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

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RAWR12
In some ways I am a very happy mother - my D has started eating very well.

- D doesn't seem to care about calories that much anymore. Or at least, if she does, she doesn't show it through her eating habits.
- She eats 'junk/treats' occassionally.
- She tackled salted nuts yesterday.
- She admits feeling hungry and asks for my advice on whether she should eat something or not (e.g. how long until the next meal so she knows whether it would be best to have a snack or not).
- She is flexible with eating times.

I think she realises she needs to gain weight quite badly - the last time we checked, she was at 38.9kg / 1.61m. We didn't measure her this morning as it's the holidays and we don't want stress... besides, with her progress, we're not really worried.

But I'm a little concerned for her stomach's sake. Last night - and also at our wonderful family Christmas dinner - she ate quite a lot. I'm talking a decent meal and almost all of our roasted sweet potatoes & vegetables (an entire tray!), an entire vegetable stir-fry, plenty of stuffing, handfuls of cashew nuts, a huge asian pear, 2 shortbread biscuits, etc.

The first time round, on Christmas, I wasn't too worried, but I am starting to as I'm not sure if her stomach can handle it. She doesn't say anything, but she definitely looked a little uncomfortable this morning.

Is this normal - does anyone else have any similar experiences? Should I intervene or not?
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AnnieK_USA
RAWR, I can understand your concern. That sounds to me like a binge eating episode. My daughter started binge eating at age 18 after a long course of restricting anorexia nervosa during which time she never got fully weight restored. She has had very difficult problems with binge eating ever since, years later. In her case, she could not stop binge eating, and her resultant enormous distress led her to purging with laxatives. I am not saying that any of this would happen with your daughter, but just to let you know that it has happened for others.

I also know that men in the Minnesota Starvation Experiment back in the 1940's did some binge eating when the restriction part of the study was over, and they gained up to 10% over their previously healthy weights before then leveling off eventually. These men, however, did not have eating disorders. They Starved So That Others Be Better Fed: Remembering Ancel Keys and the Minnesota Experiment

In my opinion, just as not eating enough food in anorexia is very unhealthy, so, too, is eating way too much food. I think it is our job to structure ordered eating for our children who have EDs, and keep that structured eating in place until they have been in remission/recovery for a solid amount of time, and they have an understanding of how to keep themselves healthy. Here is the F.E.A.S.T. page about refeeding. 
http://www.feast-ed.org/TheFacts/ReFeeding.aspx
Daughter age 28, restrictive anorexia (RAN) age 11-18, then alternating RAN with binge eating disorder and bulimia with laxatives, is in remission from EDs for 3 years after finally finding effective individual therapy. Treatment continues for comorbid disorders of anxiety, ADD and depression. "Perseverance, secret of all triumphs." Victor Hugo
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papyrusUSA
RAWR,

It does sound like your daughter might benefit from the "magic plate."  In this scenario you choose, cook and plate her food and she eats it - 3 meals/2 or 3 snacks a day.  You can continue this until she is weight restored, and beyond.  This way she will learn to eat in a structured manner, and she won't be engaging in disordered eating that could complicate recovery.

Moderators, can you direct RAWR to info on doing Magic Plate...I'm not able to quickly find it on the FEAST Website.

Have you read The FACTs on the FEAST Website.  I found them very helpful.  Also, the Lock and LeGrange book, Help Your Teenager Beat an Eating Disorder, can give you a great understanding and foundation for helping your daughter.

Papyrus, Philadelphia area
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AnnieK_USA
http://www.feast-ed.org/TheFacts/TheMagicPlate.aspx

from the Around the Dinner Table Forum - Hall of FameAdvice for Phase 1: Re-feeding:

Magic Plate
Daughter age 28, restrictive anorexia (RAN) age 11-18, then alternating RAN with binge eating disorder and bulimia with laxatives, is in remission from EDs for 3 years after finally finding effective individual therapy. Treatment continues for comorbid disorders of anxiety, ADD and depression. "Perseverance, secret of all triumphs." Victor Hugo
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Disneymom
I would also be concerned.  Do you supervise after meals?  When my daughter started binge eating, she would purge due to the extreme guilt and anxiety.  I started noticing my daughter eating large amounts of food and not being concerned with the calories, even though she spent years counting calories.  Initially, I was happy as she seemed to be eating everything again.  Although, she was eating large amount of foods she was losing weight, I knew something was up.  Some of the signs of binge eating with my daughter were: eating large quantities at meals, eating left overs of her brothers plate after eating a large meal, eating very fast and eating unusual combination of foods.  She would also be constantly picking at food with her hands.
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RAWR12

AnnieK_USA wrote:
RAWR, I can understand your concern. That sounds to me like a binge eating episode. My daughter started binge eating at age 18 after a long course of restricting anorexia nervosa during which time she never got fully weight restored. She has had very difficult problems with binge eating ever since, years later. In her case, she could not stop binge eating, and her resultant enormous distress led her to purging with laxatives. I am not saying that any of this would happen with your daughter, but just to let you know that it has happened for others.

