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strawdog
Hi All

D is doing really well after 7 months of re-feeding - BMI 20.6 and her state of mind is so much better. Our relationship is back to normal - we joke with each other and laugh together now. I am so thankful. She still has her hang ups - chocolate being a big one but we're starting to introduce more of it once a week to slowly breakdown the anxiety over it.  She scored herself 8/ 9 out of 10 where 10 is 100% her which was amazing to hear! So I was reading this article below which I found very interesting :

https://www.psychologytoday.com/gb/blog/hunger-artist/201402/recovering-anorexia-how-and-why-not-stop-halfway

In it she talks about pushing past a 'normal' BMI of 20 in order to gain full recovery. I was aware of that - perhaps that D would put on (hopefuly) more weight in the run up to full recovery and then drop down to a lower BMI after. However the BMI numbers she talks about suprised me a lot! :

Your bodyweight will stabilise without restriction – but only if you let your weight increase to where it’s meant to be. Otherwise, your still lowered metabolism will force you to keep restricting to stabilise your weight. This is your choice to make. Either you diet indefinitely to keep your BMI at, say, 20, or you let it increase to, say, 26 in the short term without restricting, and stabilise at 26 then drop back down to, say 22 or 23 (as I did) over the following months and years. Which seems like the better option?

For my D a BMI of 26 seems huge! So I wondered if anyone could share their thoughts on this - whether their D had a similar journey or whether she's way too high here
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debra18
From my experience the weight is just a number and a tool to get an idea of how much calories the child needs to gain weight or maintain weight (a growing child needs to continue gaining ). I stopped weighing my daughter. It was obvious to me when she had a problem again as she was hiding food again and behaviors changed. Luckily she was home from school and I was able to supervise to stop the hiding food and behaviors. Now she went back on a modified schedule. I did not start weighing her again because I knew how much she needed to eat . It was only the issue of watching to make sure she was eating it 
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tina72
So great to hear that you are nearly back to normal and she is doing so well.

Here we did not need to overshoot her former BMI but my d was grown out at refeeding so maybe not comparable. We did need to overshoot the professionals target weight but that was ridiculous (BMI 18,5).
State, not weight. If she is doing well now let her have a buffer for starting phase 2 and for problems in school or with friends. Listen to your gut and not to any number. If you feel she is o.k. she will be in most cases 🙂. If you feel she needs a kg more it is necessary in most cases...

I really love that you wrote that your relationship is back to normal. Can you remember how afraid you were about that a few months ago?
Keep feeding. There is light at the end of the tunnel.
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scaredmom

Well done and so happy for you that things are going well!

It really is state vs weight and how well the other ED behaviours are going and if they have been extinguished.
https://anorexiafamily.com/weight-restoration-eating-disorder/
https://www.eatingdisordertherapyla.com/are-we-setting-recovery-weights-too-low/

There was another discussion awhile ago noting that most had to get to 22  BMI  on average to see them recover well.
I think the BMI 26 she mentions is  an example to show that 20 may not be right for one person and 26 may be- for that specific person. That there is a range and that our bodies will find their own natural set point. A population "normal" is not necessarily normal for the individual. That is how I understood that article.
My d's weight did stabilize out on 4000 cal per day at the 50+th percentile for weight and she was at a great mental state.
Great job and thanks for letting us know how you are doing!

 

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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AUSSIEedfamily
Dear Strawdog,

If you look at some of my old posts about BMI you will see that BMI is a very poor measurement. Dr Rebeck Peebles did a really great pod cast with Laura Collins Lyster-Mench. Here in my home town of Perth Western Australia there are clinicians now that hardly use BMI at all. In the medical guidelines they write they describe many other measurements as more important than BMI and that not to rely soley on BMI. Those same clinicians report that they have had to admit people into hospital for critical/urgent medical stabilisation even though their BMI was 30. Please use BMI sparingly. There is also a school of thought about Set Point Therory which discusses a persons natural body setting Here is a link to some information on set point therory from a local clinic in my home town

https://www.cci.health.wa.gov.au/~/media/cci/mental%20health%20professionals/eating%20disorders/eating%20disorders%20-%20information%20sheets/eating%20disorders%20information%20sheet%20-%2024%20-%20set%20point%20theory.pdf 

