Parents, Don’t Let Your Kids Download Kurbo!

Parents, don't let kids download Kurbo appA disclaimer: I have no vested interest in Weight Watchers’ new Kurbo app. This app will in fact create more work for me. But let me be clear: I do not want this kind of work!

I know that you mean well and are merely concerned about your child’s health, but I can assure you that Weight Watchers does not share your concern. They are a commercial enterprise interested in making money and their business model is based on preying upon insecurities.

You would only need to spend a short time in my waiting room to hear from other parents who were once like you—moderately concerned (or maybe unconcerned) about their child’s weight and happy when their child committed to “eating healthier.” The story is nearly always the same. This child has been in what I would call a larger body—you might have called them “overweight”, pediatricians might have labeled them “obese”. It starts with them giving up sweets and then progresses. They start to restrict meat and starches and exercise more. It looks healthy. Over time, some switch gets tripped, and with very little warning the kid has anorexia, a lethal mental illness.

While most cases of anorexia are triggered by dieting, unintentional weight loss can be a trigger as well. It appears that people predisposed to anorexia respond to a negative energy balance in a way that flips this switch and they cross a dieting point of no return. Many of the teens I work with have been hospitalized for life-threatening low heart rates and electrolyte imbalances.

I cannot adequately express the guilt that parents feel from having allowed their teens to start these diets. I don’t blame them. I understand the pressure they are under.

Two of my three children grew out before they grew up. They had gained the weight their bodies needed to fuel puberty and impending growth spurts. I too received the warning from my well-intentioned pediatrician about their weights and weight gain. I knew enough to ignore the implied suggestion of helping them trim down. I cringe to think what might have happened if I had followed it. My children grew just fine and became more proportional according to their genetic predisposition.

My other child was lauded by the same pediatrician for growing up before growing out. It was only years later when I plotted her growth that I realized she had totally fallen off her expected weight curve at the time the pediatrician praised her weight. Yet, I did notice that she didn’t seem to be eating enough. (For more information on the intervention I did with her, read this post.)

The Kurbo app should come with the following warning:

“This app may trigger an eating disorder
from which your child could take 22 years to recover.”

Yes, 22 years! The most rigorous longitudinal study we have of anorexia has shown that at 9 years, only 31% of individuals with anorexia nervosa had recovered. Almost 63% had recovered at 22 years. If this is the path you follow, you may be facing many long years in and out of costly treatments to help your child recover.

Incidentally, Kurbo has made my job tougher. It classifies foods as “green”, “yellow”, or “red”. “Red” foods, such as ice cream, fried chicken, and pizza are “bad” — Kurbo advises kids to avoid them.

I work with children who suffer from anorexia, may be hypermetabolic, and may require ingesting upwards of 6000 kcal per day for several years to recover. I can’t express the difficulty of convincing an anorexic child to eat highly caloric foods to recover, when they immediately parrot back all the health messages they’ve received about these foods being dangerous. It’s terribly confusing to be told that the foods they’ve learned are bad for them are in fact the medicine that will cure them. This is but one reason why we cannot take a one size fits all approach to foods.

Back in my waiting room, maybe you would hear from some of the adults with eating disorders. They might tell you that years of dieting have contributed to weight gain, weight cycling, binge eating, and misery. They will typically remember that this pattern started in childhood with a diet. Dieting disconnects people from their own internal regulatory system (as does tracking calories and exercise).

What Can Parents Do Instead?  The following advice is for parents of kids of all sizes.

I suggest teaching kids that bodies naturally come in all shapes and sizes and that body size is largely genetically determined. I recommend viewing the Poodle Science video from ASDAH. This video does a great job illustrating body diversity and the risks of subjecting everyone to a single body standard. I suggest teaching kids that fat bodies are great too. We have to make it safe for people to be fat in order to prevent and treat eating disorders. Eating disorders are a more lethal problem. Parents can avoid judging or criticizing their own or other peoples’ bodies.

I suggest giving kids access to a range of foods — prohibiting “fun” foods leads kids to overvalue and overeat them. We don’t need to label foods as good or bad. Parents can serve nutritious food as well as fun food and model that they are of equal moral value. They can also model that food is supposed to be pleasurable and offers the opportunity for social and cultural connections.

Parents can also help children to move in ways that are fun, rather than teaching that exercise is penance for eating.

