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

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Yael826_
Saw our pediatrician today and she recommended we get a dietician on board our team. Our therapist a hard core FBT advocate doesn't think it's necessary for our family. We eat really healthy but are not nutty about it. I'm a nurse practitioner who works in gastroenterology and have a pretty good idea of how to pack those calories in, making 1200 calories muffin snacks, piling heavy coconut curry over piles of rice, meat and veggies. Really pushing carbs. My d however liked the idea of a dietician. She said she wanted to hear the facts about what she needs from someone other than me. Not sure that's a good thing. Is ED just wanting to focus more on food? Interested in how many of you have brought a dietician into your team?
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Mcmum
I'd agree with your therapist and indeed your own instincts.  You sound like you know exactly what to do. I'don't just say that fat is your new best friend in terms of brain recovery. 
Ed just loves overseeing food planning and preparation but its motives are all too transparent.  
I'm sure that others will be along with advice but here three snacks, three meals packed with calories has seen our son into decent recovery for now. 
The entire family is decidedly larger but very happily so!
Ed doesn't really want "the facts". Ed wants to restrict.  Best of luck with your decision.  Have faith in your gut xxx
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Mcmum
I'd say - apologies for auto correct 🙁
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Foodsupport_AUS
It is not clear to me why the dietitian was recommended. FBT is predicated on the idea that we know how to feed our children, so a dietitian is not necessarily a part of FBT care. We did use a dietitian as part of treatment but did not do FBT - one of the many families who found ED far too strong to be managed at home. The dietitians we saw were very helpful and knowledgeable about eating disorders -all were specialist trained. Things they did look at was what foods would be good to add when my D was struggling, detailing what was required. D would discuss what she was struggling with and they would suggest caloric and macronutrient equivalents that may be easier for example. They knew high energy brands of products. Most of the dietitians we saw, we also saw whilst my D was inpatient. They were well aware of the degree of mental fragility present. 
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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ValentinaGermania
Some here had a dietician but for the parents that had no idea how to get 4000 calories into normal meals. If you know that, I think you do not need one.
Be careful with your d seeing a dietitian. Your gut feeling is totally correct about that, it can really feed the ED and make herfocus more on food and the other problem is that a lot of dietitians do not know much about EDs and refeeding and focus on "healthy eating" and that is for sure NOT what you need now...
Your therapist seems to be good and know you best. As long as you get the calories in and your kid is gaining, you do not need one.

By the way, some here are for sure very interested in that 1200 calory muffin snack recipe!!! Can you post it here when you find time?
Keep feeding. There is light at the end of the tunnel.
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Enn
If your d is gaining then I see no requirement to see a dietitian from the health perspective. We used the dietitian to agree with me in order to make me look like the expert for d. It was a psychological manoeuvre. I would call the dietitian and ask her to tell d that we needed to try x that week, as d believed others in authority more than me at the beginning. So d complied as much as she could with refeeding if she felt that what I was giving her was a ‘medical necessity’. I do recall a member say that the smoothie was a medical prescription so the child had them more willingly. 
And if you ever decide to see one speak alone with them first about YOUR plans, and expectations. 
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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mamabear
Dieticians can more often than not do more harm than good. They tend to focus on numbers and amounts which is a problem as it is obviously a huge part of ED. We did not have a dietician. We never needed one. My daughter needed 6000 ( not a typo) cals a day for several years. Cream, oils, butter, pastas, creamy soups, nuts, ice cream, DAIRY- all important. HIGH FATS AND HIGH CALORIES ARE CRITICAL. I would strongly urge you to listen to your therapist. 
Persistent, consistent vigilance!
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Hendrixt
This is just our experience of a dietician. We are in CAHMS in the UK. We had been re-feeding for about five weeks and hadn’t been making much progress in terms of weight gain at all. Then on one week we had a 1.4 kg weight gain and we were overjoyed as you can understand. However in response to this our FBT therapist made an appointment for us with the dietician. I rang the therapist ahead of the appointment and asked what would be discussed with the dietician and whether it would be in the presence of our D. When the therapist said that the dietician would consider the weight gain too high and would want to discuss this with us and our D I said that we would only have any discussions with the dietician in private. The FBT therapist reluctantly agreed but said that she would record the fact that we were not following their advice.
 
We saw the dietician and she said that the weight gain was too high. We argued that we fully understood the risk of weight gain’s which are consistently high and how there is a risk (but only a risk - not definate) that this could cause anxiety, but we weren’t ready to reduce calorie intake based on one week’s weight gain. The dietician spent about an hour trying to persuade us ways to reduce calories and for our daughter to ‘eat healthily’ (too many sausages apparently 😂). Thank god we didn’t allow that conversation to happen in D’s presence. 

