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

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K63
Hi looking for advice, my d continues to loose weight even though she has upped her intake two weeks ago we added an extra 300 calory drink and this week we added a second one. I sit and eat all meals with her I do dinner desert and tea she has control of breakfast but I sit and eat with her. She had been doing jumping jacks but has promised therapist that they have stopped . I spend most of day except the few hours she works in a restaurant in evenings a few days a week with her. She is not gaining and in fact is still loosing a little.she wants to get back to school and says she wants to recover , some days this last 2 weeks are almost two easy so I am a bit suspicious.
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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Sotired
Hi k63,
If she is eating and not doing sleight of hand with the food into pockets,it's my feeling that she is purging in toilet and shower.they do learn to purge silently.is she resting after meals?when she is out working she will be on her feet all the time and probably exercising in her break.any time spent unsupervised at home she is doing sit ups and star jumps.the ed will make it so that she promises everything but can deliver on nothing.to give an example,my d promised on my mothers grave she wasn't purging,but she was,every day.
The illness does terrible things to them and makes them act in ways they would never do when they are well.
When is she next scheduled for blood tests?i think it's the potassium one that tells the doc if they are purging,so that one definitely needs to be done.if her money is not necessary to help run the house,I would can her job.the other thing about working in a restaurant is it takes the place of anorexics eating.they will watch others eat and that's enough for them.
Whenever it was easy ,which for us was over the summer I knew she was purging but received no back up from anyone to help so I am now always suspicious of 'easy'.my thoughts are with you as always,
Sotired42
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YogurtParfait_US
I would recommend raising the level of supervision. She probably also needs higher calorie meals and more fats. How old is she?

Sending warm support!
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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SuperMum61
Also, how much is she eating? You may not know exact calories, but is she getting 3 meals and 2-3 snacks per day in addition to the high calorie drinks? I would try to get control of breakfast too if I were you, just a thought.
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cjac16
It really does sound as though there may well be some purging going on there.  My d's AN is so devious that we need to supervise her 100% for 2 hours after every meal.  Even then I have found her throwing up into something in her room (she later takes it to the toilet to dispose of it).  And, yes, they can vomit as quietly as a mouse!
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Foodsupport_AUS
The short answer to her continuing loss is there is more outs than in. That may be purging or exercise as a loss. My D did not purge, but despite this sometimes there was very slow or poor weight gain. In reality for us the problems was always to low an intake. Dinner dessert and tea (does that mean snack?) may just not be enough of the days intake to make up for what else is happening at other times. What is she having for breakfast? Does it appear to be appropriate? Is she doing sneaky things even with this?

Your D may wish to recover but it is likely that her ED gives her a hard time whenever she is eating without supervision, frightening her into eating less than she needs to. 

In reality the only thing to do in this circumstance is increase her intake and watch vigilantly for any sign of purging. Reducing opportunities for purging is with certain ground rules is a good idea. Supervise as much as is feasible. 
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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Torie
Hi K63 - It's so hard to guess what might be going on.  As others have said, what's going in may be being purged by vomiting or exercising. On the other hand, some here have found that their ed-kids require crazy high levels of calories in order to gain - up to 6,000 per day in mamabear's d's case. Personally, I'd try for more calories and more monitoring, both.

Good luck. Pulling for you ...

xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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K63
Thanks for all advice and ideas I am watching out for all of these possibilities I have also expressed my concerns to therapist . As we have only added 2 nd nourishing drink since Thursday and won't be weighed till Thursday I will have to wait to see what happens . The therapist knows how concerned I am about the weight and getting it on quickly but she says I need to also take in to consideration that she my d will not be able to handle it psychologically if weight goes on too quickly that happened while she was ip and it really didn't work . She is stable now is observing for signs of purging as I am at home and says that she needs to be psychologically ready also to be able to keep the weight on. I am watching also in case she tries to hide food as she did this prior to admission.
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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YogurtParfait_US
Methinks better to get the weight on faster, not slower. Research I have read shows that faster weight gain is linked with better outcomes.

