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

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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formygirl
Both my son and daughter were a bit overweight in their middle school years, which I do not think is uncommon. My son naturally grew out of it around age 16 or so and is a normal/slim weight today (age 22). My daughter developed an eating disorder at age 14, she never had her opportunity to level off and find a comfortable weight and now her target weight seems very high. I wonder why the growth curve seems to be the only way that a target weight is determined. Now at age 19, she is a bit less than 1" taller than I am, yet her target weight (according to her growth curve) is 30 pounds above what I weigh. Shouldn't other factors be used when determining target weight? 
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Enn
It really is her state and how mind is thinking about food. Not necessarily just a weight. 
My questions to you would be:
Is she restricting? Does she worry about food? Is there compulsive exercise? Does she have regular periods? All of this can be used to see how she is doing overall. 

I will find that video about state not weight for you.
i know we use and discuss getting back to their original curves. I think it is not that simple though.
I think that it is so individual and if there are no ED thoughts,  I think that is a good sign.
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
https://www.kartiniclinic.com/blog/post/setting-goal-weights/



https://tabithafarrar.com/2017/04/trouble-target-weights-anorexia-recovery-living-paycheck-paycheck/



https://tabithafarrar.com/2018/02/recovery-stories-allow-body-diversity-setting-target-weights/
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
https://www.feast-ed.org/setting-target-weights-in-eating-disorder-treatment/
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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ValentinaGermania
How is the behaviour of your d? Is there any ED behaviour left? I would also go for state, not weight. The moment they are on a good weight for their personal body for some time x the brain recovers slowly normally. And then you should see changes in behaviour and state (mood, eating, all that).
Keep feeding. There is light at the end of the tunnel.
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PurpleRain
I go by state AND weight, my daughter needed to overshoot, she is her heaviest ever but doesn't complain. It might be temporary (we are almost 4 months w/r so early stage) or she might have to stay there. I will be monitoring her state closely  it and howr it relates with percentile. She was %50 or less all her live and is now %75. We shall see
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 go by state AND weight, my daughter needed to overshoot, she is her heaviest ever but doesn't complain. It might be temporary (we are almost 4 months w/r so early stage) or she might have to stay there. I will be monitoring her state closely  it and howr it relates with percentile. She was %50 or less all her live and is now %75. We shall see.
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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HopeNZ
Hi Formygirl

As posters above have said, state of mind is the most important consideration, but pre-diagnosis growth curve is a helpful way to get an idea of where your particular child should be.  It gives you something to aim for, which is helpful as there is generally a time lag between reaching a healthy weight and the improvement in state that should follow. 

Another weight-related measure to throw into the mix is 'percentage weight for height'. It's a tool used by clinicians (in New Zealand anyway) based on populations.  So, if the average girl at age 14 in a certain population, who is x cm tall, weighs y kg, that weight is considered 100% weight for height.  At 95% weight for height an ed child probably has a few more kgs to gain, and at 105% weight for height, ie a couple of kg over, you might be comfortable that there is a small safety buffer.  This is all presuming a really good state.  The drawbacks of this measure are that it works on averages rather than individuals;  and also they are only really helpful if your child belongs to the same genetic type as the original population for each particular scale.  A clinician worth their salt should know which population the scale they are using relates to!

I think the underlying idea is that weight, however it is measured, is only one part of the picture 😊
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ValentinaGermania
Another good sign for a good weight is having regular normal periods. But not alone, only together with the other signs, as some patients do never lose their periods although very ill.
Keep feeding. There is light at the end of the tunnel.
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hardwork
HopeNZ...here in Uk weight for height is used too, well at my d's unit it is and i am finding it impossible to get the team to consider alternatives.and they only aim for 95% wr.  It sets my d weight restored weight at 49 kgs, pre ED a year ago she was 54 kg. 
She was competitive sportswoman, playing at uk youth academy for one sport and training with GB team for another...and she was not overweight or fat, she was a fit, healthy strong toned young woman. She wore a uk size 8-10 and in all ways was perfect.

aiming for 49 kgs and telling her she is WR at that point is bloody ridiculous, she is showing signs of recovery as her state is a million times better now than even a month ago, but still says things like ' when i get to 49 kgs and am 95% weight for height then i am over this ..and can go back to all sport and eat normally'

eat normally = ED saying yippee we can stop meal plan and restrict again

I can only hope that we get to 49 kgs and her state continues to improve and we get her back into school and normal life and a bit of sport and i continue to feed her at home ..i get a lot more calories in than the IP unit

I agree that historic curves are not always useful , neither are single measures like weight for height, or just a target set point.

it is a fine balancing act , looking at state of mind, thoughts around food, ability to go back to normal life, enjoy it, reduction in other ED related morbidities such as anxiety, self harm or depression, but for me i do not care what weight my d is, as long as i see her eating freely, normally, and without needing meal support, when i see that again then i will see her as in solid recovery.
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hardwork
oh and the other thing is my d was told three periods in a row = weight restored enough no matter what her weight was
she tried self harming enough to bleed and wiped it in her pants to fake a period.
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ValentinaGermania
Same stupid things here too, mine got her periods back first at BMI 17 and lost them again at BMI 19.
I wish they would tell them no target weight at all because I do not know one child where the target weight that was set was the perfect turning point.
I wish they would weight them all blind and not tell them their weight any more. So many fights we had to fight only because of that...
Keep feeding. There is light at the end of the tunnel.
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evamusby_UK
For those reading here on this "Weight for Height" (WFH) measure:
I did a few calculations, and even without choosing extreme examples, found that a clinician aiming at 100% weight for height could easily get it wrong by 10 kilos (20 pounds) compared to looking at your child's individual growth chart.

