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

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Muminhope
Hi, I am so lost now. My AN D lost 4 pounds in past 3 months which is below her minimum safe range of weight. Her doctor suggested us to add two extra items in her meals such as hummus and cream cheese. Others the Dr. told us to discuss with D’s dietician. I know only adding some hummus and cream cheese is far less than what D needs to make up her lost. Because I added 330 calories in her rice each day when she was school before covid-19. But now since she is no school all time, I am unable to add anything in her meals. I tried several times and one time she saw it. She’s so upset to me and does not trust me any more. She said only food prepares by her father she trusts in. Unfortunately H is not convinced to add any high calories in D’s meals and he really is not good at it. D said she would accept to have more intake if the meal plan is proposed by the dietician. Before the dietician responded me D search on internet and delivered me a menu which was from South London and Musley. D said the target of this menu is 0.5 kg/day. I asked my questions in this forum about this menu last week and I realized it’s so tricky. I decided to give up this menu and follow our current meal plan now. D was very upset at the beginning but finally she agreed to follow ours and accepted to take extra hummus and cream cheese. I know D is very stressful these days but I believe this is a good chance to adjust her meal plan and increase her intake in meals. Since she said only accepts if the dietician says it. I talked with the dietician and told her that I believe D needs to have more 500 calories a day now. I told her D said she’s fine to follow the Hospital ‘s nutrition guideline when she’s inpatient before. Besides, I told her D starts to sneak exercise in her room now under her lower weight. Today the dietician responded me that she considered a good way is that we should increase D’s intake slowly based on our current meals instead of more changes. I am totally lost. D’s weight is quite low. Isn’t the essential solution to deliver her more food and more calories as much as we can? I can’t convince D to take my opinions now and I do hope the dietician could give her reasons to have changes immediately. Am I wrong? Anybody has some advice? Really appreciate for all of your opinions!
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Muminhope
Sorry for one mistake I mentioned the above. The target of that menu is 0.5 kg / week gain rather than per day.
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LaraB

I totally agree that your D needs full nutrition and I get frustrated when the team want to go slower than I think is needed too. I think you are right to speak up and sounds like you will need to continue to do so to ensure your D regains weight quickly. 

It is great that she accepted hummus and cream cheese. If that is inadequate after 1 week, more needs to be added. How often do you see your team? I have started to email my team in advance setting out the actions I think we need to take. I wonder would a calorific drink for her work? Like juice. 

is there something about the plan she found that she likes- is there a way of adding in something from that menu to her meal-plan that is just for her- like the NESQUIK drinks. 

 

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MKR
Hi @Muminhope,

You are right.  Feeding her any less has lead to a weight loss and ED behaviour (secret exercise). You can tell the dietician (and your husband) that this needs to be reversed urgently now. I am sure neither you nor your husband want to go all the way back to the bad days.. 

Would your husband be OK to put together a meal using the rice and other ingredients pre-prepared (=fortofied) by you?  That way your D sees him "cook" and serve. Just an idea.

I think your D having hummus and cream cheese is great progress! Hummus has garlic and that makes it more-ish (hard to stop). So maybe just increase the portions very very gradually. Same with dinner, make the portions slightly bigger every time.

We support you @Muminhope!!
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Foodsupport_AUS
Muminhope, I am just trying to clarify - your D is eating a meal plan that was previously agreed to with a dietitian but she has lost weight because in the past you were adding extras in, is that correct? The dietitian has suggested increasing slowly from where you are at present - initially adding cream cheese and hummus? Serving sizes will of course vary and if hummus is with crackers this could be a number of hundreds of calories increase per day. 

I feel your frustration when you are not being supported by your husband and the dietitian. The opposition from your daughter's ED is of course expected. 

The need for increased intake seems to at least be agreed to. I suspect she may be much more than 4 pounds below her healthiest weight for her, but that is for later. 

So the options are to confess to all that you have been adding in to D's foods and hence the need for a much higher intake, or alternately you try the increase for a week or so and when she doesn't gain, the increase continues - without the need to hide in extras. There are definite pros to not adding in extras (without her knowledge)- so long as she can manage the required intake. I used a combination of things both with my D, but ultimately we did end up with some very large portion sizes which she knew that she needed. 
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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Enn

In your post above you said very clearly that d will only listen to the dietitian. That is perfect! My d only listened to the professionals as well. So this is where the balance of power has to switch from the dietitian to YOU!