Sending warm support!
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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K63
It's difficult I have seen the research but when my d was ip all weight was restored but she just wanted to get rid of it when she came home . She did lose 4.5 kgs and it was difficult to stop this. She now wants to get better and even at that it's difficult to put it back on.she is 18 and is so aware of calories that's why I try to cook a lot of stuff so that she can't read and obsess about them. I would love to get the weight back on her quickly but it's so so difficult . D is being weighed tomorrow hope it will be up as she wants to go to school in September
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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YogurtParfait_US
So difficult. It sounds like you are using some good strategies to get more calories into  her. Hang in there!
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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K63
Hi all we had weigh in again yesterday no weight gain. My d is eating , still having two nutritious drinks. This is third week with only .1 kg weight gain. I have increased intake slightly each week . She is supervised fully for all,meals . I supervise for 30 mins post meals and drinks. She told me this morning she wants to get better but does not want to put on weight. She is 18 has missed a full year of school last year . She is willing to increase up a little but I want her to take another drink but she is refusing , says she will have more breakfast and bigger snacks .i don't know what to do next.
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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Sotired
Hi k63, how very disheartening,but sadly this seems really typical behaviour.our d also wants to get well with no weight gain.there are several ways round what you are currently doing for anorexia to keep a hold.
No weight gain in three weeks despite eating,means very little of what she is eating is staying in.it is very easy for anorexia to wait 30 minutes to purge,my d can sadly manage it after an hour,even two.you may need to go back to checking pockets and waistbands.exercise is always a biggie,when our d was at home full time she wasn't allowed in her room til bedtime and we supervised til she went to sleep.
Increasing portion sizes of calorie rich food is a good idea,can you be the one to get her breakfast so that she automatically gets bigger portions.ceral,toast,a milky drink...if she is truly wanting recovery,she may shout and scream a it but she will eat it-and keep it down,which is the important bit.can you use hospital admission to say if she doesn't start gaining,the hospital is where she will need to be.and gaining real weight,make it clear that you know the difference between that and water loading,where they gain and lose the same kilo week after week.for us,hospital re admission is the only thing that keeps our ds weight even sort of stable.dont be afraid to not just threaten it,but to follow through on your threat,even if it just results in an obs check.would your doc support an admission?here in NZ,they can be admitted under parental exhaustion,it's called a respite admission.if that's what you need hon,then do it.your battle is so hard with your h in hospital too that it's important for you to look after yourself.if a bed is made available for your d,take it.good luck hon,thinking of you,
Sotired42
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K63
Hi sotired I will have to observe for longer after each meal. She works short evening shifts in restaurant 7-10.30 so doesn't get any breaks . I collect her at the door and always arrive a bit early to collect her She is due to start school next week , but we are going to supervise lunch at school each day . It's difficult to fully count but she is taking in approx 2,000 calories daily, Our health insurance covers for 100 days ip admission to unit in 12 month period this has been used up as she was ip early 2015. There are no specialist ed units here except one private for over 18. The only other option is general psychiatric unit with little ed specialists staff so I am in a bit of a corner if she needs ip admission for remainder of this year .
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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Foodsupport_AUS
There are several explanations for weight not increasing. With an intake of around 2000 the most likely explanation is that it is not enough food to increase weight. Starved bodies rapidly accommodate to an increase in intake so as there is an increase in calories there is often an increase in metabolism. http://www.scienceofeds.org/2014/05/07/hypermetabolism-in-anorexia-nervosa/
Other options are that she is exercising more than you thought or purging somewhere.

To want to recover but not gain weight is incredibly common with ED. It is what keeps people trapped for years with their eating disorder. Reading blogs of those who have recovered most of them state that this was the one thing that kept them trapped with their eating disorder. Unfortunately the only way out is through the weight gain, and they need to eat enough to fuel it.
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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K63
Thanks food support-AUS, I have read about this that they need extra calories and as you have said 2,000 is probably not enough . I will try to increase again I tried today but she is resisting strongly today . Will just put it in front of her tomorrow will they an extra nutrition drink.
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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Colleen
K63, just for comparison, many parents here have refed their children on 3000-3500 cal/day.  Sometimes the body goes into hypermetabolism after a period of restriction and needs a LOT for weight gain.  Mamabear's young d needed 6000 cal/day--granted, that is really on the outer edge of normal, but it happens.

