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

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Pyohaesoo
i have allowed my d to try eating intuitively for a few days (after 2 months of recovery) as she has always been following the meal plan. I’ve noticed she has been eating around 1800-2000 calories and has still gained 0.5kg after a week. Is this normal? What do you think is going on?
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Mamaroo
It is normal to gain 10% above what she should be. For example if someone with the same age, height, built, etc weighs 60kg, then for an AN sufferer the weight could be 66 kg. It's the body's way to make sure there is some buffer against future starvation periods. My d also gained on around 2500 calories and is probably have less now that metabolism has normalised. I've included the weight height chart for girls for you. Plot her historical data on it to find her percentile (my d is 95% for height and 90% for weight). That is where you want her to be again.
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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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mtkmbc4
I hear you asking if it’s conceivable that she gained weight on only 1,800-2,000 calories per day. First of all, 0.5 kg isn’t a whole lot. It could be water retention or just scale variation. I really wouldn’t expect many teens to be able to have sustained weight gain on only 1,800-2,000 calories, unless they are very sedentary.

How old is your daughter? Have you ruled out water loading or weights in her clothes to make it look like weight gain?
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Pyohaesoo
Thank you for both your replies. Yes, I am worried as I think it is good my d is gaining weight but I don’t want her to think that she’ll gain on such Low calories. I hope she’ll be able to eat as much as she wants without worrying. Due to it being her examination period, she is mostly staying at home and not moving around, so I would say she is sedentary. She’s 17 and I make sure she’s not water loading or hiding weights.
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Ellesmum
I’m not certain by what you mean by ‘after two months of recovery’. Do you mean you’ve had her eating for two months?   It sounds like it might be early days to hope she’d eat without worry.  
Ellesmum
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Pyohaesoo
 I see. Thank you for your answer. I’m getting more concerned as my d is now eating 1700+ calories with light exercise but has gained 1kg in a week. Is this because her metabolism is still suppressed or is it slowing down again? It does not make sense for a teenager that is 5’5 to gain weight on 1700+ calories
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Ellesmum
You might be interested here, scroll down to fluid retention  https://www.psychologytoday.com/gb/blog/hunger-artist/201110/the-physical-effects-weight-gain-after-starvation 

is it possible she has extreme hunger and is eating in secret?  
Ellesmum
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Pyohaesoo
I’m very sure she’s not eating in secret as I’m always monitoring her and I check with her what she buys outside with the corresponding amount of money she spent (on the rare times I’m not with her). However she has not been getting much sleep lately and sleeps around 5 hours per night. Is it possible this is why she is gaining weight on so Low calories 
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Mamaroo
Disrupted or even too little sleep does cause weight gain. A couple of months ago I started to suffer from insomnia again and went to bed later and later. Then I started to gain weight again despite eating and being active the same. So, I decided to go to bed early (9pm) and I returned to my normal weight very quickly.

5 hours sleep is not enough for a teenager, aim for 9 hours. Make sure she has a nice big dinner with lots of protein and fat, no electronics after dinner and a relaxing bath. Some people need a lot of protein throughout the day so that there are enough amino acids to make melatonin. Ensure there's plenty of protein in all her meals and snacks every day. 

It might be hard for her to fall asleep initially. Put on the radio to play in the background or get over the counter relaxing tablets, just ask the pharmacist. Stretching before going to bed (even during the day) will lower cortisol levels and promote better sleep.
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, thank you for the wonderful reply! I’ll take that into serious consideration. My d has been sleeping fewer hours these few days/weeks due to her examinations... she’s in the middle of a test week right now, with her exams ending on Friday. I hope she’ll get more sleep after that! 
She doesn’t have problem sleeping early, but tries to study as much as possible...
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tina72
Another idea:
Is she drinking a lot in total?
Some drink more than 3 l a day which is not healthy and they store water instead of weight in their bodys.
They often do it to fill the stomach to not feel hungry.

