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Determined2help
There's probably an abundance of info out there on this but I guess I'm seeking advice about my daughter's own unique situation.

Every morning before school D will do a 10 min stretchy type exercise. I've said absolutely no cardio and I listen at her door and watch for shadows moving under the door. So far, it seems, so good.
Then, here we go, after school about 1 hr of exercise that is allegedly only lying down or on all 4s etc. Again  I have said no cardio. She seems to do some strengthening and toning.

After the evening meal another 1 hour of the same. No other sports or exercise at all. No walking to school as we drive and sometimes she goes for a walk with her dad around the neighbourhood. It's very tame, 10 mins. No running not even much PE because of covid. They don't even leave class now unless for lunch and morning snack. 

My instinct says it's too much. She says (ED🦈) that it's to help her appetite, her constipation, her anxiety etc. My feeling is that even if it's not burning much, that in a way anything is too much. I've done some research that talks about nutritionally supported exercise, I guess it's a case by case thing.

D eats 3 meals plus 3 snacks. I'm always trying to find new ways to make them more calorie dense. She's had lots of reflux and tummy pain and I think I've been duped into giving her lighter meals... I'm a slow learner sonetimes! ED is pretty sneaky though. 

Low weight remains a problem. She  dislikes her body with her clothes too loose etc. She seems to want to heal but, like many ED sufferers, also doesn't think she has a problem. She does accept there are anxiety issues though. The homesickness thing doesn't help. 

We see a counsellor but he's a general type of guy not specifically specialising in this but we've started approaching things from an anxiety point of view and it's really resonated with her. 

So my question is, what to do re exercise? She's trying to be mindful and as far as I can see she is not doing cardio etc, we seem to have said goodbye to turning on the shower to mask jumping jacks in the bathroom... 

Thanks 
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Foodsupport_AUS
I don't know that it matters much whether she is burning many calories or not. The thing that concerns me most is the compulsive and secretive nature of her exercising. I am sure it does nothing for her appetite or her constipation. It probably does relieve her anxiety because her anxiety is telling her to do it, however the more she does it may mean the more she feels she needs to do. 

If you haven't read the Safe Exercise at Every stage guide yet - this is the link here. Given you mention your D is not fully weight restored and it sounds like she is not gaining as she should she is likely to be sitting at Level B and yes this is amount of exercise is far too much for either Level B or C.

I would first of all make it clear that the amount of exercise is excessive - as per guidelines. I would suggest if there is any exercise it should be in public, ie. not in her room - if needed the door comes off. Then back on to weight gain.
Gut issues can be a problem for a long time and it is an unfortunate side effect for many with ED, high fats, low fibre diets can be helpful in reducing some of the symptoms - weirdly it is common to have overconsumption of fibre and get bloating. 
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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Determined2help
Wow thanks, I didn't think of it that way. It's not secret, she tells me but she's super guarded about it. I will look at the guide. I'm very grateful. 
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HopeE
Hi there, 
Boy, do I relate to the feeling of having been duped into going along with something and then realizing it I was accommodating ED! My d. acted similarly with the same explanation of why her walks (at least an hour) were necessary for her digestion, mood, etc. Her therapist and dietitian worked with us to get exercise down to nothing while her body healed and she restored weight. They both are specialist in eating disorders. The psychologist we went to before that would often tell her things like, "Well, that's progress that you are only going of 45 minutes" or "I try not to eat too much sugar either, so I understand why you want to eat that kind of bar instead of the ones you have at home." What a world of difference it made to see someone that specialized who identified ED for what it is and how sneaky it can be. I don't know if finding a specialist is possible and maybe you are ok with the counselor you have now, but working on the anxiety piece is only a part of the ED. 
All the best to you  - 
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Barberton

We all get duped at some point in this journey! 

I do think there is a place for gentle movement in quelling anxiety. This is probably why yoga has been shown to be helpful for ED recovery. Do you think your d would be interested in learning a few simple yoga poses that she could hold quietly for a few minutes rather than do exercise in her room?

D fell down the rabbit hole of AN at age 11 after difficulty swallowing followed by rapid weight loss. Progressing well through recovery, but still climbing our way out of the hole.
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PurpleRain
My D never really had an excersise compulsion, so I let her continue with her aerial dance class, nothing strenuous, twice a week. However, she would insist that it was the only thing that make her feel good, relaxed, etc so I though this sounds like ED. We went on holiday before she was WR and she asked to go to the hotel gym, I said no, she ask the next-day, same answer, she stopped insisting. After our travel, there was still some holiday days which we spent at home, she didn't say anything about excersise or appeared anxious about it. So, I let her continue her class but once in awhile made some excuse so she could not attend and observed her response, if she was relaxed about missing the class I would let her continue. She had a spraint ankle and needed to rest for a month, she didn't complained at all, so when she healed, I allow her to continue, checking every once in a while her reaction to: we can't make it today. 
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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Determined2help
Thank you, that's given me something to think about. It's interesting to become attuned to the behaviours. I think I've only just started in a way. 
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MKR
Hi @Determined2help and @Foodsupport_AUS,

What an amazing resource! I love this forum! I had a good look at the link to SEES and it looks like we can finally find the way out of the stalemate over exercise.

