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

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strawdog
Morning all - I was just wondering what experiences people have add with their children returning to exercise once they had regained weight? My d had started running before the ED took hold - she started at the gym first as a means to lose weight or to purge after she had over eaten. Id managed to get her out of the gym once a week for a run outside with me and she was really enjoying it and found it a great stress release as well. Obviously the exercise was driven by the ED as a way of controlling her weight but I would like to think one day she will be able to use running as a way of just keeping fit and controlling stress. Hr ED was caught early and she never thankfully became underweight and has since regained weight in her first week of the FBT so is progressing well and soon be strong enough to run but at what point could we be thinking about it or will just re-ignite those controlling mechanisms?
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tina72
This is a very tough thing. Most exercise that started around or a bit before ED moved in is ED driven and than it is a really long time before they can go back to exercise without risk of a relapse. I think I read the rule is no exercise for at least a year after WR.
My d did not do any exercise to lose weight with ED (she is naturally not the exercise type - that was really a blessing). So when her weight was restored we allowed her to join the dancing class once a week for social contact but with the rule that she is only allowed to go there when she maintains her weight and when she eats an extra snack at this day. Until now she does that. In school we allowed PE after WR but no extreme things, just "light" sports. The teacher was in the boat and if they did go out for a run for example she had 3 teams and mine was in the slow walking team.
So to make it short, if your d has done exercise that was ED driven forget all exercise and sports for a very long time. She can use other things to distract herself and have stress release like painting, music, knitting etc. Things that does not burn calories!
Keep feeding. There is light at the end of the tunnel.
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mimi321
I noticed you mentioned she never became underweight. She may not be underweight according to a bmi chart, but I have since learned bmi = basically meaningless information in terms of the designations given (underweight, overweight, etc). For example, my D dropped from between the 85th-95th percentile for weight (classified overweight) to around the 35th percentile (classified healthy weight). When she returned to the 50th the doctor declared her wr, but she was not even close to being nutritionally restored according to many factors until she returned to her traditional growth curve between the 85th-95th percentile. That is her body type, her genetic make-up, her stage of development, and she now looks and feels 100% healthier. 

If she lost her period it is recommended by Dr. Julie O'Toole there should be no return to exercise after wr until she has three consecutive regular periods. Then it is best to go slow and see how it goes, mostly social activity related exercise, pe class. Does it trigger her ED or interrupt her menses? She will need to step it back. Otherwise it would be okay to continue with that amount and continue to observe. After wr it takes time for the brain to catch up, so going too fast with a return to exercise can reignite some ED related thought/habits/rituals and keep them going.
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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tina72
Thanks mimi321,
that is really important to know, they do not need to be underweight to be seriously ill.
Keep feeding. There is light at the end of the tunnel.
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strawdog
Yes I find the BMI index is dangerous if taken on it's own - my D had fallen to the 7th percentile but it was still telling is that she was 'healthy' which we know is far far from the truth! The problem is we don't know what percentile she's been on since secondary school - so we question is now - how do we know what her WR target should be? 
Thanks mimi321 yes she has stopped her periods so that advise has to be adhered to.
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tina72
Periods in series, a good state, no problems with eating, fun with friends, no body image problems, no depression.
A happy normal child. That is your target, not a number on the scale. State, not weight.
And a child that is still growing has no target weight. Weight must increase until mid 20s.
Keep feeding. There is light at the end of the tunnel.
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Ocras68
You’re so right strawdog, those BMI figures are sort of meaningless for the individual.  Go for state not weight.  When she has three periods in a row and the ED thoughts are lessening (sadly it can take a long time after a good weight is reached) then you know you’re on the right track.  Does she have siblings, at least this could give you some idea of where she should be genetically on the growth curve?  

Until then, I would say no running.  My 14 year old d started jogging just to “keep fit” but we didn’t realise at the time that it was part of her spiral into anorexia.  Social anxiety and isolation were partly what triggered her illness, and so she now does some low-level team sports at school for social reasons.  BUT, she does no other sport.  No swimming and definitely no running.  It’s too easy for it to get out of control.  Go for gentle walks in the countryside instead (assuming you don’t live in central London) if your d needs to get out in the fresh air and reduce stress.  