For more specific advice on helping kids develop as strong intuitive eaters with healthy body images, I suggest the work of dietitian Ellyn Satter and my psychotherapist colleagues, Zoe Bisbing and Leslie Bloch, The Full Bloom Project.

To Learn More

I recommend reading the statement from the National Eating Disorders Association: NEDA Statement on Kurbo by WW App.

And also The New York Times Op-Ed by dietitian, Christy Harrison: Our Kids Do Not Need A Weight Watchers App.

 

Getting Your Teen with an Eating Disorder Ready for the First Day Back at School

Getting Your Teen with an Eating Disorder Ready for the First Day Back at School
Image by Gerhard Gellinger from Pixabay

It’s almost the first day of school and parents of students with eating disorders have additional concerns to address on top of the usual back to school frenzy. Transitions can be tough for all teens—they are especially difficult for those with eating disorders. However, there are some preparations you can make to help things go more smoothly.

If you have been supervising most meals your teen has been eating over the summer, the shift to a school day brings a significant change in schedule. A considerable portion of your teen’s day will be spent at school. You may need to increase the size of the breakfast your teen will consume before a long day away from home. Practice the breakfasts you will plan to prepare during the school year. Also be mindful that there may be less time for breakfast when you have to get your teen out the door—to ease the transition, have them practice eating within a reasonable time.

During the school day, your teen will typically need lunch and at least one snack. Now is the time to consider how you will handle these meals and snacks. If your teen is early in recovery it may be important to for them to remain under the full supervision of parents for all meals and snacks. If this is the case, you should speak to the school staff now and make arrangements. Most schools will allow a parent to come and have the teen come out and eat lunch in the car and then go back in. Other parents make arrangements for a staff person at the school (favorite teacher, school nurse) to supervise lunch. You may need to do the same thing with a morning snack. You may even consider only sending your teen for part of the school day until meals are going more smoothly.

If your teen is able to eat a meal and or snack on their own, don’t assume that doing so at school will be easy. Any change in location or schedule can increase the challenge for a teen with an eating disorder. I always suggest letting your teen know that if they can’t finish what you’ve packed, they should pack it up and bring the remainder home. It is important for you to know what they couldn’t finish so that you can add food later to make sure they don’t end up with a deficient intake which could lead to relapse. Let them know they won’t be in trouble!

Practice now with the foods you will send to school for lunch. If your teen is accustomed to hot lunches at home, have them practice eating the very foods you will pack in a school lunch to make sure they are comfortable eating those foods. I always suggest packing foods that are easiest for your teen to eat while being adequate nutritionally; save the fear foods for the meals they will be eating at home with you.

If your teen will be eating without supervision, discuss with whom they will eat. Do they have friends they feel most comfortable with? Even better if they have a friend who knows about their eating disorder and they can talk to ahead of time about making plans to eat lunch together. Encourage them to eat with friends who are good eaters.

If your teen will need to have restrictions from physical education, get a note from your treatment team and deliver it to their school.

Finally, I suggest watching closely during times of transition. This means weighing your teen regularly to guard against a significant weight change. Sometimes you can hit a bump and catching a problem early can go a long way in preventing a serious decline.

For more tips on handling your teen’s meals at school, check out Dr. Muhlheim’s book, When Your Teen Has an Eating Disorder.

Cutting Down on Food and Fitness Tracking

Cutting Down on Food and Fitness Tracking
Photo by Luke Chesser on Unsplash

Have you been tracking your food via a calorie-counting app?

Maybe you’ve been tracking your exercise through a wearable or other system. Did you know such tracking:

  • May encourage a disordered relationship with food and your body?
  • May actually be jeopardizing your health rather than helping you to monitor it?

If you’ve noticed that you’re becoming obsessive about what you eat or how you move your body, it might be a good idea to examine your relationship with any tracking devices you are using.

People may track their weights, food consumed, and workouts in the name of health. But for many people, tracking such data can actually be detrimental. Preliminary research shows that the use of MyFitnessPal can contribute to eating disorder symptoms in undergraduates (Simpson & Mazzeo, 2017), adults with eating disorders (Levinson et al., 2017) and men (Linardon and Messer, 2019).