Episode 21: State Not Weight featuring Dr. Rebecka Peebles
​September 25, 2017
http://www.circummensam.com/episode-21-state-not-weight-with-dr-rebecka-peebles.html


ED Dad
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Foodsupport_AUS
I think the initial basis for the "need for overshoot" comes from the Minnesota starvation experiment where the men generally did overshoot in weight by about 10% and then lost that weight again to return to their former weight. These of course were all adults without eating disorders. Where this fits with teens or children with ED is harder to see. I have yet to see a parent who thinks that an overshoot of 10% is fine and then the kid loses some weight and all is fine. So perhaps the best way forward is to make sure there is eating without restriction and see where this goes. The problem is working out what is restriction when our kids are eating huge quantities of food and slowly surely reduce back to normal levels. 
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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workingthrough
We thought s was in a good place; however, he’s been at a better and better place with more weight.

Did her height stall by chance? We noticed that s stalled in height when his weight was low. As he started to gain, he began growing - we then had to increase weight for new height. Such a cycle. Once his height appeared to be caught up, he has done best with a little more weight even still. 

We’re still learning as we go, but for s, adding weight helped immensely. He’s not at BMI 26, but I think ~22, which is high(er) for him.
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strawdog
tina72 wrote:
So great to hear that you are nearly back to normal and she is doing so well..

I really love that you wrote that your relationship is back to normal. Can you remember how afraid you were about that a few months ago?


Yes I truly believed our relationship was broken for a long time but it has come back so quickly! We went on holiday to France for a week and there was a games room at the accommodation with table football (fussball) and pool - I will always remember that room because that is where we found each other again - we played and laughed and joked and she found me as a Dad again and not an evil dictator that forced food on her and snooped on her! 
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strawdog
So perhaps the best way forward is to make sure there is eating without restriction and see where this goes. The problem is working out what is restriction when our kids are eating huge quantities of food and slowly surely reduce back to normal levels. 


This got me thinking - is she eating without restriction? The answer is mostly but not entirely. Is she eating everything she would have happily eaten before the ED - no. She still has a hangup over puddings and mostly chocolate puddings and chocolate itself. She also struggles to have something other than just water when eating out. But other than that she eats well. I've been thinking about State not Weight as well. I would say her State has massively improved in that:

1) She has had 5 periods in a row
2) Her personality has returned and our relationship is as before
3) She socialises well and is happy at college
4) She no longer googles calories in food
5) Her exercise compulsion has gone
6) She sometimes say she is hungry
7) She is able to eat at a restaurant

I would say her ED still has a hold of her in these areas:

1) She will still leave a small amount of food - in a wrapper, on her plate etc
2) She still has anxiety over eating out and struggles to have a dessert eating out
3) She still has irrational fear over eating chocolate and some puddings
4) She will still to a small extent go towards the least calorific option given choices

But she looks great - is a very curvy, full figured girl now and is probably at her pre ED weight. Impossible to tell as we don't routinely record adolescent weight in the UK so no idea what her growth curve was. So her State is good but could be better so are we saying keep going with the weight gain until 1-4 above disappears? I'm focusing on the chocolate now - I think this is just an irrational fear that has developed and I plan to slowly introduce to de-sensitise her to it. I remember reading on here that someone said they'd wished they worked on fear foods sooner as it wasn't until their D had overcome these foods that she moved on to full recovery.
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strawdog
Dear Strawdog,

If you look at some of my old posts about BMI you will see that BMI is a very poor measurement. Dr Rebeck Peebles did a really great pod cast with Laura Collins Lyster-Mench. Here in my home town of Perth Western Australia there are clinicians now that hardly use BMI at all. In the medical guidelines they write they describe many other measurements as more important than BMI and that not to rely soley on BMI. Those same clinicians report that they have had to admit people into hospital for critical/urgent medical stabilisation even though their BMI was 30. Please use BMI sparingly. There is also a school of thought about Set Point Therory which discusses a persons natural body setting Here is a link to some information on set point therory from a local clinic in my home town

https://www.cci.health.wa.gov.au/~/media/cci/mental%20health%20professionals/eating%20disorders/eating%20disorders%20-%20information%20sheets/eating%20disorders%20information%20sheet%20-%2024%20-%20set%20point%20theory.pdf 

Episode 21: State Not Weight featuring Dr. Rebecka Peebles
​September 25, 2017
http://www.circummensam.com/episode-21-state-not-weight-with-dr-rebecka-peebles.html




Hi - thanks for this. The first link doesn't work though.
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Mamaroo
strawdog wrote:

I would say her ED still has a hold of her in these areas:

1) She will still leave a small amount of food - in a wrapper, on her plate etc
2) She still has anxiety over eating out and struggles to have a dessert eating out
3) She still has irrational fear over eating chocolate and some puddings
4) She will still to a small extent go towards the least calorific option given choices


You are doing so well in just a couple of months! Well done!