If the doctor or the dietitian told d to eat nuts that week she did it. It was not without upset but she did it, every time. I wonder how you feel about telling this to the dietitian. You also have to tell the dietitian explicitly to give you the control. They are not with you at home with your d . You tell the dietitian what YOU want to feed her this week and the dietitian tells d that it is her idea. The dietitian should take the blame off of you. That is how it is supposed to work. For us the team told d that I knew best, that she had to eat everything I plated . When I wanted smoothies added I told the dietitian who told the doctor who told d in front of me and d had to agree. It was said like this ‘ you are doing so well and it is time to add in the smoothie three  times per week. Monday Wednesday and Friday. ‘ so that is how we started. Then it went to five days per week. That is how we did it. Then if d was upset I said ‘ well that is what the team said, so you have to have it’ 
You also mention that your d  gets to agree or not. That gives ED too much power and it does not matter how she feels about this. She has ED she will never really agree because that is ED.  

I know how hard it is to get control and go against all your old ways in of interacting with your child but for many of us it absolutely had to change. If she had cancer you would not allow her to decide not to take life saving medicine. If she had cancer we do it in the proper time frame not slow or fast but the proper way. The mindset of the parent has to change. And many of us had to become so tough and we did feel like we were becoming mean , but it is a kindness to take control. It is kindness to shorten their suffering and illness by  giving more food. Let her fight it out within herself . It is her struggle to get through . You will feel awful but I am not sure what other way to do it. I know how sad we feel for them but honestly it is only food it cannot really hurts them. Their upset is expected and I always worried if she would hate me forever. Nope that did not happen. She cannot recall all the upset she even had. I do of course. She cannot remember if I was mean to her etc... she does not remember much at all. Trust comes later, food comes first. Her lifesaving drug comes first. 

I feel you need more support for you. It should be in your hands not the team’s. Tell them that. 

I really feel for what you are going through. 

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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joanne34
I don't know if this is any use but our daughter has two bottles of 'Fortisip' - supplement milk via prescription - a day.   We found this has helped.  Initially, despite three meals with puddings and snacks in between she lost weight too.  Adding the milks seemed to just tip her over to start gaining weight.   Also, she drinks them as we have told her it is prescribed medicine from the Dr she has to have.  Each bottle is small but has 300 cals and 50% of the daily intake of various vitamins/minerals.   
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joanne34
....just to add, that is in addition to her three meals, puddings , snacks etc!
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Muminhope
[QUOTE username=LaraB userid=7074345 postid=1311682364]

I totally agree that your D needs full nutrition and I get frustrated when the team want to go slower than I think is needed too. I think you are right to speak up and sounds like you will need to continue to do so to ensure your D regains weight quickly. 

It is great that she accepted hummus and cream cheese. If that is inadequate after 1 week, more needs to be added. How often do you see your team? I have started to email my team in advance setting out the actions I think we need to take. I wonder would a calorific drink for her work? Like juice. 

is there something about the plan she found that she likes- is there a way of adding in something from that menu to her meal-plan that is just for her- like the NESQUIK drinks. 

 

Yes, she accepted to take Nesquick to replace her milk on breakfast. We visit the team every two weeks or bi-weekly earlier. Last week was our first visit to the clinics physically since February due to Covid. I am afraid she would lose more if this is inadequate during 2 weeks. I sent email to D’s dietician about my consideration and expressed my opinions which I think we should increase D’s intake significantly. But the dietician told me we should increase slowly otherwise D would feel more stressful. From my prospect, being kept under lower weight is the critical reason of stress. 
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Muminhope
[QUOTE username=MKR userid=6969228 postid=1311682495]Hi @Muminhope,

You are right.  Feeding her any less has lead to a weight loss and ED behaviour (secret exercise). You can tell the dietician (and your husband) that this needs to be reversed urgently now. I am sure neither you nor your husband want to go all the way back to the bad days.. 

Would your husband be OK to put together a meal using the rice and other ingredients pre-prepared (=fortofied) by you?  That way your D sees him "cook" and serve. Just an idea.

I think your D having hummus and cream cheese is great progress! Hummus has garlic and that makes it more-ish (hard to stop). So maybe just increase the portions very very gradually. Same with dinner, make the portions slightly bigger every time.