The research is not clear about exactly why these devices can be so detrimental. In my experience working with patients with eating disorders who track, tracking cuts people off from their bodies and their own regulatory systems. People who track become reliant on objective measures and data for making decisions about how much to eat and how hard to exercise. They lose awareness of their own bodies’ signals. Perfectionistic traits may drive them to eat fewer calories, take more steps, and increase their distance or pace during a workout. Even those who don’t struggle with a diagnosable eating disorder can be negatively impacted by these tracking devices and apps, with individuals who previously had a perfectly normal relationship with food suddenly feeling completely consumed with thoughts about what they’re putting into their mouths.

This was brought home to me when working with a patient who was obsessively tracking his workout metrics. As we discussed doing a bike ride without his fitness monitor–just as an experiment to see how it felt—he argued passionately with me, with one telling objection being, “How will I know when to take a drink?” He had been timing his consumption of water according to time and distance.

I asked him the same question back:  “How will you know when to take a drink?” Hearing it from a third party, he realized how strange the question sounded and how disconnected he had become from his own body.

Similarly, patients who count calories and carefully dole out lunches of specific caloric allotments become frightened when faced with a lunch of unknown (and likely higher) caloric value. Knowing that restaurant portions are larger and more calorically dense then the meals they make at home, they ask me how they can possibly avoid overeating. And then they are amazed when they find that they are sometimes satisfied with less than the entire portion of the restaurant meal, precisely because it’s more calorically dense and satiating.

Once they are no longer eating according to self-imposed strictures, eating becomes a different experience. They gain the capacity to tune in to how they feel while eating the food, rather than just eating to completion of their allotment–and they find that their bodies tell them when to stop eating. Life without tracking can become a freeing and enjoyable experience in which you can be fully present during meals and exercise and engage with the people around you and your surroundings—having deep conversations without intrusive thoughts and becoming mesmerized by beautiful surroundings when you exercise outdoors, for example.

Our bodies are wonderful, self-regulating mechanisms. Our bodies tell us when we need to urinate or have a drink of water or when it’s time to eat and when it’s time to stop eating. When we succumb to diet or wellness culture and stop trusting our bodies and start relying on external systems to tell us when to drink or how much to eat, we become disconnected from our bodies and we lose the ability to recognize these signals.

How to Stop Tracking

If you find that you are obsessively tracking your food or workouts, I invite you to try the following experiment:

  • Fitness tracking: do one workout without your monitor. During and after your workout, rather than looking at your metrics to evaluate the workout, ask yourself instead how your body feels/felt during the movement and afterward.
  • Food tracking: eat a meal where you do not know the caloric content. Tune in to how you feel while eating it. How does it taste?

Sources

Levinson, C. A., Fewell, L., & Brosof, L. C. (2017). My Fitness Pal calorie tracker usage in the eating disorders. Eating Behaviors, 27, 14-16.

Linardon, J., & Messer, M. (2019). My fitness pal usage in men: Associations with eating disorder symptoms and psychosocial impairment. Eating Behaviors33, 13–17.

Simpson, C. C., & Mazzeo, S. E. (2017). Calorie counting and fitness tracking technology: Associations with eating disorder symptomatology. Eating Behaviors, 26, 89-92.

 

June LACPA Eating Disorder SIG

Jonna Fries, PsyDDate: Thursday, June 6, 7:30 pm

Presenter: Jonna Fries, Psy.D. 

Title: Eating Disorders in Gender and Sexual Minorities

Description:

Hegemonic masculinity, the dominant culture’s feminine and masculine ideals, homonegativity, and transnegativity collude to create a hostile environment toward those identifying as anything other than cisgender and heterosexual. This stigma makes its way through the minds of those identifying as LGBTQIA and manifests in some functional (advocacy, community building, pride, etc.) and some dysfunctional patterns, including manifesting as body image distress and EDs.

This presentation and interactive dialogue will focus on research, theory, and interventions for gender and sexual minorities with eating disorders.

Bio: Jonna Fries, Psy.D. is a psychologist with a clinical focus on diversity, trauma, and eating disorders. She is the Director of Counseling and Psychological Services at Cal State LA, adjunct faculty for The Chicago of Professional Psychology’s forensic psychology program, is an EMDR certified therapist, Approved Consultant, and Facilitator, an Integrative Body Psychotherapy Instructor, she co-facilitates iaedp’s bi-monthly consultation group, and has a private practice in the Mid-Wilshire area. Her co-edited book, Eating disorders in special populations: Medical, nutritional, and psychological treatments was published in 2018.   

Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland) or street parking

RSVP todrmuhlheim@gmail.com

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org 

Do I Need to Quit X to Stay in Recovery?

Do I Need to Quit X to Stay in Recovery?
Image by Zorro4 from Pixabay

By Carolyn Hersh, LCSW, Staff Therapist

A difficult concept in recovery is knowing when to let go of an activity or even a job that could potentially re-ignite the eating disorder. As a therapist I find myself guiding my clients towards the realization that the sport or career path they had loved so much might be the very thing that holds them back and sets them back up for relapse. It isn’t always an easy decision.

Letting go of something that may have predated the eating disorder can lead to questions as to why it cannot remain in someone’s life in recovery. Many clients in the early stages of eating disorder treatment have to face the fact that they have to stop their sports if they are trying to regain weight or are working on eliminating behaviors that could leave the body physically weak. It is no surprise that once stabilization begins there is an urge to return to previously enjoyed activities. However, returning to these activities could potentially hinder full recovery.

Sports like gymnastics, running, figure skating, wrestling, and dancing are incredibly wonderful. As a figure skater myself, I can attest there is no greater feeling than gliding over the ice. But these same sports, especially at the elite level, can be incredibly demanding on the body. Behaviors required for full recovery can go against what a coach may be preaching to athletes to be in top physical form. What is expected of top athletes could look like disordered eating and poor body mentality from an outside perspective. The eating disorder itself may take what is used to condition a top athlete and manipulate it for its own gain.

It can be difficult to find the balance between a recovered mindset and meeting the demands of a sport or career. With some of my clients in the entertainment industry, there are pressures to look a certain way and fit a mold that their bodies may not be meant to fit. It can be difficult to navigate knowing they need to eat a certain amount of times a day and then have an agent say, “Lose five pounds for this role.”

The hardest decision is when there is a realization that staying in either the sport or career is just too detrimental to your health. It is certainly not easy to walk away from something you’ve put work into. And that can also be said about your recovery. Are you willing to give up a healthy body and mind for a potential chance at a gold medal or lucrative career even if it means killing yourself along the way? I’ve worked with a client who was a dancer who recognized as she was going through treatment that going back into a dance studio would be too triggering. She knew that staring at herself in a mirror and comparing herself to her classmates would lead to restricting her meals. It wasn’t an easy decision to walk away, but she knew there was no way she was in a place to be able to dance without being triggered.

In some circumstances, you may not have to completely quit your previous passion.  You might be able to approach the activity differently. You may not be able to return to a sport as an elite athlete, but you could still engage in the activity at a more recreational level. I’ve seen some of my clients shift from being an athlete to being a coach. Actors going from television and movies to doing local theater.  Sometimes you can still do what you love but it just needs to be re-configured to fit into your recovery lifestyle. For many, it can be comforting to know they can still act or model or run, but just do it less intensively.

You may also have the option of challenging what a sport or career emphasizes as far as body image and diet pressures. There are many models and actors who are embracing bigger bodies and not letting the pressures to lose weight define them. With this option, there is a risk of rejection along the way as we do still live in a culture that overvalues thinness. With that being said, this may be a safe option primarily for those who feel stable in recovery and are able to actively use coping skills to fight urges. If your recovery has reached a place of advocacy this definitely could be a path to take.

Leaving a passion behind or re-defining how it fits into your life can be a huge change. You may feel sad or mad. That’s okay. Ultimately, the decision you make will be the one that supports you in your recovery. If staying in the activity is going to trigger calorie counting, weekly weigh-ins or criticism for not looking a certain way, is it worth it? If you know where the eating disorder thrives then why play with fire? Ultimately, the decision will be based on what will make you healthy and happy and not allow you to compromise with the eating disorder.

May 2019 Eating Disorder SIG event

Jonna Fries, Ph.D.Date: Thursday, June 6, 7:30 pm

Presenter: Jonna Fries, Psy.D. 

Title: Eating Disorders in Gender and Sexual Minorities

Description:

Hegemonic masculinity, the dominant culture’s feminine and masculine ideals, homonegativity, and transnegativity collude to create a hostile environment toward those identifying as anything other than cisgender and heterosexual. This stigma makes its way through the minds of those identifying as LGBTQIA and manifests in some functional (advocacy, community building, pride, etc.) and some dysfunctional patterns, including manifesting as body image distress and EDs.

