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

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

Join these conversations already in progress:
• Road To Recovery - Stories of Hope
• Events for Parents and Caregivers Around the World
• Free F.E.A.S.T Conference Videos

Visit the F.E.A.S.T website for information and support.

If you need help using the forum please reach out to one of the moderators (listed below), or email us at bronwen@feast-ed.org.

Hendrixt
13 years old D is at the start of FBT in the UK under CAMHS.  First two weeks she gained 0.6 so we were concerned that we needed to get more food into her and were thinking that we will just warn her at the start of the week that the portions will be bigger etc and then just get on with it and do it (magic plate).  However, before we were able to do this, at the third session, following a 1.2k reduction the therapist entered into a long ‘negotiation’ with D trying to gain her agreement to eat more food. D was clearly not up for this conversation and rejected several suggestions by the therapist as to what additional food she would eat. The resulting ‘agreement’ was quite ambiguous as D wasn’t buying into it at all and seemed gutted that she was being asked to eat more food. We’ve got a little more food into her but we’re bracing ourselves for a another loss. I thought I had read that it is not good to negotiate over what food is eaten, and in what quantities, and I feel like contacting the therapist and asking her not to use this approach again.....
Quote
Ellesmum
This is why I'm considering dropping CAMHs, do contact them, they should supporting you in feeding her not negotiating with the ED.   
Ellesmum
Quote
tina72
"I thought I had read that it is not good to negotiate over what food is eaten, and in what quantities, and I feel like contacting the therapist and asking her not to use this approach again....."

That is totally correct, no negotiation about food with the patient, I think you know more about ED than that therapist now, stop that and tell her she just needs to say to your d that she must eat what you plate/serve.
It is unbelievable how unprofessional they sometimes act. Question ALL they do. If your gut says it is wrong, it is in most cases.
Keep feeding. There is light at the end of the tunnel.
Quote
Foodsupport_AUS
Many parents on here use magic plate to re-feed their child- parent chooses, child eats. It is true FBT in that the parent is feeding the child what they think they need. The problem always is that FBT and magic plate does not work for everyone, and people end up with all sorts of variants on the theme. I agree absolutely that asking someone at an early stage of re-feeding to increase their intake is a pointless task. Being told on the other hand that intake needs to be increased and being given a choice between one or two options can work relatively well for some families. It is not exactly negotiation, it is a discussion about what the child may find the easiest to get in. Clearly their has to be practicalities but options such as an extra glass of full cream milk with each meal or adding in a smoothie can be options that can be "discussed".  It did work at times for my D. She was not given an option whether to increase it was a case of when she was struggling to eat and had to increase what would be easier for her. 

It sounds like the "agreement" part was the worst problem in your case Hendrixt. If she could not accept one of several suggestions the choice gets made for her. It is common for kids with ED to have trouble choosing options. They are terrified of making a 'mistake'. As their brains heal they can often choose better. At the same time being offered some 'choice' can help them feel like they are not being forced to do things completely against their will. A very fine line and I suspect it is different with everyone, and will vary from time to time. 
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.
Quote
tina72
"and were thinking that we will just warn her at the start of the week that the portions will be bigger etc and then just get on with it and do it"

I would not "warn" her that more food has to be eaten next week, that sounds like food as a punishment. It is not her fault that she did not gain enough, she just had not enough intake (I think you can exclude exzessive sports and purging?).
Just increase portions slowly without any comment on that. You could use deep soup plates or bigger plates so the food will look the same size.
Keep feeding. There is light at the end of the tunnel.
Quote
Hendrixt
Hi Tina. I wasn’t thinking of doing it as a punishment, just to let her know so it didn’t take her by surprise when she saw there was more on her plate, we would never punish her as we know she is trying her best. I just thought the process of giving her choices was causing her so much stress and it’s led  to quite a bit of disruption this week. 

Food support - I agree there may need to be variations on the magic plate especially when we introduce ‘fear foods’. It’s just that, because the discussion was so difficult, with several options being rejected out of hand, the resulting agreement was quite ambiguous. When it came to feeding it to her she disputed what had been agreed. I think if we continue to do it this way and she is not truly choosing from options we might have to make the choice for her and be very clear on the decision. 

