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

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4kids1dog
Friends,  My D is about 6 weeks into recovery, has gained 1 lb. per week, is back to eating all categories of food (no longer vegetarian), doesn't throw fits any longer about eating quantities I put before her.  She eats a varied diet - same foods she grew up on.  Overall has been going well.   The therapist ( in the beginning) had recommended she see a Dietician that works in the Therapist's office.  I had explained to her a few weeks ago that my D is eating well, fruits, veggies, all meats, seafood, beans, rice, bread, sweets, dairy, soy - there's nothing she won't eat and she is gaining weight nicely so we didn't feel it necessary to add the time and cost of a dietician.  Now the therapist has recommended the Dietician again today saying:

"a dietitian would be very beneficial to "D" therapy, as I am familiar with the nutrition side of things, but feel that to build a healthy relationship with food it is best to have somebody that can work with her body’s specific needs, monitor her growth chart, and helping her challenge some of her food anxiety"


I've measured her height, checked the CDC website which provides a calculator for BMI for teens based on age, height and weight and we know what weight we are working towards (120 lbs for 5'7", BMI of 18.8). I weigh her every week.  I feel like we are on top of things and I'm not seeing the food anxiety at home.

Please give me your opinion on whether I should have my D visit with the Dietician.  I'm half wondering if therapist is just pushing business to her friend (the skeptic in me).

Thank you all.



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Foodsupport_AUS
My 2 cents worth. Right now, I don't think your D would benefit from seeing a dietitian. Having checked your other posts I gather she is 16. Right now she seems to be doing well and is managing eating a variety of foods. If YOU were concerned about not getting weight on, or variety of foods, I could see a reason for YOU to see one to give you help. Dietitians are very varied when it comes to ED, and some can do a lot more harm than good. 

When can I see them helpful? I think they are really helpful in helping an older teen/young adult look at what they are going to need for their long term health, or to help where a parent is struggling to introduce back in food variety or quantities. 
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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mdmama
Hi, 4kids1dog:

How wonderful that your D is making such great progress. Congratulations, for I'm sure you are working very hard to achieve such success. "There's nothing she won't eat" is quite an amazing statement to be able to make at this stage!

Speaking from my own personal experience, we saw a dietician only a handful of times when we were early in refeeding-- including a couple of visits after my D spent a week in the hospital. After her release from the hospital she was extremely compliant, put on weight quickly, ate pretty much everything I required her to, and in fact now (13 months later) has a more varied diet than she ever had before the onset of her AN. It's not perfect, but it's great. Within a month of her release from the hospital we were not seeing the dietician anymore, although she remained available through our ED clinic (the same place D was going to therapy and seeing a physician).

The best tip I got from our dietician when we were early in the process was to make sure to have a caloric drink as part of EVERY meal for my D (our whole family is mostly water drinkers, typically). This is a departure from our family's "normal" and it's not always convenient, but she now has either milk or orange juice with every breakfast, lemonade or juice with every lunch, and milk with every dinner-- or occasionally a soda. It's an easy way to add 150-200 calories to every meal, and her metabolism still requires that we keep this as part of her routine in order to keep her weight stable (and, gradually, still increasing). 

Again, good for you and your D for achieving such great results. I hope you continue to make progress.

_______
D diagnosed with AN November 2015 , the week she turned 12. Gaining slowly but steadily, fingers crossed...
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OneToughMomma
Dear 4kids1dog,

Sounds to me like you're doing a great job just the way things are.

I've found dieticians to be usually less than helpful, and rue all the money we spent on one over the years. I'm sure there are good practicioners out there, but I think the bad outweigh the good. As long as things are going well I wouldn't change!

xoOTM
D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
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mjkz
The quick and short answer to that is no.  We too saw dietitians inpatient and I saw one at one point when I needed ideas on how to deal with lactose intolerance and just how to get more calories in (before I found this place).  If you are happy with where things are going, then don't get pushed into something that could potentially derail it.  If in the future you find you might want to see one, then by all means do it.
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mamabear
No. Dieticians are not necessary and can be incredibly detrimental. ED thrives on information on carbs and fats and proteins and numbers.

