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

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I am feeling a bit lost.  Our child has been wr for 8 months.  They are 100% on their growth curve.   We continue to see behaviors every time we try to let go a bit.  Every time they fall out of range, we go out of activities and go back to monitoring and refeeding.  

Lately, they say they are trying to move on and yet even when we agree to certain communication when things aren't working, they refuse to follow through.  They want to change their meal schedule because they don't like eating so much after school.  However. they continue to toss out lunch at school.  They insist that if they could do it their way they would be fine.

They have convinced their therapist and dietitian that this is what needs to be done.  We agreed they could try it once they are back in range after 1 month of doing well (slight dip out last week after behaviors were engaged), but yet even with that agreement, they were caught tossing some lunch and not adjusting as requested.

We are tempted to let them go and try their way.  If they fail, send them to a residential program.  However, this is met with a sh threat if we do send them to residential.  There is no trust on either side and always a battle around keeping them eating as expected.  Of course they say they will adjust, but when required, they don't.  Can recite the meal plan, but yet can't follow it all the time.  Claims that we will adjust for them, but yet can't be open and honest about not being able to eat a lunch when triggered.  So, we are always fighting this circle.

We can't be present at lunch and have actually moved most of lunch back to after school, but that just makes them more uncomfortable at night with all of the food.

Any suggestions?
Hi, I've attached the Kartini meal plan sample for you. It contains a small lunch as it is not a supervised meal, so you don't have to worry if it is missed. You can add more calories at the other meal times. I would include a small snack on the way to school, that way you know she had something in when school starts. Ideally she needs to eat every couple of hours as it would keep her anxiety lower. I wonder if it is too soon to give back so much control. When lunch is missed or thrown out it is a sign that she can't be in charge of her food or meal plan and need closer supervision. 
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
As long as you see restriction and lying about food and meals not eaten there are AN thoughts alive.
I do not remember the age but be aware tjhat a child still growing (and my d even grew at age 18) is NEVER truely WR.
There might be more weight needed and/or more fat in nutrition to start brain recovery. I do not see that this has started from what you report up to now. There is still too much ED behaviour.
Keep feeding. There is light at the end of the tunnel.
Recovery from ED can take a really long time. Although your D is probably weight restored ( she may need more) it can take a long time for things to improve. The missing lunch/ throwing lunch is of great concern. Although you are trying to compensate with before and after school meals it means there are probably many hours a day when she is actually hungry and not eating. That may be contributing to her ongoing ED thoughts. Is there any way this can be changed? Coming home at lunch arranging someone to supervise report? Getting her to Skype and be supervised eating that way? 

If you were to send her to residential what are you hoping to achieve? I come from a country where residential treatment pretty much doesn't exist. Our recovery rates from AN are pretty much the same as anywhere. I can think of a lot of negatives for residential - cost, learning ED behaviours from other inpatients to start with. The main benefit I can see is supervised regular meals. The therapy that is provided may or may not help with her motivation to recover.

Is she currently having any therapy to help her address her ED thoughts and cognitions. ?CBT ? DBT 
D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
Hello.  Thank you for your input.  Yes, our child has been in IOP and intensive DBT for two months and then once a week DBT for 6 months.  They claim they are hungry in the am.  Breakfast is at 6:30 and lunch generally isn't for 6 hours.  They have asked to switch a snack to morning.  I do wonder if that is part of the reason lunch isn't always eaten.  That waiting 6 hours and feeling hungry may be tripping the thoughts so that when the time for lunch comes around, the trigger is active.  We are going to allow a morning snack for a week, monitor weight and see what happens.  They had been maintaining and are making active attempts to eat without supervision and claim they want to move past this.  If this doesn't work, I just don't know what else to try.  My only thought for residential is that it would be intensive and help focus in on what is going on without the distraction of school.  In this area there isn't much for IOP.  Last time we did IOP, we had to stay in a hotel and use FMLA during that period.  
6 hours between breakfast and lunch would create a big meltdown with a lot of ED behaviour here even after 2 years in recovery. That is way too long, their blood sugar gets too much down. There is a second breakfast needed in that case. I would give that a try.
Keep feeding. There is light at the end of the tunnel.