That's because Weight for Height is actually BMI for your child's sex and age.
100% Weight for Height means that your child has a BMI that is bang in the middle of the population for their sex and age (the median). (BMI is a measure of your weight relative to your height).

When clinicians tell you to aim for 100% WFH, it's like going into a shoe shop and asking for an average shoe size, hoping it will fit. When they aim for 95% WFH, they're saying it's OK to be a bit under.

I have collated many good quotes from experts exposing this nonsense.
And back to Formygirl's question, yes the experts (the good ones) say it's all a combination of things, so even an individual growth chart doesn't give all the answers.
(For one thing, there's recent research that many teens with anorexia had fallen off their weight curve as toddlers already!)
On the whole though, you are lucky, Formygirl, that clinicians may be aiming for more rather than for less -- more doesn't do any harm, whether less gets people stuck in the eating disorder.

Recovery doesn't happen just because the weight is good -- there's all the Phase 2 work to do... practicing normal life with lots of guidance and coaching.
I hope this helps a little.

Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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ValentinaGermania
I really like the picture of the shoe shop. Nobody would have that silly idea that one shoes must fit for all...
Keep feeding. There is light at the end of the tunnel.
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evamusby_UK
Thank you Tina. I think I first read that analogy from our friend Laura Collins Lyster-Mensh.
Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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sandie
Thanks @evamusby_UK I relate to the research about toddlers falling off their growth curve as that seems to have happened my D who subsequently developed AN as teen
I would be interested to read this research if you had a reference handy. 
Courage is not the absence of despair; it is rather the capacity to move ahead in spite of despair
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evamusby_UK
Here's the research, Sandie. With a list of illustrious authors:

A longitudinal study of eating behaviours in childhood and later eating disorder behaviours and diagnoses.





 

https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/longitudinal-study-of-eating-behaviours-in-childhood-and-later-eating-disorder-behaviours-and-diagnoses/5365B9ECD4A7549F49C6A7F517F83A66

 

 

Background

Eating behaviours in childhood are considered as risk factors for eating disorder behaviours and diagnoses in adolescence. However, few longitudinal studies have examined this association.

Aims

We investigated associations between childhood eating behaviours during the first ten years of life and eating disorder behaviours (binge eating, purging, fasting and excessive exercise) and diagnoses (anorexia nervosa, binge eating disorder, purging disorder and bulimia nervosa) at 16 years.

Method

Data on 4760 participants from the Avon Longitudinal Study of Parents and Children were included. Longitudinal trajectories of parent-rated childhood eating behaviours (8 time points, 1.3–9 years) were derived by latent class growth analyses. Eating disorder diagnoses were derived from self-reported, parent-reported and objectively measured anthropometric data at age 16 years. We estimated associations between childhood eating behaviours and eating disorder behaviours and diagnoses, using multivariable logistic regression models.

Results

Childhood overeating was associated with increased risk of adolescent binge eating (risk difference, 7%; 95% CI 2 to 12) and binge eating disorder (risk difference, 1%; 95% CI 0.2 to 3). Persistent undereating was associated with higher anorexia nervosa risk in adolescent girls only (risk difference, 6%; 95% CI, 0 to 12). Persistent fussy eating was associated with greater anorexia nervosa risk (risk difference, 2%; 95% CI 0 to 4).

Conclusions

Our results suggest continuities of eating behaviours into eating disorders from early life to adolescence. It remains to be determined whether childhood eating behaviours are an early manifestation of a specific phenotype or whether the mechanisms underlying this continuity are more complex. Findings have the potential to inform preventative strategies for eating disorders.

Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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sandie
Thanks. Interesting. There is so much still to learn. 
Courage is not the absence of despair; it is rather the capacity to move ahead in spite of despair
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evamusby_UK
Yes, first we'd say, "look at the growth curves before the eating disorder started", then we said, "look at least one or two years before, as the ED may have started sooner than you think", and now we have to say, look at the toddler years... The minute we think we know something, we don't. 
Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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sandie
It makes me wonder about different phenotypes of anorexia too. For example, if someone has always used restricting their eating since early childhood as a way to deal with their anxiety, then goes onto to develop anorexia, is the illness different to those who did not restrict their eating in this way till they develop anorexia? 
There may be aspects of the anorexia which are common to all but perhaps there are important differences as well. Just pondering. I have done little reading of academic articles as there has been no time!!

D’s Psychologist keeps making reference to eating having become difficult for D due to feelings, and very focussed on this rather than eating. Is this just old-fashioned or Perhaps addressing underlying anxiety at different stages is more important for some sufferers than others?
Also, we know there are differences in the course of illness. I wonder whether a young person with AN who had restricted eating in early childhood is likely to have a different course of AN or recovery path.
I appreciate that anyway each child/young person with ED is different and requires different approach although all need focus on nutritional rehabilitation.
Courage is not the absence of despair; it is rather the capacity to move ahead in spite of despair
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Foodsupport_AUS
Another option of course may be that AN is more likely to be diagnosed in those of lower weight. Those who were of higher weight, normal eaters may still develop AN but are not being picked up. I would also add that the confidence intervals mentioned for AN both go down to 0 so there is a possibility that there is no alteration in risk at all. 
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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