1) My d still leaves last bits of food, but will eat it when I point it out.
2) Just keep on eating out, start with places which don't show calories, like family own businesses and say "today we're all getting burgers or pizzas". Do the same with desserts, but don't do them both at the same time at first. Eat at home and then go out for desserts such as ice cream. 
3) I would buy a slab of chocolate and would give each family members a couple of squares. I would give my 1 and say "just to taste". At first it got all chased around the plate, then half melted, but some got in. Rinse and repeat. You can maybe add a little bit of chocolate sauce over some ice cream, just a drop at first and then slowly increasing the amount.
4) This takes time. Try and reduce the choices until you are happy when she picks the lowest calorie one.
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
strawdog wrote:

1) She will still leave a small amount of food - in a wrapper, on her plate etc
2) She still has anxiety over eating out and struggles to have a dessert eating out
3) She still has irrational fear over eating chocolate and some puddings
4) She will still to a small extent go towards the least calorific option given choices


Sounds like a twin of mine about 6 months after WR, but all that disappered slowly about 12-18 months after WR and now 2 years after I would say it is completely gone. It takes time. Try to be patient. 😁
Keep feeding. There is light at the end of the tunnel.
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PurpleRain
oh strawdog I used to read your posts before I was able (mentally) to write my first one, I am SO HAPPY to read how well you´re doing!
we are in a similar timeline and my D is doing well too. Not fear foods left really, I am currently working on the clothes (she wears her daddy´s t-shirts and little else), I'm reading older posts about it so I now it is ED and has to go. 
Well done!
13 yo d started to eat "healthy" september 2018, she had a growth spur a bit later, followed by tummy bug. She started restricitng breakfast and school lunch in january 2019 (that we know). We are refeeding at home (succesfully I think) since the beginning of march.
I have found inner strenght, patience and compassion that i did not know I had. Never retreat, never surrender
Just keep feeding
 
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PurpleRain
A little later after reading your post (the part about you having a back to "normal" relationship with your daughter struck Ia cord) I went to get the kids from school, then back home to eat, and while I was washing the dishes and asking them to help me withit I thought: wow for the first time in months I feel like I live in my home again, with my usual kids again, it felt so normal (pre ED normal) I couldn't believe it. I have tears in my eyes now. Just for this moment I feel happy. Thanks for your update post strawdog.
13 yo d started to eat "healthy" september 2018, she had a growth spur a bit later, followed by tummy bug. She started restricitng breakfast and school lunch in january 2019 (that we know). We are refeeding at home (succesfully I think) since the beginning of march.
I have found inner strenght, patience and compassion that i did not know I had. Never retreat, never surrender
Just keep feeding
 
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tina72
PurpleRain wrote:
A little later after reading your post (the part about you having a back to "normal" relationship with your daughter struck Ia cord) I went to get the kids from school, then back home to eat, and while I was washing the dishes and asking them to help me withit I thought: wow for the first time in months I feel like I live in my home again, with my usual kids again, it felt so normal (pre ED normal) I couldn't believe it. I have tears in my eyes now. Just for this moment I feel happy. Thanks for your update post strawdog.


I am so happy to read this, this is so great that you have your life back! There will be little bumps in the road now and then but if you continue your great work it will get better with every month. You are a warrior mum!
Keep feeding. There is light at the end of the tunnel.
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strawdog
Glad all is moving forward for you too PurpleRain. We are the lucky ones - so many don't recover quickly or at all. I am thankful she came to us for help and we were able to get quick access to the Eating Disorder Team. That and the fantastic advice we all get on here as really contributed to her rate of recovery. I know there is still work to do and I will be patient tina72! 😉 
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Mamaroo
That's great PurpleRain! This illness will make one appreciate the boring, normal day stuff of life. Thanks for the update.
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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