I do not mean water loading directly before weighings but drinking a lot through the day.
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
No, she is drinking 1 litre a day.
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Foodsupport_AUS
This is stariting to sound very concerning.worrying about her weight gain on  X food is probably not where you should be focussing your concerns. One month ago you reported she was drinking 2 litres per day, and as you pointed out you are in a hot country. If she is only drink 1 litre per day in total she is at risk of dehydration. It is also possible to gain weight from swelling related to malnutrition. What medical oversight do you have to make sure she is stable? It sounds like she may need more assessment to work out if something is going on. She should e contininuing to eat the amounts she needed to gain once refeeding got going, but also drinking more than she is.
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
Yes, I was afraid drinking too much water would make her seem like she’s ‘water loading’ in a way, and I hope she’ll gain fat instead of just water. 
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Mamaroo
I've linked an article for you. It describes the different types of processed food:
https://www.abc.net.au/news/health/2019-05-30/highly-processed-food-and-disease-risk-food-labels/11153774

Now normally, it doesn't matter what type of processed food a child needs to regain weight (my d was refed on ensures, which is highly processed), but in your case it might be a good idea to replace the ultra processed food with more natural food. If you give us what she is typically eating as meals and snacks, we might be able to help you out even more.

Another thought I had is that she could be snacking during the night, since she's sleeping so little. Look for discarded wrappers in the bin or under the bed. It might also be a good idea to spot check her school bag to see if her class mates give her snacks.
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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tina72
Pyohaesoo wrote:
Yes, I was afraid drinking too much water would make her seem like she’s ‘water loading’ in a way, and I hope she’ll gain fat instead of just water. 


Too much is dangerous (but only if it is more than 3 l in a short time) but too less is also dangerous. 1,5-2 l depending on heat would be fine.
Keep feeding. There is light at the end of the tunnel.
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Pyohaesoo
I see... she is still gaining weight on 1700 calories... while not eating any extra... she has gained another kilo since the last time we weighed her. I am extremely confused. Will not drinking enough water (1 litre a day) make her retain water? 
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Pyohaesoo
Is it possible that she’s secretly exercising so she’s gaining weight because of water retention after not exercising at all for a few months? 
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Mamaroo
I don't know about weight gain due to too much or too little water. One of the ways our treatment team tracked progress, was to measure her non writing mid arm's circumference. It was done at her weekly medical appointments along with weighing her and measuring her heart rate and blood pressure lying and standing up. Does her dr do this weekly? That is the absolute minimum health checks she needs on a weekly basis.
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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treebird
Does anyone know at what stage it is ok to discuss actual weight? My D is 2 years out of hospital for AN and after many iOS and downs, is doing well but does not have film control of her food. She still needs to gain some weight - around 8-10lbs. We would like to tell her this is what she must gain in order to play competitive hockey in the fall, leaving us only 2 months to get there. I feel like all the mystery around numbers has been justified up until now due to the disease, but wondering if it’s time to just be transparent at this stage, so we can get to the goal and stay there. She is trying 16 in September and hockey is everything to her. 
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Foodsupport_AUS
The difficult part is that we are often expecting them to be realistic and logical about this, whereas many kids can eat to maintain, it is much harder to get them to eat enough that they are gaining by themselves. It is also uncommon even in the first few years for them to agree they are "underweight". I would not raise this with her as a weight issue, rather to be playing hockey she needs to be fuelling her body well, eating all you give her, along with eating more at game time. If she can't eat what you give her (which would be enough to put on the weight) she is not well enough to play. 
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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tina72
I see it the same. In most cases it is not that easy that you tell them "you need to gain 5 kg to be able to play hockey again" and then they eat and gain that 5 kg and can do that.

So if she is still underweight no sport is possible. It is a huge challenge to get that 5 kg on in 2 months itself. If she then gains alone further on and can eat extras on days with exercise she can slowly start to do some sports but very surely not competitive ones. She will not be able to eat enough to burn so much calories for a long time. My d does only 1,5 hours dancing a week now and she has to eat an extra snack to be able to do that on these days and if she does not she cannot leave for dance class. They need to eat a lot even after WR for a long time. We are in year 3 now and my d is still eating the same amounts as during refeeding just to maintain her weight now.

At age 16 she is still growing and developing a female body and there is no target weight. She needs to keep gaining in the next years. That itself is difficult enough without any competitive sport in addition.

If you have only 2 months it is very likely she will not reach that target of 5 kg gain. What then? If you give her that carrot that she can maybe do hockey again and then when she does not reach that target, what then? It will probably feel like a big failure for her and be a set back in mood and recovery.