Don't expect her buy-in.  It's not necessary for recovery and it's highly unlikely to happen.  Think of it as "she can't" rather than "she won't"--she can't make rational decisions around food right now.  She needs you to do that for her.

Keep upping those cals till you see consistent gains.
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
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mamabear
Yep- 6000 for 2.5 years but my D was 11,12,13 and growing and going through puberty AND making up for lost time AND hypermetabolic. She also had a very severe exercise compulsion and required 24/7 supervision including sleeping with her for a year.

We did what we had to do. It worked. It was hell but it worked and she has been back to a " normal" kud now for a couple of years.
Persistent, consistent vigilance!
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OneToughMomma
K63,

It sounds to me like you are having a hard time getting enough food into your D.  Have you said or do you know roughly how many calories you are managing to get into her each day?

Assuming you are right about her not purging or exercising, she will need to eat more in order to get better.

From what I understand from your posts, she gets upset and resists when you add more, right?

Let me be blunt, and I'm sorry, but you just have to push through that.  She will never be able to do this herself.  She is not willing or able to gain weight on her own. That is normal, very normal for our kids.  That is what RAN is all about. They are unable to eat. We have to 'make them'. 

You can't be afraid of her Ed, you can't be afraid of feeding her, you can't be afraid of her distress, you can't be afraid of what her ED is afraid of. 

Our FBT told us that he believed there had to be confrontation in order for there to be a cure. 

My D talks about how she could never have done this on her own. How she never chose recovery, how she was 'dragged kicking and screaming'.  And that was ugly but she is well and happy now: we are teaching her to cook so she can go away to uni.

When you say D resists, what does that look like?  What do you do?  What is the outcome?

Can we help you in any way? Or am I completely off base?

xoOTM
D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
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K63
Hi thanks again i am watching diligently for exercising and purging and there don't seem to be any signs so I need to push up intake. Onetoughmomma , you asked what are signs of resisting eg evening after weigh in and no increase at snack time I offered bigger size bar, she said I am not having that , she spoke to me an ed conversation saying I already have increased to which I say I am not speaking to ed.i offered other like options refused to have them and walked out of kitchen slamming the door. I put out an extra slice of toast for breakfast and she won't eat the extra slice. My son who is home from hols was near her room and in a nonsense conversation talked her around and she came back apologised and ate her snack. She isn't in the kitchen when I cook but is in and out through it sometimes. I can't add butter as she will taste it and refuse to eat it. I had a conversation yesterday around the fact that she needs to get to above minimum healthy bmi before she will begin to heal.she is 18 and wants to recover but doesn't want to put on weight these two are not compatible . We have spoken about all this that it's not ok to be underweight for a long period of time. I appreciate any advice to help push through this as I now realise we need to up it.what do you do when they refuse. Thanks again
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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OneToughMomma
Oh, bless you K63! It's really hard, I know. It seems like you are trying so hard to talk her into making better choices and not seeing any results and that must be so frustrating for you.

I'm afraid the solution is that you have to change what you are doing. It's like Charlotte used to say (I never 'knew' her but her legacy lives on), that it's time to put your big girl pants on.

  • In order for D to get better she MUST put weight on.
  • In order for D to put weight on, she must eat more (and not purge).
  • D CANNOT eat more on her own.
  • You have to insist that she eat more.
  • Then she will get better.

It really, really is up to you. 

As long as we let our D decide how much and what to eat, she was dying.  It was a long, slow suicide and I didn't want to watch it anymore. 

So we stepped in. I'll be honest--this was the hardest thing I have ever done, and I've had a few knocks in life. But we really knew that without our help, D would have a crappy half-life and be that pathetic aging, lonely woman people talk about. (less than half of adult anorexics have married, reported in a book by Jan Norre, Stephan Van den Broucke, Walter Vandereycken). Or she would be dead.

