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

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Pyohaesoo
My d was admitted inpatient at 1.65m and 43.5kg, and eating 2500-3000 calories a day with bed rest. After 2 weeks, d discharged with a weight of 46kg, which is 2.5kg higher than admission. However, now, one week later, d gained another 2kg to become 48kg, but is moving more as she is going to school, and eating around 2000-2500 calories a day. Why is she rapidly gaining weight even though she’s eating less and moving more? Is this a bad sign that she will keep gaining?
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TouchandGo
I wouldn't worry too much, 48 kg is still underweight for her height and this type of weight gain tends to level off.

A lot of people describe having to give their kids thousands upon thousands of calories for them to gain an ounce, but obviously this isn't universal.

3kgs in two weeks and 2kg's in one week of actual weight gain on that amount of calories is virtually impossible. I suspect the cause of the issue is water retention. My D experienced for the first month or so of properly refeeding her weight shot way up but she didn't look like she had gained that much. She complained about stomach pains, bloating (that looked non-existent to me) and that she wasn't having bowel movements. After a month of that, her digestive system seemed to suddenly get moving again and the weight dropped way down. Closer to reality and still higher than it was at hospitalisation, but way lower than it had been.

Another explanation if she really doesn't look like she's gained much of anything is that she's waterloading or hiding weights before she's weighed. They can artificially bump their weight up several kilos just by drinking heaps of water before they're weighed. I'm dealing with that now, myself.

Or she might be secretly binging on ridiculous amounts of calories. Still seems too high too quick for actual weight though.

But essentially, I wouldn't worry. If nothing else is throwing up red flags I would hedge my bets on your D's body still adjusting to large quantities of food. I mentioned water retention, but digestion speed is often a lot slower in ED patients (both bulimic and anorexic) so she may have a lot of food backed up in her systems or may not be having bowel movements regularly that in turn make her measure heavier than she is.

This goes doubley so if purging or laxative abuse was a part of her ED, as stopping these behaviours leads to massive short term water retention.

Don't worry too hard about it, as it should either reverse itself or slow down on it's own. If it's still going up at the same rate in a month or so times, I would just start slowly cutting back on some of the calories. Talk to your doctor/dietitian, but probably along the lines of -100 a week till she's putting on .5 - 1 kg a week or maintaining her goal weight.
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Mamaroo
Welcome from me as well. It's great that your d has gained weight IP and is doing well at home. As TouchandGo has said, water retention could be a factor. My d was very dehydrated when admitted to IP, so a lot of her weight gain was just to replenish all her cells. Binging, water loading and hiding weights are also possible causes. Also, again as TouchandGo has said, not all children need high calories, my d gained on around 2500 calories a day. The best measure of true weight gain is to measure the mid arm circumference. This should be done at every medical appointment (which should be weekly at this stage). This can't be faked as it measures the increase in muscle. 

Weight gain is not a linear process, it's rather 2 steps forward 1 step back. Just keep an eye on increased anxiety on your d's side. As soon as visible weight gain took place, my d got a lot more anxious and started to self harm. Note that weight gain starts at the tummy and face and after several weeks (with continuous feeding) redistributes to the rest of the body. This is to ensure that the internal organs are protected in case restriction starts again.

Sending you lots of hugs 🤗🤗🤗🤗
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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Pyohaesoo
Thank you for your prompt and helpful replies! Really appreciate it. I’m glad to hear that it is normal and my d is doing well. However, my d is currently dealing with lots of anxiety as she happened to see her weight during the supposedly blind weigh in at the clinic today... 

She told me that she is afraid that her metabolism would still be suppressed since she’s back at school and moving around more but eating fewer calories... should I increase her calories to 3000 (without her knowing) to pump up her metabolism? I’m not really sure whether her metabolism has really slowed down or she’s just being too paranoid... 

