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

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Muminhope
Hi everyone! My AN D lost 4 pounds when we visited the clinics this Tuesday. She haven’t been to the clinics during 3 months due to covid-19. It’s actually out of D’s expectation about her losing weight. She searched a menu which I attached and agreed to have 0.5 kilos gains per week. I do have some questions about this menu and looking for your comments. E.g, it’s said 200ml semi-skimmed milk mix with hot chocolate/Ovaltine/Nesquik at tea and supper. Most of these products are powders. I am wondering how much should be these powders in mixing with milk. D has same questions. We did buy Nesquik drink yesterday. Each carton is 200ml. Seems Nesquik only produces less sugar products. We had to buy it and I found that one carton is only 100 calories. Is this the same mix which is said in the menu? Anyone is familiar with this menu? Thank you!
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teecee

Hi there I’m not familiar with the menu and was quite shocked when I saw they were endorsing semi skimmed milk. That was the first thing that CAMHS told us to dump and replace with whole milk. 

Is this a ‘maintenance’ or refeeding menu? 

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LaraB

Hi You must have had a shock to find out she had lost weight. I am glad she is engaging with a plan to increase her weight and It is good that your D is prepared to try different things. If your daughter is already drinking whole milk, if it were me, I would stick to that ( and add cream to bottle if possible). A 100 calorie carton of Nesquik sounds very low really. I agree with you that that does not sound enough and I try to avoid those low sugar products too. 

If you are interested I did find a range of meal-plans on the same NHS site (south London and Maudsley)which cater for different calorie requirements up to 2500 per day but I know many kids need more than that. But it might give you some ideas. I think I remember you mainly prepare Asian food and I am sure there must be ways to increase the energy content of Asian foods too. See page 116 and 117 of the manual at this link.
https://www.national.slam.nhs.uk/wp-content/uploads/2011/11/Maudsley-Service-Manual-for-Child-and-Adolescent-Eating-Disorders-July-2016.pdf
Take care. 


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Enn
I would get rid of the meal plan. It creates
rigidity and may not allow you to add more as required.
Was this given to you by the team? 
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Foodsupport_AUS
Sorry to hear about the weight loss, but it is also a positive that she is agreeing to weight gain, it may help reduce resistance at meal times.

This meal plan has been around for a while and comes from the Maudsley hospital adult site. The children's unit as attached by @LaraB does recommend full fat milk. There are of course numerous nutritional guidances that still recommend semi - skimmed milk (unfortunately).
You specifically ask about the Nesquik . It is unclear when you search as to whether the formulations sold in different countries are the same, they may be. What is clear from the the nestle website is that they are recommending two tablespoons per glass. https://www.nesquik.com/en/products/powder/nesquikr-chocolate-milk-powder-small.  The goal of adding powders to milk is to boost them a bit further so full cream milk can be boosted with something like the Nesquik. It just makes more calories to a smaller volume, in this case some protein, vitamins and sugar. According to this nutritional chart the main content is sugar. 
When it comes to the drink, if it only has 100 calories this seems to be even less than suggested on their website .You would definitely get more in by adding the powder to whole milk. 
The thing about this meal plan is that you had mentioned elsewhere that you were already following a plan. It sounds like this is switching one thing for another. There are many pros and cons to following a plan. Unlike some of the others we did follow a plan - it was that or have her readmitted to hospital, as happened numerous times. There is no one way to do this. That being said, how do you know that this plan is greater than your previous plan, it sounds like very different food from what you have been eating? Many people do need a significantly higher intake to achieve consistent gain. We don't know what your D will need. If you do decide to follow this plan be prepared that it may need to change, further if weight gain is more than expected don't back off. Keep going. After a while things even out. if it is less than expected you will need to add an extra 300 to 500 calories per day and see how that goes. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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MKR
Hi @Muminhope,

Enn wrote:
I would get rid of the meal plan. It creates
rigidity and may not allow you to add more as required.


I would only use the plan as a rough guide, as a reminder to ensure all food groups are included, but I would increase the quantities, especially for snacks at school. The meal plan doesn't sound sufficient for a growing teenager, though.

In fact, I would include Asian dishes, too. My children often take dumplings for snacks at school. She can then have a Nesquick after some solid food.

Your instinct is right, keep feeding!
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Muminhope
Thank you so much for all of your inputs. They’re really helpful to me. I have decided not to use this plan and stick on our current one. Extra ones will be added right now. I will do it immediately and see if there’s any gain on next appointment. If not, add more based on her current intake. Thanks again and so lucky to have you all.
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deenl
We drink Nesquik a couple of times everyday. Two full tablespoons, a half of the glass with cream and top up with full fat milk. For the rest of the family, I just use milk and for myself (close to menopause middle aged woman) I use a combination of milk and water.

When I started, I did a couple of tablespoons of cream and gradually increased it until it was basically half and half.

Just FYI.

Warm wishes,

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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Muminhope
[QUOTE username=deenl userid=4325929 postid=1311658022]We drink Nesquik a couple of times everyday. Two full tablespoons, a half of the glass with cream and top up with full fat milk. For the rest of the family, I just use milk and for myself (close to menopause middle aged woman) I use a combination of milk and water.

This is so interesting to learn your experience. It reminded me my experience for water and milk for myself, I did it for me and D saw it. She was so upset to me. Currently, I am so frustrated to find out a way for D to have extra calories since she refuses any milk shake and doesn’t believe me to prepare food for her. I added in her rice earlier when I prepared lunch for her in school. But being no school since March, she eats same rice with ours I can’t add high calories in our rice.
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LaraB

I Have used different approaches depending on what will work at any particular stage.

At one stage, I was able to be clear up front to her that everyone eats according to their needs and to my surprise that worked although I was afraid of what the response would be.

we have different milk - whole milk with added cream for her and semi-skimmed for everyone else ( although when starting out we all used whole milk to get her used to it). 

At other times, I make high calorie rice for all but take a smaller portion for myself and to avoid any swopping of plates, I start to eat mine before she arrives at the table. 

i have found I need to be sneakier than the ED to beat it. 

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MKR
Not being able to cook in peace is another hard part of FBT. At one point I was seriously looking to move to a home that had an old-fashioned closed-off kitchen, not the open-plan that is fashionable at the moment.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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