This presentation and interactive dialogue will focus on research, theory, and interventions for gender and sexual minorities with eating disorders.

Bio: Jonna Fries, Psy.D. is a psychologist with a clinical focus on diversity, trauma, and eating disorders. She is the Director of Counseling and Psychological Services at Cal State LA, adjunct faculty for The Chicago of Professional Psychology’s forensic psychology program, is an EMDR certified therapist, Approved Consultant, and Facilitator, an Integrative Body Psychotherapy Instructor, she co-facilitates iaedp’s bi-monthly consultation group, and has a private practice in the Mid-Wilshire area. Her co-edited book, Eating disorders in special populations: Medical, nutritional, and psychological treatments was published in 2018.   

Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland) or street parking

RSVP todrmuhlheim@gmail.com

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org 

Seven Reasons You Should Eat When You’re Not Hungry

challenging diet rules
Representation Matters

One of the cardinal rules of dieting is “Eat only when you’re hungry.” I often find that the fear of eating when not hungry is one of the most difficult bits of dogma to overcome. People with eating disorders and good dieters everywhere have been taught that this is all that stands in the way between us and complete loss of control and utter disaster in our lives. Many don’t even see it as an actual choice or symptom of the eating disorder.

Successful recovery from an eating disorder or disordered eating or chronic dieting requires overcoming and challenging this rule.

Just off the top of my head, I can think of a lot of reasons to eat when not hungry. Here are a few related to disordered eating:

  1. You have overridden your hunger cues for years from cycles of dieting, bingeing and purging. You don’t recognize normal hunger cues or satiety. Your treatment team has told you to eat regularly—three meals and two to three snacks per day. You feel like it is too much food and you’re not hungry. Should you follow their meal plan? Yes! Eating regularly is a crucial step in recovering from any eating disorder and it helps to regulate your hormones and circadian rhythms so you can regain your hunger and satiety cues and become a more intuitive eater.

 

  1. You are in recovery from a restrictive eating disorder and rarely feel hunger. You are told you need to eat more, but you don’t believe it. Isn’t it better to delay eating until later in the day? Should you really eat breakfast and lunch at the times scheduled by your dietitian? Yes, absolutely! Regular meals are critical to getting all of your body functions to work properly again. One of the reasons you may not be feeling adequate hunger could be delayed gastric emptying, which occurs when someone is undereating and food remains in the stomach far longer than it should. One of the consequences is low appetite. The solution: eat regularly as prescribed, even if you’re not hungry.

 

I can think of many more situations that apply to all of us, not just those with eating disorders:

  1. You normally eat dinner at 7 pm and your circadian rhythm is conditioned to get hungry then. But your sister has scheduled a family dinner at 5:30 to accommodate her children so they won’t be cranky at the table. Should you eat at 5:30 before you are hungry? Absolutely! Adjusting our schedules allows us to have meaningful social interactions that typically revolve around eating.

 

  1. You have a meeting that is scheduled from 12 to 3 pm. You’re not hungry at 11 am; breakfast was only at 8:30. You have the option to have a proper lunch at 11:30. Should you? Of course! Be practical—it’s better to eat before your meeting. Then you’ll be properly fueled and will be better able to concentrate during the meeting. Our brains don’t function as well when they’re low on glucose. Planning ahead and adjusting mealtimes accordingly is an important act of self-care.

 

  1. You are traveling to another country. You arrive at your destination and it’s dinnertime. Your circadian rhythms are all thrown off. You feel like you’ve been eating constantly. Should you eat? Yes! Acclimation to a new time zone is ushered along by institution of regular eating at the times appropriate to the destination. You will adjust faster if you get your body in synch.

 

  1. You just had a rough breakup. You’re eating meals, but sad. Your friends show up and want to take you out for ice cream to cheer you up. You’re not hungry. Should you go and eat ice cream with your friends? Absolutely! Food is not solely about nutrition – it’s also about bonding and comfort, and you should let the ice cream and your friends soothe your broken heart.

 

  1. You’re stressed and preparing for a presentation tomorrow. You’ve eaten adequately throughout the day and are not truly hungry. But you know that crunching on some popcorn will soothe your nerves. This is an old behavior that you’ve overused in the past. Contrary to popular belief, emotional eating is not itself a problem. Food is our earliest comfort and humans are designed to find food to be rewarding. If it were not, we would have died out as a species. There is no shame in using food as comfort—what can be problematic is if there are no other tools in your emotional toolkit. If eating is your only coping skill then I encourage you to learn some other strategies for managing negative emotions to give you a broader range of alternatives.

