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

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Yael826_
Hi, my 15 year old daughter diagnosed with RED and bulemia 5/19. We have been seeing a great FBT therapist. She is fully weight restored + about five pounds. We still have not let her return to track and intense athletics since exercise nervosa was a bit part of her disorder.  I had a question about nutritionist. We've recently had some drama around food choices, portion size, amount needed. Daughter currently eating about 4-4,500 calories daily. But as soon as she does any even moderate exercise we need to increase food or weight starts to drop. Our FBT therapist finally recommended this awesome nutritionist but wants only my husband and I to consult with her and no one on one session with daughter. Her feeling is that the parent's should really be in charg,  can get input/help from nutritionist but shouldn't want to had over food authority to nutritonist. Alternatively I've had a few friends with daughters with anorexia who've said their kids found the nutritionist hugely pivotal in their recovery. The teen seemed to love the additional support and guidance from the nutritionist. I found a nutritionist with strong FBT background who has lots of inpatient and outpatient experience and has worked a lot with athletes with ED's. Any input. I would kind of like to have her on the team and have a feeling my daughter would benefit from one on one sessions.  
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Torie
For myself, I would prefer that the nutritionist just meet with us parents and not my d.  It is rare to find a nutritionist who will not say at least one stupid thing that will cause problems with re-feeding - not something I wanted to risk.  Just my opinion; your mileage may vary. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Foodsupport_AUS
I am with Torie on this one. At the very least I would be meeting with the nutritionist one on one to see how things go for a while. I would also be wary of the name nutritionist - anyone can call themselves this, but you may mean dietitian. https://nutritionsciencedegree.org/what-is-the-difference-between-a-nutritionist-and-a-dietician/  The ability of someone to engage with a dietitian of any sort I think is very dependent on the stage of recovery. We did have some great dietetic help early on from dietitians who would offer some helpful suggestions to D and myself about what else could be added in to meals - we struggled a lot early on with multiple hospitalisations. 

Later my D has been able to see a dietitian by herself - at a point where she is able to reflect more on her illness and what she needs to do to keep herself healthy. D is now 23 though. I agree good advice can help someone to see what they need to do, and we only had one dietitian contact of any concern out of 6 or so that we saw. They were all expert in eating disorders but some "got it" so much more than others. 

You mention your D still needs 4000 to 4500 to maintain weight which suggests she is fairly newly weight restored - it may be it is just too early to start to do other things, and of course there is a possibility it is not all going in?
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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ValentinaGermania
I would also follow your therapists advice (which seems to be a very good therapist) and only see the nutritionist for the parents.
It is not normal for a kid to see a nutritionist and all this talk about calories and portion sizes will only trigger her.
She should now not think about that at all. She should be sozialising with her friends and think about clothes and boys and all that 🙂.
Keep feeding. There is light at the end of the tunnel.
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Yael826_
Good advise. Thanks.
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Yael826_
This women has a great reputation in the FBT therapy community. She’s actually a RD and PHD with 3/4th of her practice specifically detected to ED, particularly athletes with ED. So I’m confident in her. Just not sure if my D needs to hear all this information. thanks for your imput
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Scaredmom2019
I think parents can be the "nutritionists " for kids. We know what they need,  how to plate, how to diversify and fortify food. Too much focus on food amounts etc with a nutritionist could have a negative effect on kiddos and have them start focusing even more on quantity and quality etc. My D saw one as part of her program for RAN but it was essentially another therapy session. In some ways, too much ED programming and people have caused my D even more "confusion" about food - the constant repetition of "how does this food FEEL" has her totally confused and unable to eat "normally".
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ValentinaGermania
Yael826_ wrote:
This women has a great reputation in the FBT therapy community. She’s actually a RD and PHD with 3/4th of her practice specifically detected to ED, particularly athletes with ED. So I’m confident in her. Just not sure if my D needs to hear all this information. thanks for your imput


I think she can be perfect for YOU. Go with your gut feelings. If you are not sure it will help your d, then why risk anything.
Keep feeding. There is light at the end of the tunnel.
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Human
The dietician at CAHMS was great. She made me team leader of food and said this in front of my daughter. She would back me up on getting certain foods and drinks into her. We did see the dietician altogether, and there was no talk of calories or portion sizes. She would actively talk to my daughter about eating, cake, crisps, chocolate and all yummy foods. If i felt i needed to talk to the dietician alone, then i would orchestrate this at the end of the appointment and my daughter would go out with her dad.  
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MKR
Human wrote:
The dietician at CAHMS was great. She made me team leader of food and said this in front of my daughter. She would back me up on getting certain foods and drinks into her. We did see the dietician altogether, and there was no talk of calories or portion sizes. She would actively talk to my daughter about eating, cake, crisps, chocolate and all yummy foods. If i felt i needed to talk to the dietician alone, then i would orchestrate this at the end of the appointment and my daughter would go out with her dad.  


Torie wrote:
It is rare to find a nutritionist who will not say at least one stupid thing that will cause problems with re-feeding - not something I wanted to risk.

Often nutritionists and dietitians say things with the best intentions - but with disastrous consequences!

We started off with a dietitian and I am grateful for the rapport she had with our D to get her eating more etc. Why wouldn't she? She was a sporty type, just what our D wanted!

However, D took her words as gospel, would resist a single mouthful more than what the dietitian suggested. More than words: pictures and charts on the office walls have been even harder to shake off, even 2 years on. 

Perhaps you can speak to the nutritionist first, check out her vocabulary (and office decor!) then insist on the cautious approach. A bit of a minefield, to be honest. Far easier to go without one...

Even our ED therapist sometimes discussed strategies right in front of our daughter. You could almost see the D's head buzzing with ideas how to get around them and trick us.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Torie
Yael826_ wrote:
Our FBT therapist finally recommended this awesome nutritionist but wants only my husband and I to consult with her and no one on one session with daughter. Her feeling is that the parent's should really be in charg,  can get input/help from nutritionist but shouldn't want to had over food authority to nutritonist.

It sounds like you have found a great FBT therapist who has done a really good job with your d and family.  Disregarding her advice about this might strain your relationship with her. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Hope42019
We started meeting with a nutritionist at the beginning of refeeding with D included in mtgs. Nutritionist did a lot of teaching with D about food needs and goals to recover but ultimately we were responsible for feeding. D was not in a state of mind to walk away from those meetings with motivation to work on recovery. She did not have rational thinking. At one of our meetings nutritionist told us we needed to increase calories and D flipped out. She slammed the door and ran out. She has not been back since and refuses to go which is fine. H and I meet with her as needed for guidance on progressing weight gain, meal plan or challenging foods. We are really the ones in charge and so we can use all the help we can get and just need to implement the changes as needed. That was our experience. Overall our nutritionist was very helpful at the beginning and now we know where we need to go with Ds food plan and challenging her behaviors. 
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Human
The dietician did say ofc the cuff ' i am not bothered if you just drink only water, as long as you are drinking'. Obviously, this is what my daughter did!!! I was sooooo cross with the dietician. Anyway, i fought and fought, with the ED and got my daughter drinking juice etc again. 
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