And five seven and 120 lbs? BMI of 18.5?
No way is that a good weight. WAY TOO LOW.
Persistent, consistent vigilance!
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mdmama
Mamabear, I was thinking that 5'7" and 120 sounded too low, too. Despite 4kids1dog's daughter's awesome-sounding current state, I'd be pushing the weight higher if I were her.


_______
D diagnosed with AN November 2015 , the week she turned 12. Gaining slowly but steadily, fingers crossed...
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Torie
If someone is tallying votes, here are mine:

Dietitian: No
More weight: Yes

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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EC_Mom
There is no magic number....but 120/18.8 sounds way too low! The important thing is that when she starts, slowly, to show signs of being normal and capable of eating well, then you might be approaching a healthy number. The number doesn't matter much. The state of her illness does.
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4kids1dog
Thank you everyone!!  Gained another .5 lb this week.  Based on the comments I am not going to visit dietician for now (and won't feel guilty about it either).

120 is definitely at the low end of the percentile for her height, but it is considered 'healthy' according to the CDC.  My husband at her age was skinny as a rail so some could be heredity.  Ultimately I will wait for her doctor to release her for any physical activity and I know BMI and weight will come in to play then.  Meantime... just keep feeding her all day long!!

All advice and opinions always welcome here.
xoxo

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mjkz
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but it is considered 'healthy' according to the CDC. 


Is it just me or is there something ironic about the Center for Disease Control telling us what is healthy?  Healthy is a relative term remember.  One can have well controlled diabetes and still be "healthy".  What they might consider healthy for one is not necessarily what is healthy for another so I would put little faith in their charts other than to know that whatever they think of as healthy should be a weight that should be the very bottom of what is needed.
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Foodsupport_AUS
Definitely some irony there in CDC determining what is healthy. 

I think even more important is to look at the wording and charts used. These charts have been developed from measuring large numbers of children. It was assumed they were healthy, that is there was no overt disease at the time, however this at no time whether this was the best weight for them in the long term, nor did it assess their health down the track. Essentially it just a cross section of the community and the weight ranges. Health doesn't really come into it. The assumption has been that those at the upper ranges and lower ranges are more likely to be in an unhealthy weight range, but really this is not assessed in anyway. 

All being on the charts tell us is that for a certain age, weight and height there are X proportion of kids higher or lower than that percentile. Most of us have found that being in the lower levels of the charts in no way brings about brain healing. Most guidelines suggest somewhere between the 25th centile and 75th centile is needed for healing, and a lot of centres aim for 50th centile with still not a lot of evidence behind it. 
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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HateEDwithApassion
From one who has had a pretty good experience using a dietician, I still don't think it's necessary in your case.

It sounds like you are getting food in and your D is compliant. If that would change, the one thing our dietician did that was super helpful was provide evidence-based responses to my daughter's ED nonsense: "I read in People that liquid diets are good for you." or "Milk causes cancer."  Goodness - there's no end to the nutrition BS that our kids will find and use. Our dietician had the Minnesota starvation study in her file cabinet, and whipped it out to challenge my D. Don't know how many would do that though. [smile]

My D is about 5'6 and for her, I would feel 120 is too low. And she's always been a lanky kid. Do you know what your Ds historical percentage was before the ED? For example, my D was in the 50% percentile for weight most of her life pre-ED, so we need to have her at least at that percentile now. It's a big range, which is unfortunate, but anything below it wouldn't be following her historic growth curve and has no business being a goal weight. I'm guessing at 5'7 your D should weigh more that 120, even if she's a slight kid.




19 yo D. AN - since about 15 years old. WR quickly - but the last four years have been tough. Since Sept. 2017, two residential stays, now in IOP, fighting a relapse. ED is hanging on, mental state not great, can't get her to remain at a weight long enough or high enough to see mental healing. She's on a gap year that will likely now turn into two.
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