Ellesmum- we’re going to contact the therapist prior to the next session. I’m just dreading there’s going to be another weight loss 
Quote
scaredmom
My d listened to authority. I would call the team prior to an appointment and tell them for example, that I wanted to add smoothies to the plan. The team would pretend that it was their idea. And then we got them started.
i did give some choices between two things to make d feel that she  has some control. Like a chocolate bar or doughnut. That worked for us and as she gained and felt more trust in the process adding foods was easier. For us at the beginning every food was fearful.The meals were  nonnegotiable but snacks a bit of choice, 
Just a question, are you adding in extra calories via oil or heavy cream to help increase the calories and weight? 
I did that as well and that got the weight up more rapidly and then I found she ate more readily. It does take time and ingenuity to figure out how your d will respond.
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)
Quote
Hendrixt
Yes scaredmom my wife is doing a great job with all the food, loading up the calories into everything at every opportunity using double cream, frying everything in loads of butter etc 

i think the choice between 2 items at snacks sounds reasonable 
Quote
tina72
Hendrixt wrote:
Hi Tina. I wasn’t thinking of doing it as a punishment, just to let her know so it didn’t take her by surprise when she saw there was more on her plate, we would never punish her as we know she is trying her best. I just thought the process of giving her choices was causing her so much stress and it’s led  to quite a bit of disruption this week. 
 


My d did not do well with any choices at the start. She needed more than 10 minutes to decide between strawberry and cherry yoghurt...🙂
To tell her that you will increase portions might scare her and she might not be able to cope with that information.
You can try to increase portions without making it too visible. Same amount of mashed potatoes but more butter and cream in it for example.

I know that you do not want to punish your d. I just wanted to show you that when you tell her "if you lose weight we need to up your intake next week" can SOUND like punishment to an AN patient.

I think at the moment it is best reaction just to find out how to increase portions and calories on a small footprint and no choices at all if she cannot chose.
Keep feeding. There is light at the end of the tunnel.
Quote
Hendrixt
That’s good advice Tina. We just have to find a way to increase portions without placing her under unmanageable anxiety as we’re doing everything we can to increase intake in a covert way 
Quote
tina72
Have you already compared brands in the supermarket? It gave us about 300 calories extra by just changing brands of yoghurt, bread, cheese etc. to the most caloric brands.
If you could give us an example of a typical meal plan we can help with ideas where to increase calories without making the portions look much bigger 🙂.
If you increase portions slowly (for example one table spoon more every day) she will probably not recognise it. And try to trick out the eye with bigger plates, bowls and glasses, that works very well. My d really thought a big glass filled 3/4 is less then a smaller one that was full...
Keep feeding. There is light at the end of the tunnel.
Quote
Ellesmum
Good ideas from Tina, my d is doing great but I still bump up calories when I feel she needs a boost.  There may be things we do you’ve not yet thought of.
Ellesmum
Quote
scaredmom
Hendrixt,
I am sure you already know this, the anxiety fighting is part of the illness and she will have to feel it and learn to self soothe a bit. It is hard to see the anxiety at its peak and I had to learn to tolerate her distress. Truly it does not make sense that she would be upset with a bit more food and so we need to be calm, I know you are already. I am only talking from what I experienced. I would get  upset when she was upset and then I became too anxious to be effective. I had to learn that the fighting equalled terror for her. 
Some have used meds to take the edge off the anxiety with meals too and my d is on sertraline and it has been helpful.
olanzapine can help them feel less upset too at meals. It has immediate sedating properties. Unfortunately it did not work for my d and I had hoped it would.

Adding an extra tablespoon or so at meals can be less noticeable and there may still be a time that no matter what, you will have to increase portions and she will know and you and she will get through it. 
Sending my best,
i think you are doing marvellously overall with how you wish to challenge Ed!!
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)
Quote
Hendrixt
tina72 wrote:
Have you already compared brands in the supermarket? It gave us about 300 calories extra by just changing brands of yoghurt, bread, cheese etc. to the most caloric brands.
If you could give us an example of a typical meal plan we can help with ideas where to increase calories without making the portions look much bigger 🙂.
If you increase portions slowly (for example one table spoon more every day) she will probably not recognise it. And try to trick out the eye with bigger plates, bowls and glasses, that works very well. My d really thought a big glass filled 3/4 is less then a smaller one that was full...


