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

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LaraB

Hi my D is losing weight and very chaotic in eating currently.

 Has expressed interest in doing weights and making protein shakes using shop bought protein powder to build her muscles. This is ED talk which has re-emerged during weight loss. I have explained that she needs fuel to build her muscles. Has anyone used the ED desire for protein shakes to get more energy in? I considered buying protein powder but I worry about the risk of reinforcing ED thoughts around “healthy” food versus the benefit of potentially getting more energy in. 

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KLB
Is she wanting a shake as a meal replacement or in addition to normal meals and snacks? If it’s the latter I’d consider allowing it...the more calories the better and could possibly be fortified further? If she wants it to replace a proper meal I’d be saying absolutely no way. Just my two pence worth. 
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LaraB
Thanks. Probably a replacement as currently only having 1 meal and a few snacks. Right I like your certainty. Absolutely not- back to 3 meals and 3 snacks. Thanks 
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MKR
Hi @LaraB,

We have had that situation for about a year now!

My d has actually gained weight - but largely on her terms, unfortunately. She is after big muscles etc so she takes more calories but we are battling over protein shakes, lots of ED talk of course. Luckily, it has been fading.

I reiterate to my daughter that Mum's food is medicine, so it takes priority. In other words, protein powder can be extra, not replacing the meals that I prepare. Too often she has claimed she was too full to finish a meal and I had to put my foot down.

Good idea that it will be you buying the protein powder and you are in charge! If you look at the packaging, the instructions encourage use pre/ post-workout, with meals etc - too often for my liking. 

Still, from time to time we have to do a clearout of all the hidden containers of protein powder. This hoarding is strong ED behaviour.

Looks like you are good at spotting ED behaviour.
I hope the muscle building will work as an incentive while you stay firmly in control 😀
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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teecee
Protein shakes are not a replacement for meals/snacks. My D took them (and does still) after a workout. Be mindful of using natural soya based protein and not manufactured. Kids should not have creatin. Our dietician said the ones we were using were fine (SIS). 
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Enn
Given my professional background. I have significant concerns regarding protein shakes in teens (and in some adults). Athletes
or not. If they are a way to get more calories on if YOU make them and add more fat etc.. like a
smoothie that we use here is one thing but a ‘protein’ shake to build muscles I am not so sure. 
https://www.google.ca/amp/s/blog.chocchildrens.org/protein-powders-and-teens-are-they-safe/amp/
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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Enn

I am sorry @LaraB I feel it is ED. 

I did find an article about ‘protorexia’ like orthorexia but with excessive protein. 

 

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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Foodsupport_AUS
Fabulous article Enn. I like you have huge concerns about the use of protein shakes as meal replacements or to "increase muscle bulk". It is marketing with risk. 

LaraB in answer to your question I think it is probably going to far down the pandering to ED path. If she was to add in a protein shake as an "extra" meal or snack, though as per article above it should not be needed, then I would go with it. As a meal replacement I think it is pure ED. One thing of note with ED is that commonly kids with AN don't get protein malnutrition as to the ED ways of thinking protein is often the last thing to go, first fats then carbs, then restriction of protein. This to me sounds so much like AN I would be pushing back hard on three meals and three snacks. It is the old trap for parents of "at least they are eating something" which is so tempting but probably allows ED to get a greater foothold. 
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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LaraB

Thanks both. Yes article is excellent. Really helpful to have others confirm that this is pandering too far to ED. I will “push back hard” on 3 meals and 3 snacks. 

Love that phrase “pandering” to the ED and far too easy here to fall into that trap. 

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MKR
Great article! On the spot, as ever, @Enn. I will now make note of daily quantities, as well as other ingredients added.

Thank you 😀
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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LaraB

I read a bit about protorexia.  No sign of that here- just restricted disordered eating. It is quite strange.

last year, I refed largely on safe very narrow range of foods but she was never reached a good enough weight. Now, that she is sliding backwards since lockdown, she eats dinner and only eats sweet food otherwise and she is not as comfortable eating her dinner as she used to be..
She chooses pizza and cookies and even some ice cream in preference to other food. These foods that were fear foods last year have become safe foods but her intake is less than half of what it needs to be. The fact they are energy dense is preventing faster weight loss. If her weight continues to fall, I expect the range of what she will eat will narrow. And then on the other hand, she is hankering for protein shakes and building her muscles. This is an awful illness. But she more or less acknowledged her illness to me yesterday which helped me remember that she is suffering. It can be hard to remember this when constantly faced with defiance. 

Somehow need to reverse the slide. Services stepping up but I am at a loss about how to reintroduce meal-plan right now. Feels frighteningly inevitable that there will be further weight loss until we reach a point where hospitalisation starts to enter the equation. Strangely feel like an observer in this. 

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Aefw001
Hi Lara,
Two items to share: we often do use protein powder in our D.'s daily milkshake as it ups the calorie count significantly and she doesn't mind the taste, however it is not a meal replacement as it's part of her regular daily afternoon snack.  

I empathize with that sense of being an "observer" as your daughter struggles with falling down the ED rabbit hole again. Lockdown has made many things much more challenging for our family dealing with our 17 yo.  We were not keeping to a meal schedule in the same way as we did when she attended school in person.