 
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mimi321
Thanks, Tina, this is true, EDs can happen in a range of body sizes, and more often than not occur in larger bodies, according to Dr. Gaudiani. I personally think the classifications themselves (underweight, normal, healthy, etc) are bogus and harmful. Although a bmi chart would indicate otherwise, my D was in fact underweight when she was ill and healthy when considered in the overweight range. The classifications do not account for bone structure, muscle mass, body type, how "developed" or curvy you might be, the fact that children grow out then up so typically put on a little weight before a growth spurt, etc. (Ironically, some people's "set point" goes up due to food scarcity, disordered eating, dieting, etc.) Unfortunately a lot of doctors still abide by the bmi chart, so that is something to keep in mind when working towards a healthy recovery weight for your child, and perhaps reframing what it means to be underweight/overweight. Okay, getting off my soapbox now, lol.
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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mimi321
strawdog wrote:
Yes I find the BMI index is dangerous if taken on it's own - my D had fallen to the 7th percentile but it was still telling is that she was 'healthy' which we know is far far from the truth! The problem is we don't know what percentile she's been on since secondary school - so we question is now - how do we know what her WR target should be? 
Thanks mimi321 yes she has stopped her periods so that advise has to be adhered to.


If you have the information, you typically look at their growth chart throughout childhood up until two years before the start of ED, because ED can creep in before we realize and disrupt the pattern. That range is usually the minimum goal, but as Tina mentioned, you may not know until you get there. I like these guidelines set out by Dr. O'Toole: 

https://www.kartiniclinic.com/blog/post/weight-restoration-2.0/

I would also say that most do not see an improvement until a minimum bmi of 22. 

https://www.eatingdisordertherapyla.com/are-we-setting-recovery-weights-too-low/
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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Ronson
Hi 

I’ve not had chance to read all the thread so forgive me if I’m repeating others.

My rule with d has been if it was what you would do before then that is ok.  So she has swam for many years (since she was 6) and danced.  She has returned to these - all done in monitored clubs and not to excess, extra calories on days when exercising.  

She had started going to gym - this was alone and I think for the wrong reasons - so this stopped. 

My d has had no exercise compulsion - she will miss swimming cos she can’t be bothered or something more fun comes up.  So I’m content with this.  She is also healthy physically (normal periods, weight, blood pressure etc)

If your d is not healthy I wouldn’t do exercise.  If it is solo exercise with no social elements then I would say no.  If it started around the Ed time I would say no.  There are other stress relievers, colouring, puzzles etc which can be better at this stage. 

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Mcmum
Absolutely what Ronson said. We have recently returned to sociable team sports in moderation, 6 months after diagnosis but definitely after sustained and continuing weight gain.  We pack the calories in on those days and make sure our s is sedentary around the rest of the activity.  There's pleasure and social interaction now where before there was compulsion and a weight loss goal. For the first few months before and after diagnosis we mainly aimed to sit on the sofa. Literally! ! 
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strawdog
Thanks for all the advice - I think what you are all saying, deep down, I knew was what we had to do but I guess I was hoping for a few - don't worry our d went back to running and it really helped her mental state. I know now that was just wishful thinking. The nurse who did her checks said it wasn't a problem that she had stopped her period and that they would come back once she started re-feeding - no impact on fertility. However, on reading on-line, I'm not sure there is no impact? I guess it depends on how long she stops for?
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tina72
No, there is no impact unless it does not come back 🙂 but that is not to be expected. Normally the periods come back around 3-4 months after WR. Here it was longer but we had some contraceptive in between which was needed but no good thing to see if periods come naturally. After taking away contraceptiva it was 10 months to come back.
It depends on the fat intake how long it takes, the hormons that do that need fat.
Keep feeding. There is light at the end of the tunnel.
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Ronson
Also be careful using periods as a judge - my d didn’t lose her period, but was mentally in a very bad place.  Although they are a good indicator of health generally it can be misleading to think her periods are here that is all ok 
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strawdog
And i read somewhere that if you make too much of them coming back - ie we need to re-feed you because your periods have stopped due to your body being starved - that when they get them back they equate that - period must equal getting fat again?

Trigger point this morning was putting on clothes that now feel tight which didn't a couple of weeks back - that's great news for us but obviously bad news for her. I was thinking the other day how to people cope - especially if their Ds had tight clothes when they were at their thinnest which are very quickly going to become tight? I mean it happens to us all - even men - I know if I've put on a few pounds as my work trousers feel tight around my bum! 😉 Not much you can do I guess other than give them a free budget to replace clothes and encourage loose fitting clothes?
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scaredmom
Hi ,
The weight first redistributes on the face and abdomen. 
The tighter clothes thing can be quite triggering and some have done a “magic wardrobe”. You go buy newer and bigger clothes , so she does not know , a few bigger sizes. Take out the tags. Just be supportive if she gets upset.
At one week of weight gain, hard to know if she is just feeling clothes are tight versus if they really are tight.
XXX
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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scaredmom
Best at the beginning not to make a big deal about anything. It can back fire and make them very upset. 
Keep your demeanour cool, confident and calm. That it what helped my d. The less said about anything worked.
XXX
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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strawdog
scaredmom wrote:
Hi ,
The weight first redistributes on the face and abdomen. 
The tighter clothes thing can be quite triggering and some have done a “magic wardrobe”. You go buy newer and bigger clothes , so she does not know , a few bigger sizes. Take out the tags. Just be supportive if she gets upset.
At one week of weight gain, hard to know if she is just feeling clothes are tight versus if they really are tight.
XXX


