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

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Lovingavocados
hi all,
d has been on a low(ish) calorie meal plan for a few weeks and we’ve been waiting for her weight to stabilize before increasing. She’s been eating around 1100-1500 and her weight continues to increase, putting her about 5 lbs above where she was when she started. She is distraught, saying her metabolism is messed up forever and that she should have started on 2000+ calories. Should we go ahead and increase her to 2000? What will her weight do then? 
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Foodsupport_AUS
Yes you should put up her intake, even higher than 2000. From your posts though she is not really gaining at all. You posted that she was worried about gaining 4.3 lb in the first week so about 5lbs now suggests she is not gaining at all. It is important that we acknowledge that anxiety that they have but it is not rational. Getting her weight up faster is what is going to give her the best chance of recovery. The goal should be at least 1 -2 lbs per week.
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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sk8r31
Lovingavocados, what is the status of medical monitoring?  Who is deciding the meal plan?  What professional support, if any, do you have?  According to your first post, your d had almost a 5 lb gain in one week early on.  Does that mean there has essentially been no gain for several weeks?
As you doubt know, deflecting anxiety as much as possible, & moving forward towards nutritional rehabilitation as quickly as is possible (with medical monitoring) is the best way forward.  Let us know more about what services your d and your family currently have in place, and then we can better suggest & advise.
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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Lovingavocados
We are currently working with an out patient team (therapist, nutritionist, etc.). She dropped a little when she got *regular* again (Lord she would kill me for putting this on here) but it’s since returned. 
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Mamaroo
She is distraught, saying her metabolism is messed up forever and that she should have started on 2000+ calories. Should we go ahead and increase her to 2000? What will her weight do then? 


We started low as well and I can assure you that my d's metabolism is not messed up. The body is very resilient and with the proper nutrition can heal it self and fix its metabolism. My d had a high metabolism for 2 years post WR and it has returned to more normal levels now. Go ahead, increase the calories until you see weight gain of around 1 lb a week.
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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tina72
Does she know before that she is going to be weighed? Is she weighed in underwear? Is she weighed blind or open?
I asked that because many patients fake weighing by waterloading before, by putting heavy things into ther pokets, by tricking us out.

Normally you see no real weight gain with that intake.

Why not increase it to 2000 or even more? It is evidence based that the faster they are WR the better the outcome and the faster brain recovery can start. What do you fear? What do you wait for?
Keep feeding. There is light at the end of the tunnel.
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Lovingavocados
Weighing is random so she can’t be waterloading. I figured it wasn’t “real” weight gain but it’s been sticking around for a while so I wasn’t sure? 
We are just doing what we’re told but it seems as if it would be more distressing for her to continue to gain on a lower intake then a higher one. 
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tina72
Normally they are distressed on whatever intake you give them. If you make her gain slowly the pain is lengthened and brain recovery will start later. There is no reason to do this. Go for more weight gain, the rule is 500-1000 g a week would be great to see. Whatever this means you have to feed her to get there...🙂
Listen to your gut. You know her best. If you hear her asking for more intake why not use that??
Often even the professionals go for slow weight gain against all evidence based research like they are as afraid of ED as the patients...they told me it would stress my d too much to make her gain more than 300 g a week. In fact she was stressed about eating 50 calories the same as about eating 500 calories.
The faster you get them WR the earlier you get your child back.
Keep feeding. There is light at the end of the tunnel.
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Lovingavocados
You all are right. Would it be best to jump to 2000 right away or increase more gradually? 
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Foodsupport_AUS
Most good professionals recommend increasing by 500 calories every few days until consistent weight gains of 0.5 to 1kg (1 -2lbs) per week are seen. Many would suggest that the goal should be even higher for weight gain. 
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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tina72
If you are able to jump on 2000 (try to have small amounts with high calories so she does not need to eat that much food) I would give it a try. If not increase it daily until you see steady weight gain.
Keep feeding. There is light at the end of the tunnel.
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Mamaroo
Start by introducing high calorie, low foot print food such as nuts. Just a handful of nuts has as many calories as a muesli bar or muffin. You can add oil or butter to most food and fry it or look for the highest calorie version of everything she's already eating. I spent many hours at the shop hunting for the highest calorie version of bread, muesli bars, yogurt, ice cream, fruit juice etc. You won't believe the variation you can get. Let us know if you need help to supersize a meal.
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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Lovingavocados
Thanks so much to everyone who has replied. Today we are upping to 1700 calories, and increasing even more over the weekend. Here’s to hoping she’s compliant. 
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tina72
Try to up it every day until she is on a good intake. She does not need to be compliant about it. Food is her medicine and if she had cancer and needed chemotherapy she does not need to be compliant with that, too. It is necessary and not negotiable.
Keep feeding. There is light at the end of the tunnel.
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