No doubt some people will have had a more positive experience. I would just check what the dietician is going to say in front of your D first 
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sk8r31
We are a family who suffered a lot due to the dietician's influence.  She was the person my d most 'liked' on the team, precisely because she agreed with my d about lower 'healthy weight' and undermined my concerns as a parent.  In response to my worry about d not drinking milk (or anything other than water), the RD said 'they don't drink much milk in Japan and are healthy', a totally unhelpful and unrelatable comment, but one which my d picked up on as being that she didn't need to drink milk (or smoothies...and that was a HUGE struggle).
In the end, we 'discharged' the dietician (who was the only 'game' in our small town for ED clients), and focused on what we needed to do with input from this forum.

Trust your instincts; it sounds like you have a great handle on what needs to be done to help your d move into strong recovery. 
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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mamabear
Hendrixt 

there is no no such thing as too much gain in a week. And as far as it “ causing anxiety” that is a bunch of BS. This disease has inherent anxiety. It’s part and parcel. There’s no way around it. And the ONLY way through is by pushing through the anxiety with eating. All data points to best outcomes with fast and furious gain. 
Persistent, consistent vigilance!
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Hendrixt
mamabear wrote:
Hendrixt 

there is no no such thing as too much gain in a week. And as far as it “ causing anxiety” that is a bunch of BS. This disease has inherent anxiety. It’s part and parcel. There’s no way around it. And the ONLY way through is by pushing through the anxiety with eating. All data points to best outcomes with fast and furious gain. 


Yes I agree. When we saw the dietician the argument she made about fast weight gain did seem to make sense. But we felt there would only be a small risk and how can you change your approach based on only one week so we stood our ground. Since then we have continued to feed her to get the fastest weight gain and never looked back. Just recently, for the first time, D had a melt down about her most recent weight gain (which takes her within 0.4kg of the weight she was when she first started restricting in January). We just reassured her and kept on feeding and she is still taking the food. We will keep feeding her till she is a few pounds heavier than her pre-AN weight and then keep feeding her to keep her at the weight which matches her growth curve. 

I’m glad we ignored what the dietician said about gaining weight too rapidly. As you say, it was a load of BS 😂
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ValentinaGermania
Just want to add that you aredoing REALLY great and that you have a good gut feeing what is right and what not. Keep going and get through it and your d will get better week by week.
Keep feeding. There is light at the end of the tunnel.
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teecee
I know our experience is the opposite to the above....our dietician was fab. She advised us on what portion sizes should look like (way bigger than we ever thought!!) and gave us a changing meal plan which helped us refeed and then maintain. 
Our D also stated she thought the dietician was more credible than us (even though we were educated by the dietician and regurgitated her advice - that all food is good etc and the difference between carbs and complex carbs which helped us to know what to feed when D was struggling to sleep) and needed the counter narrative against the ED voice. 
She helped us to reassure D when the ‘tummy’ appeared with her professional speak...D would not argue against her. 
You will choose what is right for your family 🙂
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graceforthemoment
I am not sure why one would not use the dietitian. The dietitian is the one that is trained to provide medical nutrition therapy, not the doctor nor the therapist. The dietitian is the expert in food, weight and everything related.  Why leave out the dietitian when this is their role?  The dietitian can guide you with what to feed, how much, and provide meal support and help with nutrition education. You should see a CEDRD.  Is the therapist a CEDS? Does the pediatrician regularly treat ED?
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Enn
graceforthemoment, 
It is unfortunate that many on the forum have had bad experiences with dietitians. Some have had great dieticians as well (we did)  Some have told the child what a serving is and so the child with ED in their minds think that that is the max portion of that food they should have. As you can see from above replies to this thread the experiences are varied. 

Of course dietitians are well trained professionals. 
Some of the experiences are well illustrated in this thread: 
https://www.aroundthedinnertable.org/post/what-would-you-like-student-dietitians-to-be-taught-about-eating-disorders-9863092?pid=1305651728&highlight=dietitian
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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Holroyd957
D
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Holroyd957
Sorry about previous post but I’m currently in a poor internet area!

Disclaimer: I am a dietitian with 10+ years experience of working in both CAMHS and adult services in the U.K.