 

So, not eating when you’re not hungry is a rule that should be confronted. How can you start to challenge this rule and, if you have one, the eating disorder that uses it as an excuse?

You must face it head-on with new behaviors, deliberately defying it. If you have been instructed to follow a meal plan: follow it. If you have been told you are undereating: practice eating one thing per day when you are not hungry. The next time you have something in your schedule that interferes with a normal meal time: eat beforehand. Accept invitations to eat at times to which you are unaccustomed. Eat something spontaneously when it shows up, even if you are not hungry.

By practicing these behaviors, you will become less fearful of eating when not hungry. You will learn that this, too, is a normal part of being a human. You will be more relaxed around food and you will see that nothing horrible happens if you eat when you’re not hungry. You do not have to continue to be a victim of diet culture.

Nana’s Poundcake, Food, and Cultural Connection

Nana's PoundcakeFood for us comes from our relatives, whether they have wings or fins or roots. That is how we consider food. Food has a culture. It has a history. It has a story. It has relationships. –– Winona Laduke

Food is about more than sustenance. It is about pleasure and joy and connection. Food is one of the ways we connect with our cultural traditions and our ancestors. This is one of the reasons I am so passionate about my work to help people with eating disorders. When someone has an eating disorder and they are fearful of eating or of eating certain foods, they miss out on the pleasures of food and they miss out on the opportunities to connect with others through food. They also miss out on their own connection with their relatives and their cultural heritage.

In my own family, my 103-year-old Nana has always been known for her piano playing and her delicious poundcake. While her prized Steinway piano now stands in my home, I did not inherit her piano-playing her abilities. I did, however, learn her poundcake recipe.

From the time I was a young girl, I have memories of “Nana’s poundcake.” Simple to make with only 5 ingredients, buttery and yummy. During visits to Kansas City, I looked forward to making it with her. And when she visited us in New York we would make it together. And, occasionally my mom and I would make it without Nana. My kids have had the experience of making poundcake with my Nana, their great grandmother. And they have made it with me. After she eventually passes, we will retain this connection to my Nana and my kids will hopefully continue to make and share her recipe with future generations.

 

 

 

 

 

Photos of my daughters making poundcake with Nana back in 2012 at her apartment (she was 96)

I am glad to have this connection to Nana and to be able to fully enjoy making and eating poundcake with all its rich butter and sugar. What joy and connection I would be missing out on if I were afraid of eating it. To be able to make it and eat it with enjoyment enriches my life and allows me to have a shared experience through four generations of my family. I will always have joyful memories of baking and eating poundcake with the different generations in my family.

Bonus Feature — Nana’s Poundcake Recipe

  • 1/2 pound salted butter (2 sticks) – softened
  • 1 3/4 cup sugar
  • 5 eggs
  • 2 cups sifted flour
  • 2 T vanilla

 

  • Cream butter and sugar
  • Add eggs one at a time while beating constantly
  • Add flour and flavoring
  • Pour into well-greased loaf pan (or bundt pan)
  • Bake at 350° for 90 minutes

Photos from a poundcake I made with my daughter in 2019.

When Your Child With an Eating Disorder is Sick….

Guest post by Dr. Jennifer Johnson

When Your Child with An Eating Disorder is Sick...
Gambar oleh Clker-Free-Vector-Images pada Pixabay

When parents are renourishing a child with an eating disorder and that child gets sick, parents often don’t know what to do. Some families may back off on feeding every time a child gets any illness, which can be a risky practice. Especially during Phase 1 of FBT, ensuring eating is a priority. To help parents, I’ve asked Jennifer Johnson, MD, a medical doctor who specializes in treating patients with eating disorders, to share some advice.

First, let me say that in general, minor illness should not cause a kid with an eating disorder to lose weight. Parents who are refeeding their child know that even missing a meal or a snack makes a difference in their progress. Don’t let illness throw you off course. As you know, failure to gain as expected may occur if nutrition is even a bit compromised. It is absolutely not a given that illness or surgical procedure must cause weight loss. When I hear that someone has lost 3 pounds “because they had a cold” the previous week, I ask a lot of questions – that should not have happened.