But I have already considered hiding weights and water loading and has made sure it didn’t happen! I was with d the whole day today as she missed school for the appointment at the doctors.. I entered the toilet with her and we stayed at home together so I knew everything she was doing... from what I observed, she has bowel movements once every 2 days or so and sometimes complains of stomachaches/having diarrhoea... but I don’t allow her to go out by herself (ever since discharge from inpatient) so I know she doesn’t have laxatives (it was never something she knew of too). Hence I’m quite sure the weight gain is real, but I now consider it may be due to water retention after reading your replies! What do you think of this? Should my d continue to eat at this rate? Doctor did not give a specific weight target but rather said that she will be fine as long as her period returns... so I’m not too sure what weight i would let her gain to
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Foodsupport_AUS
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Doctor did not give a specific weight target but rather said that she will be fine as long as her period returns... so I’m not too sure what weight i would let her gain to


This is very concerning. It indicates your D's doctor does not have a lot of ED experience. A return of periods is a minimum weight level of physiological functioning and may not be where she needs to be for health. Some people have periods even whilst quite underweight. A few guides are she should be at or above her previous growth curve. She will likely need to be above her previous highest weight. There is good evidence that the faster someone gains weight the faster they get better, so there is no too fast weight gain, just too slow. She should therefore continue to eat at the same rate and things including usually after weight restoration. What will mostly happen is weight gain gradually slows down for the same amount of food, often close to weight restoration. 
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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Pyohaesoo
Thank you for your insights and help. I will take note of your opinion about the doctor and see what I can do. 

My d has always been in the lower end of healthy weight, at around 50-52kg (bmi 18-19). Should i make her gain till that weight and then reduce her calories? Or should I just make her continue eating 2500-3000 calories even at that weight if her period returns? Will her weight plateau on its own or do I have to reduce calories?

I am also unsure if I should make her have more than 3000 calories now that she’s in school and moving around, unlike in the hospital when she was on bed rest. Will eating 2000-2500 calories suppress her metabolism as she claims?

my d is also extremely paranoid and says that she can see herself getting fatter.. I do not see a big difference other than a little bloating, but I don’t think it’s fat. Is it possible to gain fats within merely 3 weeks? How do I convince her it is just water retention? When will she start gaining fat?
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Mamaroo
Hi, I've attached the weight / height chart for you to see what is a good weight for your d. Plot data on the chart from before she became ill and see at which percentile she is falling. My d is 90% weight and 95% height. Usually the weight and height percentiles are close to each other, see what her historical data shows you. If you don't have historical data have a look at the rest of the family, are you short and curvy or tall and lean.

You need to feed her until she is back on that percentile curve plus a bit extra as it is normal to overshoot when one was starving. In my experience I was only to reduce the calories about one year after her period has started. The body needs a lot of fuel for puberty.

As for her anxiety re weight gain, no amount of explanations is going to help. Logic does not work with fear. Just acknowledge her feelings and change the subject, for example: "I'm sorry this is so hard for you now, let's watch some cat videos". I also told my d she was not fat, over and over until whenever she got that thought in her head, she would hear my voice saying: "you're not fat". 

Look for weight gain around .5kg a week and adjust food according to her weight gain. You are already doing a great job. Take time to look after yourself as well. Click image for larger version - Name: images.png, Views: 31, Size: 66.13 KB
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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Ronson
My d never lost her period - she was unwell though.  It is an indicator but not an absolute.  She has put on 12kg and has had her period the whole time. 
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Pyohaesoo
Thank you so much! I’ll definitely take your advice and try to distract my d as much as possible. 
You mentioned that I should look for .5kg gain per week. Am I doing anything wrongly such that my d has gained 5kg over 3 weeks?
And do people usually gain more than their previous weight and stay there? I’m afraid it would be too much for d to handle
my d keeps asking me when she will start gaining fat — I don’t know either, is there a fixed time for that? So that I can mentally prepare her (or should I not)?
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Mamaroo
Inpatient weight gain is typically 1kg a week, while for an outpatient setting it is typically  0.5 kg. However you'll have weeks where there is no weight gain, and weeks where the weight gain is above average, you are very early in this journey,  so I would give this time before cutting back on calories. I think a lot of the weight gain might just be water (rehydration).