Thanks for the offer Tina I’ll bear that in mind. My wife is a really good cook and at the moment she is quite confident that is piling as much calories as possible into the food and she’s really good at finding the brands with high content. I do think though, having got through the first 4 or 5 weeks and established a good eating routine we need to increase portion sizes. Also, up to now all the meals have had just one item so we  need to look at adding something, for example all snacks have just been a milk shake, or some nuts or a couple of cream crackers. I think, for a snack we need, say aa couple of cream crackers plus a yogurt for example. And then I think we need to add a desert to the main evening meal. So these will be obvious additions to her intake and it’s just managing the anxiety this will cause. Maybe  I’m going too fast, but, having established a good routine with virtually all meals being accepted with only the odd problem meal I thought it was time increase intake. Before our last session at CAMHS we were discussing to how do this and what to say to D about it. Our issue with the therapist is that, without telling us first, she started this conversation with D, informing her that she needed increase her intake and then stared negotiating, giving her several options of food to choose from, which massively stressed her out. We would have rather the therapist first discuss it with us so we can understand what approach she was wanting to take.
Quote
Hendrixt
Thanks Scaredmom maybe I’m going too fast - I don’t know I suppose it’s all trial and error. I just thought just one item for every meal (eg for lunch she has a sandwich and nothing else) may not be enough no matter how much we maximise the calories in that one item of food. We’ve now increased 2 of the snacks from one item to two items. So the morning snack used to be some nuts and now it is two items, eg some nuts and a small piece of malt bread and we’ve done something similar with the evening snack. She won’t budge on the afternoon snack because she mistakenly believed the therapist had said she only needed one item on that snack. She had one of the biggest melt downs ever when we presented her with 2 items for her afternoon snack - that resulted in no snack eaten and only half the evening meal eaten. I
Quote
sk8r31
Truly sounds like you are moving forward Hendrixt, though there is trial and error involved for sure.  And even when you find a strategy or system that 'works' it can all change again in a week or two.  
I will share an 'aha' moment that we had with our d while during the 5-Day UCSD program.  We thought it was helpful to give our d choices for her snack, but the team said that actually it was causing her much more anxiety, as in her brain d would be trying to figure out which items had the least calories and the distress would just ramp up.  So we began with no choices, and gradually moved to choice between 2 items for snack and finally (a couple months later) d serving herself portions and we would accept or ask her to add more.  And we did at that point allow her to make her own lunch, with a bit of oversight as to whether she needed to add a bit more spread to sandwich or had enough items in her lunch bag.

I like your idea of adding more than 1 item to a meal or snack.  The ultimate goal, after WR, is to 'normalize' eating.  So you'd want a few different items at each meal, the ability to eat out socially, and the ability to join in celebrations that involve food (birthdays, holidays, sleepovers) that include treats.
I am a 'rip the bandaid off' person, but others have more success with a 'ladder' approach to change with respect to meals and snacks.  Getting weight up at this stage should be the highest priority though, over expanding variety/number of foods.  Go with your gut; speak ahead of time with therapist if needed to help present a united front to your d.

I found that I could be very effective at being a strong advocate with the professionals when I felt calm.  And knowledge is power; projecting confidence because I had skills, tools and knowledge helped us to convince our GP to support us fully.  We ditched our therapist, and found another who was willing to collaborate.

Sending warm support,
sk8r31
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
Quote
sandie
Yes, i agree with need to add snacks/items when every calorie counts. we needed sandwich and snack for lunch eg cereal bar or crisps. It took us ages to consolidate expectation of dessert after dinner but finally got there ( and we need to keep it from slipping).
We have not done particularly well with dessert and have so far only managed petit filou (75 calorie yoghurt) or piece of fruit. I would love to be able to introduce ice-cream. We have had professionals tell us to take it one step at a time with respect to changes but i think difficult if your child is starving. And as you say, i think you will just have to judge yourself. I found and still find it useful to think about a goal for the week. Good luck.
Quote
Hendrixt
Hi Sandie,

