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

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lou7
So sorry - here comes yet another question about W/R.

First of all, a BIG THANK YOU to everyone for your posts and answers. I found this site - as most of us did - during the darkest hours of my daughter's RAN, and even though I've only been lurking around until now, the help you all have given has been immense.

My D's anorexia started two years ago when she was 12. She was always a skinny little girl, on percentile 3-10. Nobody, including me, paid any attention to this since I was the same a child, as were my sister and dad, as well as my husband (he's still that way, I'm not [smile] ) and she was a good non-fussy eater. We all love food in my family, and my daughter's RAN started by her wanting to eat more healthy than the rest of us - first went the candies, then the Friday pizza etc. Before we knew is, she barely ate at all. All of a sudden life was hell - the raging, the screaming, the compulsive exercising... She hit and scratched me & my H - you know the score. Eventually she went to a clinic for 4 months and after that we did FBT. We are a knose-knit family, and I think her motivation to get better was wanting to stay at home, and luckily she has been co-operative, acknowledging her illness. It's been six months since the release, she's 14, has BMI 18.6 and is somewhere on percentile 35-40. But most important of all, my darling D is BACK! She's the funny, witty, special, loving girl she was before this all started. Her period started (for the first time ever) 4 months ago and has been regular ever since. She goes to PE and dance classes, and still the weight has been going up. And she eats anything, including the candies and pizza! She herself is adamant that she is cured and the voice in her head is silenced.

Our therapist says we should entering Phase II. Or problem is, he's very vague about when my D will be W/R, saying "you'll know when". But we don't! To be honest, I do think we are in a good place and could be slowing down the speed of the refeeding - I am aware that her weight should be going gradually up until the early 20s - but I know many of you think that we should continue way over the minimum W/R. We just do not know where we are in that respect, given that my D was always so skinny. She looks great and feminine now. But, occasionally she says she is tired of eating so much food, and I don't know if it's her or ED talking... I mean, it IS a lot she eats! What do you think?

I feel that my question is a light-weight one since so many of you still struggle. I've been there... but as you can see, there is hope.
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Kali
Hi Lou7

First, what a wonderful job you have done to help your daughter!
The weight restoration question and when they are there fully can be a little complicated. There are a couple of ways to look at this.

First you could take a look at your daughters historical growth chart. Take a look at where she tracked right before she got ill and see what percent she tracked at then and see if she is on her growth curve.

However there can be situations where the person has always tracked a little underweight and because of that it is really hard to tell what they should weigh, and adolescence is that time where they would be filling out. From what you say it sounds as though your d. may be in that group. (My d. was also usually on the 3-10% growing up but the year right before she got ill, at 16, she was starting to fill out and in fact was at a BMI of 20.3 and suddenly shot up to about the 25%. So I think she needs to be tracking at the very least at that higher percentile instead of where she was growing up) In that case you could evaluate where she is compared to this: 100 lbs at 5 feet tall, and then add 5 lbs on for each inch above that. There are also the metropolitan life height and weight charts which give detailed breakdowns of appropriate weight ranges by small, medium or large frames, which you can google and take a look at and see how your daughter compares to that. 

Weight is one thing but state is another. Many people will still be quite ill at a BMI of 18.6. If your daughter's state is much improved that is a good sign that you are going in the right direction. My opinion is that you should keep up the refeeding and not slow down now that you are making real progress. 18.6 is only slightly above an underweight BMI. And if she has now just recently reached a "normal" BMI and is lobbying for you to reduce her food intake and complaining about having to eat so much that may be the ED speaking so don't listen to that and just keep feeding her.

Kali
Food=Love
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sahmmy
<<< "My d. was also usually on the 3-10% growing up but the year right before she got ill, at 16, she was starting to fill out and in fact was at a BMI of 20.3 and suddenly shot up to about the 25%."
That's very interesting. After plotting my d on mygrowthchart.com, the very beginnings of her symptoms (irritability/anxiety?/fatigue) began about 9 years old when her height shot from a very consistent 50%ile to 75%ile, weight shot up from 25%ile to 50%ile.

Speaking of having a BMI=18.6 and still being very ill,
check out this Dr. Hall's website
http://halls.md/met-life-ideal-weight/

Apparently, a BMI of a whopping 27.3 has the lowest mortality rate!

So this 'badge of honor' I wear in the form of a few extra pounds and some new clothes as a consequence of 3 years of heavy whipping cream, butter, whole milk, and lard in my house, may help me live longer![wave]
That's payback for the years 'lost' in this mess.

Eat! Girls! Eat!
d=18, R-AN, Generalized Anxiety Disorder. Refed at home with information gathered from this forum and lots of books. Relapsed. Refed. Relapsed. Refed. 17 sessions with an excellent individual therapist. 19 sessions with unhelpful dietician. 3 sessions of DBT (didn't like it). Psychiatrist available if needed. Prozac - fail. Lexapro - fail. 5HTP - fail. Clorazepam/Klonopin = major improvement, only used when necessary. Genomind SLC6A4 short/short - not able to process SSRI's.
d=15, lost 14 lbs in 8 months, Ped [nono]diagnosed as a crystal on a hair in the ear canal
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Dobbin
Hi Lou7
I am one of those lurkers who have also learned and continues to learn so much from the expert contributors to this site, self conscious because in comparison with many here our problems are "light weight". However, after over a year reading here and nearly two years into our RAN journey, I don't think that your question is a light weight one at all, It is THE second question, THE first question being "how do I do phase 1"!
There's good advice above on thinking about what WR might be for your daughter as well as elsewhere on the site but I'd be wary of getting fixated on a number, whether a weight, a BMI or a percentile. When your therapist says you will know when your daughter is WR, I think what he might mean is that you will know when she is ready for phase 2 and if she is running with you into phase 2, then she is probably WR (or close). My D was older than yours, just over 15 when it hit us like a train and now 17. We were 6 months bringing her up 14 kg from a BMI of 15 to nearly 19, at this stage the professionals advised us to start backing off on the food supervision, things went rapidly down hill and after several kg lost we as parents took the decision to take back responsibiliy (not sure I'd have had the confidence to do this without having read so much on this site). We ensured that she gained slowly but consistently again for another 9 months and slowly but surely we began to see the signs that she was ready for phase2. I think it is these signs which show you that she is possibly WR. It was little things for us, like pouring herself a full glass of juice one morning rather than waiting for me to do it, reaching out and taking a biscuit when the family were sitting around chatting over coffee, noticing that she continued to eat her dinner when I was distracted by her sister. Little signs that maybe she's ready to take on some independence. There are some excellent posts about this phase 2 dance and the importance of letting go so very slowly, for example if she still needs encouragement (no matter how little) to finish her crusts when with you, there is no way she will be able to eat them all up if out for a sandwich with friends. So my advice would be to keep up the good work, carry on feeding her to gain and watch her like a hawk, but watch her now for the positive signs as well as the negatives, then set about "accentuating the positives". It is all so very hard and each child and each age group can be so very different but it sounds like you are doing an excellent job.
Wishing you all the best and following on from Sahmmy, LETS EAT!
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