From memory, our d was recovering best when we (her father and I) were encouraged by the therapist to allow our d to take part in 1 (team) sport.

During lockdown she became restless and has been pushing for gym more intensly every day. I like hiw the SEES guidelines recommend exercise to:
  1. rejuvenate the body, not exhaust or deplete it.
  2. enhance mind-body connection, not allow or induce disconnection.
  3. alleviate mental and physical stress, not produce more.
  4. provide genuine enjoyment and pleasure, not pain and dread.
This is something I can show the school, any coach and, last but not least, to my daughter as she gets more independent. We can check any proposed activity against the 4 criteria.

Many thanks for bringing this up and I hope your daughter can join a social sporty activity once she is back with her peers. Like some say on this forum, steering away from individual sport like running or swimming is reciommended. A volleyball or basketball team that goes for a pizza after a game is a good alternative.
Mum's Kitchen

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

I do like the SEES protocol. There are a few things to be mindful of however:

1: these were written/developed for adults and not children
2: There is a very specialized multidisciplinary team that is administering this with extremely intensive supervision in case this go south. They would have very specific protocols as to the what , when and where and most importantly, when does it need to stop and parameters to make those decisions. 


This protocol can be adapted for children, but I think the rate limiting factor is the professional oversight. It would be great to have it here where I live but there are no funds to be had for that type of program. Paying attention to periods and bone health too is important as too much exercise can affect their bone health. 

I do feel that the principles are sound, in general.
For my d team sports was not good at all, well no sport was good at all. With soccer she tried to compete with the others to be the fastest and the strongest kicker etc.. She did private yoga lessons with her dad and that became obsessive too! I did not know she had ED at that time. H was at a conference once and I went to yoga with her and she got so angry that I did not do it the way her dad did! That was a real ah ha moment for me. We had to stop yoga  and she has not gone back. But she does do other things, with less internal angst and somedays is happy to lay on the couch. 
The key here ,as I see it is this: joy of movement for sure, but it has to be supervised and not obsessive and to be able to not do it for a few days at least and not feel upset. 
I think the exercise piece is so difficult. Some here have been ok with exercise and moving forward, we just were not one of those families. There are so many different "recipes" to treat ED and you have to use the "ingredients" you have at your disposal and figure it out. So many experiences here and so many wise minds. use what works for you. 
Sending my best. 


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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MKR
I agree about caution, @Enn. The right answer and strategy are still ellusive. Over the two and a half years I have spoken to gym teachers, coaches and sports dieticians but they've all admitted they don't have a definite answer. By contrast, solution to weight loss, ie refeeding, is a lot more straightforward.

I agree that compulsive exercise is different for everyone and please follow what works for you, @Determined2help.

We first saw the d doing "funny walks" - not quite like Monty Python but still very odd - like turning the corner by walking on the outer edge for extra steps, walking fast ahead of us and returning several times, going up and down stairs several times, jumping up a flight of stairs with both feet together, jumping onto benches. That eased off with refeeding and team sports (1 per term) but now she is harassing wider family by emailing images of body builders and their "motivational" blurb like no pain, no gain (we've put a stop to this online bullying), hoardes buckets of protein powder.  So trying to distract from that. 

What I am hoping for is for the child to re-gain "exercise cues" (is this fun or is it hurting?), a bit like hunger cues, recognise when the behaviour doesn't fit into normal and correct themselves by following the guideline steps.

I apologise for grabbing the SEES with both hands, the frustration comes from my long search for something that will stamp out the obsession.
Mum's Kitchen

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

We had to stop ALL exercise for my daughter when she was at a lower weight and for a very long time after. She could do exercise laying in bed at night. She would do planks under the covers and all sorts of abdominal muscle work literally in bed. 

It sounds like from what you describe that it is compulsive and ritualistic in nature and this goes hand in hand with her eating disorder. Especially with the fact that her weight is still too low.

its mind boggling how much energy/calories they can burn simply by doing even yoga when underweight and with a messed up metabolism. When my D was inpt she was given yoga as a reward for finishing meals. I had to put a stop to it immediately as it was obvious it was FEEDING the ED as it became all she talked about. The girl could turn brushing her teeth into a cardio event. 

Bottom line- if your GUT feels something is wrong then it is. If her tummy is giving her troubles how about just a slow and gentle walk WITH you? See how she does just doing that. Does she comply? Does she complain? Does she try to sneak in other things? The fact that she had been previously exercising in the shower etc gives  me pause - she is likely doing more than you’re aware of if she’s not monitored 24/7. ED is a sneaky jerk. 

After we stopped all exercise my Ds ED voice was loud and it was pissed. We gave 3 warnings about movement and then she had to have Ensure to replace those calories. It was not fun. And I have to tell you that months later she was able to tell us how RELIEVED she was bc her body hurt and ached. Her joints and back hurt all of the time. Her ED was pissed but SHE was relieved. 

The only way out of this is through. I urge you to ramp up fats and calories and get her weight up to where it needs to be- her own individual growth curve plus 10%. 

You can do this! 

Persistent, consistent vigilance!
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