thing is we hardly ever did desert before she became ill but obviously we’ve now got to take every opportunity to get more calories in. Funny thing is she doesn’t seem too worried about a smoothie we make which she knows is full of ice cream, although she tries to get us to limit the amount of ice cream 
Quote
Hendrixt
Hi Sandie,

thing is we hardly ever did desert before she became ill but obviously we’ve now got to take every opportunity to get more calories in. Funny thing is she doesn’t seem too worried about a smoothie we make which she knows is full of ice cream, although she tries to get us to limit the amount of ice cream
Quote
tina72
So maybe that helps a bit:
We had the "rule" that every meal must have 2-3 components and a beverage that is NOT water.
So breakfast would be porridge and some fruit and a milkshake.
Snack would be yoghurt and cookies and juice.
Lunch (big warm meal here) would be 1/4 plate meat/fish, 1/4 plate vegetable and 1/2 plate noodles, rice or potatoes (mashed or baked). Desert afterward.
Afternoon snack would be a muffin and some fruit and a milkshake.
Dinner would be 2 slices of bread or toast with cheese and bacon and a youghurt and a smoothie. Desert afterwards.

We also had desert only on Sundays before AN moved in but have now twice a day 🙂.
Here it helped to tell her that all meals must have all components of vitamins, dairy, carbohydrates and proteins (we did nt call it "fat") to have a full nurished meal and that the body needs all components of food.
Keep feeding. There is light at the end of the tunnel.
Quote
Hendrixt
tina72 wrote:
So maybe that helps a bit:
We had the "rule" that every meal must have 2-3 components and a beverage that is NOT water.
So breakfast would be porridge and some fruit and a milkshake.
Snack would be yoghurt and cookies and juice.
Lunch (big warm meal here) would be 1/4 plate meat/fish, 1/4 plate vegetable and 1/2 plate noodles, rice or potatoes (mashed or baked). Desert afterward.
Afternoon snack would be a muffin and some fruit and a milkshake.
Dinner would be 2 slices of bread or toast with cheese and bacon and a youghurt and a smoothie. Desert afterwards.

We also had desert only on Sundays before AN moved in but have now twice a day 🙂.
Here it helped to tell her that all meals must have all components of vitamins, dairy, carbohydrates and proteins (we did nt call it "fat") to have a full nurished meal and that the body needs all components of food.


god that seems so much to us. We’ve got a lot of work to do to build it up to that!!
Quote
Hendrixt
Ellesmum wrote:
Good ideas from Tina, my d is doing great but I still bump up calories when I feel she needs a boost.  There may be things we do you’ve not yet thought of.


Thanks Ellesmum I’m open to suggestions. I think at the moment we need to build on the number of components to each meal 
Quote
Ellesmum
Sorry if I’ve missed it but do you all eat together at dinner? I’m wondering if side dishes you all have might be an idea, like garlic bread with a pasta dish and you all have a slice.  It’s great she’ll have her smoothies, so much potential for extra calories there.  

I still struggle with getting d to eat ‘proper’ meals by which I mean chips with the burger things like that, although she’s pretty good when we eat out. 
Ellesmum
Quote
debra18
I did have some sort of meal plan with my daughter, gave her options of two equivalent choices and told her when I would increase food. Laura Hill has an interesting video on YouTube about the noise in their head and how meal plans and predictably helps reduce the noise. I know everyone had different experiences with this. For snack my daughter knows she has to take two items. Breakfast and dinner she had high calorie drinks. You can add many things into milkshakes and smoothies .I was honest with my daughter and I told her I would be adding more toppings so she wouldn't have to eat more. It was a statement and there was no room for negotiation.
Quote
tina72
Ellesmum wrote:
Sorry if I’ve missed it but do you all eat together at dinner? I’m wondering if side dishes you all have might be an idea


I think that is an important note by Ellesmum, it worked best here when ALL at the table ate the same. So no different plate for ED person.
To give you an idea of portion sizes, my d eats mostly the same as hubby 🙂. Without gaining any weight now as she is grown out (19).
Keep feeding. There is light at the end of the tunnel.
Quote

        

WTadmin