Second, plan ahead. After you’ve read through my answers and looked at other parents’ recommendations, be proactive. Make a plan with your child and treatment team about what you will do if they get sick (which they inevitably WILL at some point during recovery). They should know that they WILL still be eating. But talk about what foods they tend to like when they are ill, and think about how to plug maximum nutrition into them. Buy any non-perishable supplies and stock up on over the counter medications for colds, coughs, and fever. (And please have a thermometer on hand! A $10 digital one is plenty good to give us doctors valuable information.)

What should parents do in terms of feeding when a child with an eating disorder has a head cold or sore throat and loses their appetite? Is it necessary to avoid dairy?

If your child is listless and feeling unwell, they will often not be very hungry for a couple of days. A sick child needs care and comfort. Caring for a sick child who has an eating disorder includes keeping up the nutritional intake. You don’t want the eating disorder to think that illness is a good way to sneak through the back door. And, there are other times when your child is not hungry, just from refeeding itself, and they have to eat anyway. So, push ahead, but gently. Present nutrition dense food and beverages that will be particularly appealing to your child. Does a milkshake sound appetizing? You can add a packet of Benecalorie. (There’s nothing wrong with dairy, by the way.) Chicken noodle soup? Maybe add some extra pasta. There are lots of helpful posts from parents on the Around the Dinner Table Parent Forum.

What about if they have a fever?

Having a significant fever (101 or above) increases fluid needs as well as metabolic rate (more calories are burned). Your child will feel better if you control the fever with regular doses of acetaminophen or ibuprofen. Giving the medication at regular intervals, say every 6 hours for acetaminophen, may prevent the fever from getting as high as it otherwise might. This also helps with the headaches that usually accompany fever. Keeping your child hydrated, particularly with something like Gatorade, will also help them feel better – and thus more likely to have some appetite. Some kids maintain their appetite when they have a fever and of course, it’s fine to continue refeeding. Otherwise, know that keeping up nutrition during an illness helps your child feel better sooner, and push on. Again, it’s helpful to adjust what you give them based on their preferences.

What about when kids in recovery have the stomach flu?

What do you do if they’re vomiting?

Generally, vomiting is worst at the onset of an episode of stomach flu and becomes less frequent over the next 24 hours. A parent’s main goal when a kid is vomiting is to keep them hydrated. I recommend not giving anything by mouth for 2 hours after they’ve thrown up. Then you can give them ice chips or a couple of teaspoons of water. This liquid will get absorbed from the mouth. Do this every 5 minutes or so for half an hour. If they haven’t vomited again, you can have them try slightly larger amounts of liquids at less frequent intervals. They should be able to keep down about 2/3 of a cup of liquid, and be hungry, before you try a very small amount of food. Slowly increase the amount you give them. Kids may become ravenous and eat a huge meal, but then throw up everything they’ve just eaten. A kid who throws up a day or two into recuperation may have just overdone it. In that case, you’ll need to let up a bit before pushing back into refeeding.

What about diarrhea?

For kids with diarrhea, we don’t generally recommend giving any medications that are designed to decrease the number of stools (bowel movements). No major food restrictions are needed. There is nothing magical or beneficial about the so-called BRAT diet (bananas, rice, applesauce, toast), which is of low nutritional density. Studies have shown that having diarrhea for a few days does not make someone lactose intolerant. We know that eating when you have a “stomach bug” with diarrhea will generally increase the number of diarrheal stools. But we also know that at the end of the illness, people who have continued to eat will end up better nourished (= digested more calories). And that, of course, is the ultimate goal.

One thought: you may want to speak with your child’s doctor about a proactive prescription for a small number of anti-emetic tablets (that dissolve in the mouth) to have on hand in case your child gets stomach flu. I don’t normally recommend this but refeeding is an exception. We want to minimize the duration of nausea and vomiting to make it easier for your child to eat. Also, many of my patients who have eating disorders are afraid of truly fearful of vomiting (a condition called emetophobia), which only makes stomach flu worse for everyone. If your doctor is willing to do this, they undoubtedly want you to call before you give the medication.

What if your child has no appetite (due to illness)

Biology is on our side. When a kid (or another human being) eats less due to a minor illness, appetite typically returns with a vengeance and we make up for what we’ve missed. For a kid in the early refeeding phase, of course, it is normal to not feel hungry. So you may not know whether your child is not hungry because they’re not feeling well or because they’re refeeding. In either case, your eating disordered child needs you to continue to push forward. Refeeding is the mainstay of treatment and you’re the team leader. Go for it!