I think the take home message here is that whoever you consult be it GP, paediatrician, therapist or dietitian make sure that they are experienced and up to date with current practice in ed or in close contact with those that are. Eating disorders are not part of most professionals general training (at least not in the U.K.) and so many will not have the experience and expertise needed unless specialists (and up to date) in this area. 
If you think it will be helpful for your daughter’s recovery for her to meet with the dietitian take her along. If you don’t then go on your own. It may be wise anyway to go on your own to the first appointment and then decide. If you are currently achieving good weight restoration with help from the FBT therapist alone then you may not need a dietitian at this point. I’m curious as to why the paediatrician thought it may be useful? Are the paediatrician and therapist in contact and providing connected, cohesive treatment?
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ValentinaGermania
I am not sure why one would not use the dietitian. The dietitian is the one that is trained to provide medical nutrition therapy, not the doctor nor the therapist. The dietitian is the expert in food, weight and everything related.  Why leave out the dietitian when this is their role?  The dietitian can guide you with what to feed, how much, and provide meal support and help with nutrition education. You should see a CEDRD.  Is the therapist a CEDS? Does the pediatrician regularly treat ED?


In a perfect ED world that would be that way. But in the normality of 2019 we experience often the opposite:
Here in Germany most dietitians know how to make people lose weight and are focused on obese people and healthy eating. I tried to work with one that told me on phone she was trained in ED. When I saw her I knew from moment one she was "trained" because she had one herself. She showed me a meal plan that was ridiculous and only fed AN. I was very glad that I did not take my d with me for that appointment.
Keep feeding. There is light at the end of the tunnel.
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Kali
Hendrixt you did the right thing; I don't think that 1.4 kg weight gain in a week is too much. When my d. was being weight restored 2.75 lbs a week was the goal. The patient is going to experience anxiety whether they gain 1kg or 1.4.

We were one family who did have positive experiences with dietitians. Although I'm not sure I see the value in a younger child meeting with a dietitian while undergoing FBT, when my d. returned to college at age 19, and was eating on her own, the dietitian served as kind of a food therapist and monitored her weight and food intake. She worked with her on her weekly diet, on the challenges of how to schedule meals within her class and homework schedule, and worked with her on increasing her portion sizes. She served as a safety net should our daughter lose too much weight, and helped us set limits to encourage my d to stay in remission; all paperwork was signed so that I could call her and ask about my d.'s weight if need be. She was essentially another voice in the village surrounding my daughter saying "eat enough in order to create a life worth living". She was knowledgeable and kind and firm. If my daughter lost weight she was very helpful in getting her to gain it back. She was trained specifically to work with eating disordered patients and worked in a team in the same hospital with the eating disorder MD my d. saw.

Kali
Food=Love
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mamabear
Graceforthemoment- 

if i I had time to type out all the horror stories I’ve heard I would be here a week. 

Ive been emailing back and forth with a few top notch dieticians asking what training is in the US etc. I even had the ED guide for dieticians sent to me. 

The average dietician gets zero training on eating disorders in school. NONE. 

If they decide to treat EDs they don’t have to get really any special certification. It’s on the job training for the most part. You could be hired right out of school to work in an ED center. 

The really truly great ones have gone above  and beyond and do their own research and learning. And even those who get trained in FBT still are not all created equal. 

Yes there are some great ones. If you have an awesome dietician- share there info far and wide!

too many are fat phobic. 

Too many don’t understand the severe hypermetabolidm of ED recovery 

too many are hung up on “ healthy eating” 

Too many focus on numbers and will talk numbers to the child. Serving sizes, calories etc.

Too many are worried about “ too much weight gain” 

Too many will tell you to back off once some magic number they think is ok is reached 

Too many do not understand it is weight AND state. 

I wish i had better news news to report on my investigation but it’s the reality. It is really the same as many doctors and therapists as well. If you get a great one- you’re pretty damn lucky. Hopefully that will continue to change as more scientific answers evolve. 
Persistent, consistent vigilance!
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Kali
I do think that as parents we need to do our homework on providers and make sure that they have the appropriate backgrounds and training to help our kids, and to speak with them first about how they work, what they focus on and how they would handle working with our kids. For example we had a lot of trouble finding outpatient psychiatrists who didn't make what I considered to be VERY unhelpful comments. We cut the psychiatrists out of the team and the eating disorder MD prescribes medication at this point instead, and that works much better because she is a specialist in ED and can look at the whole medical picture. 

Kali
Food=Love
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ValentinaGermania
I would like to add that many dietitians are not familiar with patients without any hunger cues and force them too early into intuitive eating and cannot imagine that there are patients that cannot eat intuitivly for years.
Keep feeding. There is light at the end of the tunnel.
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graceforthemoment
That is why you should see one certified by IAEDP rather than criticizing the entire field 
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debra18
By definition FBT does not use a dietician. If you have a good FBT therapist and are making progress I don't think you need one.
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ValentinaGermania
That is why you should see one certified by IAEDP rather than criticizing the entire field 


Please notice that I live in Germany and here EVERYONE can call himself a dietitian. There is no IAEDP certified member in Germany according to their webside.
Keep feeding. There is light at the end of the tunnel.
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