the questionnaire and print out the GP report card. It includes lots of info about ED's as well as info for the GP to consider why this may be an eating disorder and what to do.

BTW the site does suggest plating meals and establishing regular mealtimes if possible, it gives feedback as to how much resistance there is. 


D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
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