It's definitely a big trigger for her. We've been having pudding after dinner since Thursday and she's doing great and eating it but got up the minute she finished yesterday and went straight upstairs to get into loser clothing. Looking at what she wearing it wasn't that tight actually - so perhaps its the ED telling her they are tighter than they actually are. It's very hard to be supportive when she gets her triggers - I just get a mouthful of abuse from ED!
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scaredmom
I ignored ED talk. Took awhile and others here to teach me that. When d would get abusive, I would say , literally, I am not talking to ED. Then I walked away or told her to go to her room for a bit of time out l. It took about a week of being consistent in that and it worked. 
XXX
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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mimi321
Leggings are great at this stage if shopping for replacements. 

Yes, I wouldn't tell her that periods returning = wr, but they are an important marker along recovery. We pushed the weight until her period returned, which seemed to coincide with an improvement in state/wr, then we added 5 lbs as a buffer. That was bmi 22. We kept feeding of course and she has since "developed" even further. Sometimes their period comes back much ahead of wr, so keep in mind you may have a ways to go after that.

I liked to use the "crap sandwich" approach when my D got worked up, angry at me, yelling, etc. Supportive/validating statement ("I can see you are quite angry right now about x") + boundary ("but it's not okay to x") + supportive/reassuring statement ("but we do really care about you.") If this didn't help much, then I would say something about tempers being flared and we both need a break right now.
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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tina72
strawdog wrote:
And i read somewhere that if you make too much of them coming back - ie we need to re-feed you because your periods have stopped due to your body being starved - that when they get them back they equate that - period must equal getting fat again?

Trigger point this morning was putting on clothes that now feel tight which didn't a couple of weeks back - that's great news for us but obviously bad news for her. I was thinking the other day how to people cope - especially if their Ds had tight clothes when they were at their thinnest which are very quickly going to become tight? I mean it happens to us all - even men - I know if I've put on a few pounds as my work trousers feel tight around my bum! 😉 Not much you can do I guess other than give them a free budget to replace clothes and encourage loose fitting clothes?


Yes, I would not comment too much about periods coming back or not because she will argue then "I got my periods so that means I am at a good weight" - no, that is not the case. Having NO periods is a sign of being on a bad weight but having periods means not too much because some do never lose their periods and some do get them back on a BMI of 16 (mine did) and that is for sure not a healthy weight at all.
I would not talk about that at all to her.

I bought the same jeans but one and then two sizes bigger, took out the labels and "lost" the tight one in the laundry. She did not get it.
Leggings are a blessing at that time. Also all trousers with stretch.
She might be not in a state to buy new trousers herself. It will feel like a failure for her and a sign that she is "too big".
Keep feeding. There is light at the end of the tunnel.
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Mcmum
I also bought bigger sizes of the same clothes and cut labels off.
When our s pushed the insults too far we'd say "it's an eating disorder not a rudeness disorder" and move on.  We sometimes joke now about some of the more offensive things he said.  Not so funny at the time but keep feeding , it gets better! 
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tina72
"it's an eating disorder not a rudeness disorder"

I really love that, Mcmum!
Keep feeding. There is light at the end of the tunnel.
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Ronson
My d said things were getting tight when they weren’t - she would stand there in jeans  that fit crying and screaming - look how fat I am they don’t fit (they obviously did fit) I found that very hard.  At this stage there is absolutely nothing to say to make her feel better - no logic will be accepted.  I would avoid commenting on anything to do with health or weight.   Anything will be taken out of context, twisted etc.  If you say it’s not important what you weigh she will hear - you’re fat.  If you say will we go shopping - she will hear - you’re fat.  If you call her healthy - she’ll hear you’re fat.  If you say she’s not fat - she will cry - but you wouldn’t tell me if I was cos you’re my mum.  

It is futile.  Be inwardly pleased with progress but keep a poker face.  Do not engage with any talk about appearance etc. We didn’t do magic clothes - d didn’t lose too much weight so still fits a lot and wears a lot of leggings anyway.  But it can work great for people who had a really noticeable change in body shape.  

Ignore as much of the chat as you can, often she will be looking for a reaction so she can endorse Ed thoughts. 
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Ronson
Oh and for us - no changing after dinner for sometime - she would see all her fat in the mirror after she had eaten 
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