After a big setback over the past month, we put her back on 3 meals/3 snacks Monday-Friday--meaning we have to wake her up at 8:30 a.m. and drag her to table for breakfast but she, so far, has complied with gentle encouragement and the promise that she can go back to bed immediately when she's done.  On the weekends, we let her sleep until 10:30 and then skip morning snack. We've also had to implement "pat downs" after every meal and snack which she endures but not happily (hiding food has been a big issue with her) and search her room every two days or so for any hidden food. It has been effective in the past week but requires a huge amount of our energy and we are considering residential treatment for her as we're not sure how long we can keep up this level of surveillance. Wishing you strength during these stressful times.
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PurpleRain
I let my D sleep in on weekends, but then I feed her every 2-3 hours, so we keep the 3 meals 2 snacks status all week.
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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PurpleRain
I let my D sleep in on weekends, but then I feed her every 2-3 hours, so we keep the 3 meals 2 snacks status all week.
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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Foodsupport_AUS
You have mentioned her disordered sleeping contributing to this as well. Gradually moving this and changing her timetable as well may be a way to slowly introduce her meals. One of the sleep books I used when my D was young (she had terrible patterns) suggests for teens actually increasing the day length progressively - that is moving bed time back  1-2 hours per day and moving wake up time progressively as well, then stopping when they finally get back to waking and sleeping at normal time. You may need to do this with her but hopefully then you can look at trying to get more meals in in a day as well?
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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LaraB
Thanks. We were trying to address this. She does not have a bedtime as such. Spends a huge amount of time in bed. Spends most of the night watching films and sometimes does not sleep at all at night. She may not get up until 4. Trying to impose rules around electronics did not work. The psychologist gave up trying to address her sleep for now to try to fit in meals at times she agreed but it has not worked. I am due to discuss options with the team. She will now have sessions 3 times a week including one home weighing and that step up of support will hopefully make a difference but I need to clarify with team what role they see me as playing as they have not wanted me to take control of eating for the last year to work on her motivation etc. And no that has not worked although there has been lots of learning and brain healing but weight is declining since lockdown and meal plan rejected.  She is so defiant there is no way I will be able to do FBT unless the team support this. Just to be clear, I obviously try to get her up. I bring her food to bedroom etc but she does not comply, and gets more entrenched in her refusal as I insist more. 
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MKR
Hi @LaraB,

Sounds like ED is digging its heels in.

As a small step out (just an idea, you can discard it if it doesn't suit), can you offer a protein shake ONLY at 8 am, after breakfast that you make? 

We turn off wi fi at 8.30 pm for everyone (including adults) and even that I feel is too late, because it's impossible for anyone to go straight to sleep after looking at the shimmering screen for a long time. Kids get agitated or hyper for an hour before settling, so I factor that hour in.

My other child gets to have her phone only after she has had breakfast, washed, dressed, tidied and done her (lockdown) school work. The longer she takes, the less phone time.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Kali

Hi Larab
Sorry that your daughter is struggling and you along with her.

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they have not wanted me to take control of eating for the last year to work on her motivation etc. And no that has not worked 


Your daughter's team is not doing you or her any favors by adopting this way of working with her. They do not have to see it as control, it can also be considered as support. And you know it is not working so starting a discussion with them about changing the current situation could be helpful. I know you are doing your best to feed her and that she is very resistant.

How old is your daughter?

Perhaps you can use her interest in protein drinks to get more calories into her. I can recommend one that my d. used to drink after leaving the hospital. It is made by a company called Naked and is really a smoothie with protein in it....and a calorie count of 380 a shake. They have them with different fruits, mango, bananas, tropical, etc. We used to use them as a breakfast along with a granola bar for mornings when she had to leave the house and needed a quick breakfast since one of her particular ED excuses was that she didn't have time to eat. Or maybe you could try making her a calorie laden smoothie with fruits and heavy cream and full fat yogurt and then put a little bit of protein powder in as well and let her know that you are giving her a protein shake? 

Also as someone mentioned above, I also used to get my d. up and have her have breakfast with the promise that she could go back to sleep afterwards. My d. is also currently on a crazy schedule, up most of the night and then sleeping to 12 noon. So we have breakfast at noon, lunch around 4:30-5 and dinner at 9-10.  Not ideal but it is possible to get the three meals in if you can just get her to eat them which I know you are having trouble with.

What are the consequences of her losing more weight? Will the team recommend that she go into the hospital? How long will they allow this downward trend to continue if she is clearly not getting any better?

You say that she had safe foods that she was eating last year? Can you make a menu for 3 meals a day using those foods and snacks then gradually build up the portions? It used to help if I posted the menu on the fridge for the week with breakfast lunch and dinner and a schedule, and then she knew what to expect. Another option would be for you to try going back to the meal plan she agreed to and make the food and get it ready for the two of you and then sit with her and eat it? And if she cannot do that perhaps it is time to talk about a higher level of care?

Ok so she wakes up at 4pm and then has her breakfast. That then means you can give her lunch at 8 pm and dinner at about midnight. But since you might not want to stay up that late, I would suggest trying to wake her up an hour earlier each day and try to adjust her schedule and having her breakfast ready for her. Offer her a "protein shake" which is really a fruit and cream smoothie with a little soy protein powder in it and some eggs, for example and talk about how much protein the eggs have in them since protein seems to be attractive to her. You could try finding some other foods which have protein, nuts, meat, etc and stress the protein content and make them for her. My d used to try to sleep through meal times as a way to get out of eating but when I just adjusted the schedule so that the meals were at different times and she had to eat them anyway, suddenly that didn't seem so attractive anymore. 

Just trying to throw out a few ideas since it sounds as though you are feeling stuck.

warmly,
Kali 

Food=Love
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LaraB
Thanks everyone for all your kindness and support. And Kali thank you. You are absolutely right about need to have discussion with treatment team. I have done that now and emphasised need for my support for my D and I feel heard. My D (16) will be closely monitored as she is on downwards track and has been advised that if she continues she will need hospitalisation. Wish me luck. I will try various strategies and tips that people have shared. I don’t think you can get those Naked Protein smoothies in U.K. Kali - just the ordinary ones, but faintly possible we could do something homemade. Good luck with feeding everyone today. Xxxxxxx
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