Tell your d that she's not going to get fat, I told my d that we won't make her fat, we're only going to stretch her so that she's nice and tall. Talking about fat, is just anxiety talking, no explanation would help. When my d said she had gained around her tummy and face, I told her that it was normal and that it would redistribute to the rest of her body later. All my d heard was that I said yes, you are fat. She was very distressed about that, so I went back to my "you are not fat" replies.
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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Pyohaesoo
I see... so it’s safe to say the rapid weight gain is not abnormal? When will this rapid water retention stop and when will I start to see 0.5kg gain per week? She has eaten 3000+ calories for a few days now

Its so extremely hard to understand what is going on in my d’s mind... I love her very much and want the best for her but is it bad that sometimes I give in to her food requests? She may have underlying ed reasons and I honestly do not know.
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Mamaroo
There is no firm answer to what the timeline is, each person is different. What is important is to get her back to her historical growth percentile as soon as possible.

What food requests does she have, are the changes to eliminate a food group, such as sugar, fat or meat or does she want different flavours? In general, you are in charge of her food and her job is just to eat.

Here are some resources:
Eva Musby wrote a great book and has good videos. You can find more information here on her website:
https://anorexiafamily.com
And here is an excellent video by Laura Hill:
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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Pyohaesoo
Thank you, I have watched the video and she has explained it so well. I am extremely grateful towards you!

i have tried increasing my d’s calories to 3000 from 2500 since Wednesday and I just did a blind weigh in at home and she has gained another kilo in 2 days, which gives a total of 5.5kg in 3.5 weeks. I know that weight gain is good but should I be alarmed at such a fast weight gain? 
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scaredmom

Hi there, 
The weight gain in 2 days is likely not 'real' with fluid shifts etc occurring. I would suggest weighing every week -two weeks and then see how that goes. 
Is there something you are frightened of with the weight gain?  I feel that you are very anxious about this and if she is gaining true weight and that is what is needed, I would think you would be pleased overall. I am not sure if I have misunderstood your concerns and please let me know how we can best support you.
Have you discussed this particular concern with your team? I think it would be wise to discuss with her medical team if you are worried. 
Do you have a specialized ED team? Does your d have proper/regular followup with them? 

A few questions as well:
How old is your d?
Is she eating well for you? 
Are there other issues ie exercise compulsion, behavioural or emotional, that she is struggling with? 
We all do wish to help. Please ask all the questions you have. 

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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Pyohaesoo
I am pleased with the weight gain but I am afraid that if it is too fast, my d will panic more and relapse quickly. I think a slow weight gain would be better for her mental state as I do not wish for her to return to her restrictive behaviours. 
Furthermore, I am worried as she may be gaining too fast so I’m unsure whether something unusual is happening within her body, so I would like to know what is going on and if I could help her adjust. Thank you for your concern!
my d is turning 17 this October and is eating well but still with many anorexic thoughts. No exercise compulsion as I am monitoring her constantly but lots of emotional distress which I can’t seem to help her with. 
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tina72
It is evidence based that a fast weight gain is better for recovery and that the longer it takes you only lengthen the pain.
If she has still many anorexic thoughts she really needs that weight gain for brain recovery to start. Brain recovery can only start at a good weight and it will take 6-12 months then to see progress.
Keep feeding. There is light at the end of the tunnel.
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scaredmom
So in that case, please talk to her doctors and the faster they get the weight on it is actually better. She may panic and over time that can get better. Slower gain is actually more painful as she will worry longer than is necessary, to be honest. 
The more weight my d gained the better her brain and less anxiety about many things.  
I do think if you feel something unusual is occurring, she needs to be assessed by medical personnel.
We are not doctors here and cannot speculate as to what physiological issues are at play.
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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Pyohaesoo
Thank you for your replies and sorry for being terribly ignorant. My team seems to think quite differently, probably because I’m in a different country. I have tried to discuss what my d’s target weight should be with my team but the paediatric and psychologist we see both told me that her period is the only indicator we should look at and weight is totally unimportant. I disagree with that to a certain extent as I feel that being underweight is a bad sign. They have also not shared with me that rapid weight gain is better than slow weight gain and hence, its incompetence on my part for expressing such concerns here. 
I have read some forums that say fat gain would start after 3 weeks to a month so I would know when to take note and track my d’s progress to make sure that she’s eating properly in school. I would only want to know when fat gain starts so that I can tell if she’s only maintaining her weight by water loading. 
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tina72
Periods is no ED sign any more, it was taken from the list for AN last year because it is not relyable. Some do never lose their periods, some do get them back at a very low weight (my d did on BMI 17, would that mean your team would be content with a underweight patient???). Periods is no sign for recovery, and weight is also not relyable, we go for state not weight here.
She will be at a good weight when her brain recovery starts and you see all ED behaviour slowly fade away.