When she refused food I would insist, saying, things like in this video, 'you need to eat this. It's going to be OK.' 'After this we can -insert fun thing-'. If she tried to get up I would block her way and try to make her stay at the table.

If my d left the table, I followed her with the food and kept saying over and over and over and over, 'This is your lunch. You need to eat your lunch.' I would follow her to her room, sit on her bed, stand outside the toilet. If she locked the doors we had the key to unlock them.

When she poured the food out I gave her more.  If she had yogurt dripping from her hair I would send her to the shower, then bring her back to the table to face another bowl of yogurt.

When she screamed at me I kept on.  When she broke the dishes we got plastic ones. When she hurt me I said, 'That's not ok. Here's your sandwich. Eat it now.'

When she threatened me I called the police and after they left I set her at the table to eat.

She said she would hate me forever and I said, 'But you will be alive, so that's OK. Eat the bar.'

She told me she would never let me see my grandchildren and I said, 'OK, but eat this so that you can have kids.'

When she ran away we said, 'You can come back as long as you are eating what we ask.'

We NEVER GAVE UP.  We never stopped. Food was her medicine and it was my job to give it to her. 

ED tried to break me but he couldn't.  All of that noise and arguing (oh, Lord, the arguing!!!) and bluster and anger and resistance was ED trying to keep my D.  And I was going to do my best not to give her up.

And now we are mostly done.  D will be moving out in 4 months to go to university.  We are so so proud of her.  She loves us very much.  She is learning to cook after years of being banned from the kitchen.  She likes food.  She makes us laugh.  She's a normal, sometimes-difficult teenager and we are all a bit battle-scarred and fragile, but we are here and she is well. And she was worth it.

Ed sucks, there is no way around that. I wish our kids could get better by themselves. I wish they liked food.  I wish they weren't so afraid of ice cream that they fall to pieces around it. I wish you didn't have to go through this. But they have ED and they need our help.

You can
  1. sneak calories into the foods that she already eats
  2. make her eat more
  3. prevent her from purging and exercising
  4. make her well

xoOTM

edited because I messed it up!


D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
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K63
Hi onetoughmomma, your post made me cry but thank you for it , as it is right now my d is about 5 kgs below very minimum healthy bmi, she is stable but looks so so thin. I know she is only surviving and she doesn't want to end up like any of these people you described and we most certainly don't want that her to have that life. I need to push it up for her she cannot make any food decisions for herself except to reduce what I want her to take in so I need to up it more and be prepared for the battle . Thanks for taking the time to post.
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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OneToughMomma
I really am sorry, K.  Sorry you are here and sorry I made you cry.  How many buckets of tears have been cried over ATDT keyboards? I've shed my share, that's for sure.

Eds are cruel, and getting our kids better requires counter-intuitive parenting and so ugly.  And so hard!

But in the end it will pay off. Right now I couldn't be prouder of our D and our family.

You can do it, too. I'm sure you can. And we will help in any way possible.

xoOTM
D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
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Elena
Sending you much love and support. Fighting an ED is one hell of a ride, made more difficult because it seems as if you are fighting the D whom you love. But you do it because you love them, if you didn't care you would shrug your shoulders and walk away. I'm afraid I agree whole heartedly with what OneToughM has said. My D hates me a fair bit of the time, but I just tell her that I'm doing my job, and my job is to get food into her no matter what.

Have you read Eva Musby's book "Anorexia and other eating disorders"? It is full of practical advice, part 3 of "Help your teenager beat an eating disorder"2nd edition by Lock and Le Grange is quite practical too.

Best wishes...
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K63
Hi all thanks for advice, weight gain .4 kgs today it's not a lot but al least it's starting to go on. She was not happy about same doesn't want to keep eating but is doing it thankfully . I will try to keep increasing the nutrition.school started today so hopefully this will keep her motivated. We are supervising ourselves as it didn't work last year with school doing it ed was too devious.
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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