So to answer your question, I would not discuss weight, weight gain or intake in that state. When they are at a good weight and brain recovery started and you give slowly back control and they start to eat normal again then you can discuss these things when they realise that they are sick.
Keep feeding. There is light at the end of the tunnel.
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mommiful
I would also reconsider the possibility of weight manipulation if weight gain is proceeding with lower intake than expected.

This is something we struggled with a lot. We found it can be very difficult to detect, even when providers (including residential programs) believe they are taking the correct steps to detect it. Gowned weights are essential, but not always adequate. Weights can be hidden in places and ways that are hard to detect. Getting a urine sample and checking specific gravity is important, but not perfect. Water loading can timed. A patient with access to a scale (maybe outside of the home) can carefully increase the amount by which the weight is manipulated to give the appearance of weight gain. 

Some signs that weight manipulation might be going on: 
  • getting squirmy ("anxious") on the way to any appointment or while waiting
  • spending longer in the bathroom before leaving the house or at the doctor's office before weights
  • insisting on changing clothes or stopping at home before appointment, instead of going straight from school/activity
  • walking strangely or sitting in an unnatural position prior to appointment
  • dense objects like rolls of coins and batteries or beverages (water bottles, juice pouches) missing from their usual locations at home or found in child's room, bathroom or car 
Some ways to prevent or detect weight manipulation (beyond gowned weights and specific gravity of urine):
  • unannounced change to time of appointment (or extra weight-check), ideally with her not knowing where she's going until she's in the car
  • spontaneous weights at home--refusal to submit to spontaneous weight is equivalent of a confession (If you do this, you might want to weigh her right before or after an appointment sometime, so you can calibrate your scale to the doctor's. You might also want to keep the scale locked up somewhere.)
  • observation for 1.5+ hours before appointment with no drinks allowed
  • no bags or jackets allowed when getting changed into gown
  • change with you present, instead of alone in an exam room
  • when at the doctor's office, bathroom with door cracked and her singing or talking the whole time, so she doesn't water load after giving urine sample and voiding
  • no access to bathroom after weighing; wait at doctor's office for an hour under your observation, then redo urine sample, void and weigh again
You probably don't need to do all this at once; you could talk to the doctor about what they can facilitate and try different methods at different times. 
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scaredmom
treebird wrote:
Does anyone know at what stage it is ok to discuss actual weight? My D is 2 years out of hospital for AN and after many iOS and downs, is doing well but does not have film control of her food. She still needs to gain some weight - around 8-10lbs. We would like to tell her this is what she must gain in order to play competitive hockey in the fall, leaving us only 2 months to get there. I feel like all the mystery around numbers has been justified up until now due to the disease, but wondering if it’s time to just be transparent at this stage, so we can get to the goal and stay there. She is trying 16 in September and hockey is everything to her. 


H treebird,
I would suggest you try to increase the weight fast and not just because hockey season is coming. You have a short window until she turns 18 to get this better for her for the rest of her life. I don't think discussing and asking her to agree would be helpful. Was she playing hockey last year? and Was she ever WR? 
Do you have a proper ED specialised team for support and care? Sorry for all the questions. 
All the best,
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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treebird
She did play last year and even the season she came out of hospital. Did we do the right thing by allowing her to play? I don’t know. We had a dietician at first, but I was the one who re fed her and tracked calories and upped the intake to compensate for the activity. There were ups and downs, and I believe she was weight restored or pretty close. Since coming out of hospital two years ago, We have had her doctor, a dietician, her hockey coach, her therapist as her main support team. No one FBT trained, but we discussed with the therapist and took that overall approach.
We felt that hockey would be the most therapeutic think for her and in many ways it has, but she has grown in height and her weight has not kept up. We made her decision (along with her therapist) about 6 months ago to the give her some responsibility back for feeding herself. This turned out to be a huge mistake and she dropped about 10lbs. We took control back about 1.5 months ago, but have only managed to get a few pounds on her. She is now doing equine therapy with a counsellor and seems to be doing really well. She has taken more of an interest in herself, which was non-existent before - eyelash extensions, dying her hair, getting her nails done, etc., which I think is a good sign. She has great friends, does well in school, has a part time job.
When we have broached the subject with her about needing to be at the proper weight in order to play this season, she says she understands and will cooperate. I just think it would be so much easier to tell her she needs to gain a certain number of lbs in order to play and attain a weight of xx and maintain it. I know it’s easier said than done...am I way off base? 
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