We support you @Muminhope@Muminhop

This is a good idea! I will think it over and talk with H.
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Muminhope
Really appreciate for all of your advice and feedbacks. I’ve got so many creative ideas. Really helpful and show me the right direction. So lucky to have you! 
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Muminhope
Muminhope, I am just trying to clarify - your D is eating a meal plan that was previously agreed to with a dietitian but she has lost weight because in the past you were adding extras in, is that correct? The dietitian has suggested increasing slowly from where you are at present - initially adding cream cheese and hummus? Serving sizes will of course vary and if hummus is with crackers this could be a number of hundreds of calories increase per day. 

I feel your frustration when you are not being supported by your husband and the dietitian. The opposition from your daughter's ED is of course expected. 

The need for increased intake seems to at least be agreed to. I suspect she may be much more than 4 pounds below her healthiest weight for her, but that is for later. 

So the options are to confess to all that you have been adding in to D's foods and hence the need for a much higher intake, or alternately you try the increase for a week or so and when she doesn't gain, the increase continues - without the need to hide in extras. There are definite pros to not adding in extras (without her knowledge)- so long as she can manage the required intake. I used a combination of things both with my D, but ultimately we did end up with some very large portion sizes which she knew that she needed. 


Yes, you’re absolutely right. I added in D’s lunch on base of meals which was presented by the dietician before. I confessed to the dietician but she said the extra intake should be happened slowly. The dietician meets D once a month. Before she meets D the physician who checked D’s weight last week told D that right now we can add two extra hummus and cream cheese in meals. The physician and dietician didn’t say the quantity of hummus and cream cheese. But D insisted that the physician told us the exact quantity, 2 tbsp hummus and 1 tbsp cream cheese. This is very tricky to me. @Enn You’re right. I need to ask for support from the team and I need to take back the control for meals at home.
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LaraB

If it were me I would lie. I would tell my D that I rang the doctor to check on portions of cream cheese and hummus and the doctor said x. X being whatever you want to serve your D. 
I am not saying that this is the best way- it is the way I would do it. 

I agree that 2 weeks is too long to stay with a nutritional plan you think is inadequate. When we have had weight loss, i have insisted on weekly weighing ( based on advice from someone on this forum).

I read an article in the newspaper yesterday that made me think. It was about solution-focussed therapy and basically what it was saying is that often when we have problems and feel hopeless, if we reflect we already know the solution and are already doing some of it and we need to do more of it. I found that a very useful way to think about problem-solving

It sounds like you know your D needs more; you know you don't want to increase slowly as this is causing more stress; you know you need the team to support you and you are already contacting them to tell them what you need; and you are thinking of different ways to increase the calories, and seeking support from others. 
Sending a hug.
Xxx

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Enn
@LaraB I did lie and told d I called the team and that they told me to add to in X. It did work.
i did call the team later and told them what happened and they always backed me up. 
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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Muminhope
LaraB wrote:

If it were me I would lie. I would tell my D that I rang the doctor to check on portions of cream cheese and hummus and the doctor said x. X being whatever you want to serve your D. 
I am not saying that this is the best way- it is the way I would do it. 

I agree that 2 weeks is too long to stay with a nutritional plan you think is inadequate. When we have had weight loss, i have insisted on weekly weighing ( based on advice from someone on this forum).

I read an article in the newspaper yesterday that made me think. It was about solution-focussed therapy and basically what it was saying is that often when we have problems and feel hopeless, if we reflect we already know the solution and are already doing some of it and we need to do more of it. I found that a very useful way to think about problem-solving

It sounds like you know your D needs more; you know you don't want to increase slowly as this is causing more stress; you know you need the team to support you and you are already contacting them to tell them what you need; and you are thinking of different ways to increase the calories, and seeking support from others. 
Sending a hug.
Xxx


Yes, you said what I am thinking now. As many parents said in this forum, the best solution is feeding and more feeding with more progress. I am so frustrated that the team(therapist/physician/dietician) told me to keep calm and increase intake slowly. I agree to keep peaceful but not agree to act slowly. They can’t provide weekly visit for D to be weighed. Currently we visit the clinics every two or three weeks. And monthly meeting with the dietician. D doesn’t accept blind weight at home. This is another challenge for me.
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