Please note that none of the above should be construed as medical advice. If you have concerns about your child’s health, contact their doctor. Some examples of when you should call the doctor are: Bloody diarrhea, high fever (102 or above), vomiting that continues more than 24 hours, weakness, severe dizziness or fainting, or very little urine.

About Jennifer Johnson, M.D., MS, FAAP

Dr. Johnson is a medical doctor. She has more than 20 years’ experience as a pediatrician and adolescent medicine specialist. She practices in Newport Beach (Orange County), California.

Dr. Johnson is certified by the American Board of Pediatrics in Adolescent Medicine as well as in Pediatrics. Dr. Johnson also has an advanced degree in public health. She has been a professor in the Department of Pediatrics at the University of California, Irvine School of Medicine, where she served as director of the adolescent medicine program. Dr. Johnson has taught medical students, residents, faculty, and community physicians, for whom she continues to present educational programs. She has presented at national meetings of many organizations, including the American Academy of Pediatrics and the American Academy of Family Practice. Dr. Johnson has written many research articles and book chapters related to adolescent and young adult medicine.

Dr. Johnson is an advocate for adolescents and young adults. She is a Fellow of the American Academy of Pediatrics (AAP). She has led many activities in the Academy’s Section on Adolescent Health and served as its chairperson. Dr. Johnson is active in the Orange County chapter of the AAP, as well. Current projects include the Teen Safe Driving Initiative and healthcare for GLBTQ teens.

Dr. Johnson has also been active in the Society for Adolescent Medicine. As a member of the medical advisory board for Teengrowth, Dr. Johnson wrote many articles and answers to reader questions. Articles and webcasts by Dr. Johnson are posted at Healthology.com, medbroadcast.com, and the New York Daily News. 

Dr. Johnson is on the medical staff of Hoag Hospital in Newport Beach.

Parent Volunteers Needed for Eating Disorder Recovery Research Study

Parent Survey Eating Disorder

 

Mayo Clinic researchers are conducting a study examining parents’ perspectives on eating disorder recovery. We believe that parents have valuable information about their children that can help us better understand eating disorder recovery and improve treatment outcomes. If you are a parent of a child or a teen with an active or past eating disorder, we would appreciate your input by taking an online survey. If you are interested in participating, please click on this link:

Parent Survey of Recovery

You may share this message and link with anyone else or any group that you think might be interested in participating.

This survey is for parents who:

  • Have a child or a teen who was diagnosed with an eating disorder before the age of 18
  • Have access to some data about their child’s heights and weights prior to diagnosis, at diagnosis, and after diagnosis (any measurement system is fine!)

We will be asking you questions about your child’s illness and aspects of recovery, including weights and heights if you have them. If you have growth records, it would be helpful to gather them before taking the online survey. The survey should take about 30 minutes to complete and will be anonymous.

Study Information

Understanding Carers’ Experience in Treatment for Their Child’s Eating Disorder

Principal Investigator: Jocelyn Lebow, Ph.D.

Additional Investigators: Erin Accurso, Ph.D., Leslie Sim, Ph.D., and Lauren Muhlheim, Psy.D.

You are being asked to participate in a research study to understand carers’ experience in treatment for your child’s eating disorder. This invitation is being posted on blogs, social media groups and sent to listservs for parents of children or adolescents who have had/ currently suffer from an eating disorder.  If you agree to participate, you will be asked to spend approximately 30 minutes completing an online survey. We will ask you questions about your experiences during your child’s treatment and your personal definition of “recovery” for your child. The survey is anonymous, so your answers cannot be identified or traced back to you.  The risks and burden associated with this research study are minimal. While there is no direct benefit to you if you choose to take this survey, we believe that this research study will provide a better understanding of carers’ perspectives of their children’s treatment and recovery, with the goal of improving treatment and outcome assessment.  Please understand that this is a voluntary study and your current and future medical care at Mayo Clinic will not be affected by whether or not you participate. Contact the Mayo Clinic Institutional Review Board (IRB) to speak to someone independent of the research team at 507-266-4000 or toll-free at 866-273-4681 if you have questions about rights of a research participant. Thank you for sharing your time and expertise.

 

The researchers