I also know that men in the Minnesota Starvation Experiment back in the 1940's did some binge eating when the restriction part of the study was over, and they gained up to 10% over their previously healthy weights before then leveling off eventually. These men, however, did not have eating disorders. They Starved So That Others Be Better Fed: Remembering Ancel Keys and the Minnesota Experiment

In my opinion, just as not eating enough food in anorexia is very unhealthy, so, too, is eating way too much food. I think it is our job to structure ordered eating for our children who have EDs, and keep that structured eating in place until they have been in remission/recovery for a solid amount of time, and they have an understanding of how to keep themselves healthy. Here is the F.E.A.S.T. page about refeeding. 
http://www.feast-ed.org/TheFacts/ReFeeding.aspx

I've read that article several times after my husband introduced it to me... after my daughter introduced it to him. It's probably another reason why I brought this up to the forum rather than taking any immediate intervention.
After the last 'binge', her eating has been stable. I think she knows how to keep herself fed now - I think it's just that when she doesn't get enough food that her behaviour returns. I notice her becoming quite anxious occassionally, but it usually gets better after she fixes herself a snack or eats a little more at a meal. I have a feeling that the binges were due to not eating enough throughout the day as when I think back to it, she was not at her brightest on either days.

papyrusUSA wrote:
RAWR,

It does sound like your daughter might benefit from the "magic plate."  In this scenario you choose, cook and plate her food and she eats it - 3 meals/2 or 3 snacks a day.  You can continue this until she is weight restored, and beyond.  This way she will learn to eat in a structured manner, and she won't be engaging in disordered eating that could complicate recovery.

Have you read The FACTs on the FEAST Website.  I found them very helpful.  Also, the Lock and LeGrange book, Help Your Teenager Beat an Eating Disorder, can give you a great understanding and foundation for helping your daughter.


Although the magic plate has been helpful for others, I don't think it would work very well in our house. It would just feel a bit awkward for all of us as it's not really how we're used to eating due to cultural reasons.

(Feel free to skip this part if you're familiar with Chinese eating habits.)

We've always let our children choose when or what they eat - before the ED, we've fed them three good meals and usually prepared them a snack in the afternoon. However, we've also always let them eat freely - they would choose what they eat and how much of it. At meal times, we would ask them what they wanted to eat - of course, being kids, this usually would be pizza or instant noodles for lunch - and as long as we could supply it, we would give it to them. If they were still hungry afterwards, then we would let them eat something else, or if they weren't then we would just let them leave the food for later. At dinner times, ever since I quite my job and have had time to cook, I would prepare quite a few dishes - usually 2 or 3 veg-based stir-fries and 1 or 2 protein based dishes. We would each have a serving of a staple food - e.g. potatoes, rice, noodles - and then we would all just share and take as much as we wanted from the other dishes at the table, then leave the left overs for another meal.

I think this picture best explains roughly what our dinner table usually looks like (the staple food is usually left in the kitchen and we would just take more if we were still hungry, leave some for another meal if we're already full):
http://farm9.staticflickr.com/8076/8311180544_10e4b1e0bf.jpg

The only times that we ever intervened with their eating were:
 - When they didn't have enough of something - usually fruit or vegetables for my son (they have never been a problem for my daughter).
 - When they were really ill or had digestive problems (e.g. for diarrhoea or when they don't eat much when they have the flu)
 - They really were eating too much (e.g. at a party). (Eating too little never was a problem until my daughter's ED).
...And even then, we never take control forcefully - we just tell them to 'eat some cucumber' or 'you're going to hurt your stomach if you eat any more'.

-----

I've read the facts and found them very useful, but thank you for the book! I will have to check if any libraries nearby have it.

Disneymom wrote:
I would also be concerned.  Do you supervise after meals?  When my daughter started binge eating, she would purge due to the extreme guilt and anxiety.  I started noticing my daughter eating large amounts of food and not being concerned with the calories, even though she spent years counting calories.  Initially, I was happy as she seemed to be eating everything again.  Although, she was eating large amount of foods she was losing weight, I knew something was up.  Some of the signs of binge eating with my daughter were: eating large quantities at meals, eating left overs of her brothers plate after eating a large meal, eating very fast and eating unusual combination of foods.  She would also be constantly picking at food with her hands.


I'm not too worried about purging after eating.
Sometimes, my daughter will go to the toilet after a meal and we would stand outside the door without her knowing - but we never hear anything.
Purging's never been a problem for us during any time of my daughter's illness - it's always been not eating enough or 'I can't eat this if I don't do xxx'.
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mec
Rawr,

This illness changes what is normal in our families, at least for a period of time. I also tried hanging on to normalcy in our home for 18 months while our d got sicker. The thing is that when a child/person has an ED, life is not normal. We were all dancing around the ED pretending to be normal in our homes, restaurants, other homes, etc when there was this huge pink elephant in the room. Sometimes it is more important to put normalcy and traditions on hold for the greater good.

Some people have succeeded without magic plate but most find that serving the food to the sufferer serves two purposes: it objectively gives them the amount and variety that need as their medicine and it reduces the anxiety that they feel about having to choose food.
21 year old daughter who was DX with RAN at 9 years old. The work of recovery is ongoing. 
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