There is NO rule for gaining and fat gain. ALL patients are different. It depends on too many factors. We needed 6 months to get my d (age 17 then) WR and another 4 months to see slowly changes in behaviour. About a year after WR the brain recovery was visible.
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
I wholeheartedly agree with you that just by gaining her period back does not mean she is fully recovered. I am hence slightly disappointed with my team for suggesting that... my d is now bmi of 17.8 and is getting close to a healthy weight. I hope the doctors do not assume that she is fully recovered when she reaches bmi of 18.5. Do AN patients usually get their period back at the weight that they lost it?

also, should I be letting my d make her own food choices? Nothing too extreme but she usually requests to eat slightly healthier foods, but still containing carbohydrates, proteins and fats. One example would be a sandwich from subway, with chicken, veges and mayonnaise (with drinks and cookie). I am not sure if I should force her to eat whatever I choose instead of allowing her to make decisions. Even though I feel it is important to overcome her fear of foods, I do hope she enjoys what she’s eating so I do allow her to choose at times. Is this an appropriate decision?
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tina72
No, there is no "usually" with AN patients. Some do get them back at BMI 18, some at 23.
Please tell your team that it is old fashioned treatment to think that they are recovered when periods are back. I will try to find some articles for you later when I have more time.

"my d is now bmi of 17.8 and is getting close to a healthy weight"
She might be close to me not underweight due to standards any more but that does not mean she is close to a healthy weight. Most parents saw changes at BMI 21-23 but some needed to overshoot their former weight for some time and go even to BMI 25-27 to be in good recovery. You will see and feel that when she is at a good and healthy weight. Try to find out on which weight/heigh percentile she was the rest of her life before ED moved in, that might give you an idea. Many professionals set target weights too low, that is a common mistake and they keep them sick with that, and that is sad.
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
My d’s highest weight was at around a bmi of 18.5-19... so she has always been at the lower end of healthy. Of course, I’ll try to get her to overshoot a little so she will be more stabilised first, which I feel is more important that anything else. What bmi should I aim for? 
I would like to think that I can make more responsible decisions than my team, considering what they have told me... 
thank you very much for your time spent on replying my questions!
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tina72
No thanks needed, I got help here when I needed it 🙂.
You should not aim for a fix bmi but for a change in state and mind. No ED thoughts, no ED behaviour, relaxed eating, extras and snacking without stress. That are the goals. It is not healthy when she has always been near underweight, you must make sure she has some buffer or a simple infection will throw her back to AN. AN patients must be kept on a healthy weight and are not allowed to lose weight again and get underweight again, that is biggest relapse risk. My d is in year 3 of recovery now and doing really well but she still needs to eat 3 meals 2 snacks and if she skips a meal AN thoughts are back within a few hours and she feels horrible then.
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
I see... would I be able to tell if my d is still having ed thoughts? I am worried that she may act as if she is weight restored as she is scared of gaining more weight... how do I know that she has completely recovered, without having anymore ed thoughts?
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Pyohaesoo
I see... would I be able to tell if my d is still having ed thoughts? I am worried that she may act as if she is weight restored as she is scared of gaining more weight... how do I know that she has completely recovered, without having anymore ed thoughts?
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