I struggled with eating-disordered thoughts and behaviors for over twenty years, and even I don’t fully understand the illness. So, I never could expect my family to understand. Yet, as a young adult when I finally sought help for anorexia nervosa, I did need my family to listen to me, to believe me, and to love me. Gratefully, they did just that. With time (a lot of it) and professional help, I was able to recover. We hear a lot about how eating disorders can tear families apart, but we don’t hear enough about how recovery can bring families together—making relationships stronger. I want to send a big shout out to authors Casey Crosbie and Wendy Sterling for writing a beautiful book to help families. Thank you for allowing me to share an excerpt from How to Nourish Your Child Through an Eating Disorder below.
Excerpt, How to Nourish Your Child Through an Eating Disorder
Parents, often directly involved in the task of helping their teens to eat normally again, feel overwhelmed and immobilized by this task. Should they start slowly or dive right in? Should they include their child in decisions surrounding food? Should they add more protein? More fats? As registered dietitians with nearly thirty years of combined experience treating eating disorders, we have developed an approach to addressing these questions that is unlike any other used in eating- disorder treatment.
Feeding a child with an eating disorder is likely the hardest thing you have ever had to do, and yet providing nourishment to your child is an essential first step before recovery from this disease is possible. The caloric requirements necessary to nourish a child with an eating disorder can be two to three times their baseline, and plating such volume at mealtime is not intuitive, even for the most nutritionally savvy parents. Because the nature of an eating disorder is restrictive, secretive, and explosive, the task of nourishing your child back to health, a process referred to as “refeeding,” is anything but easy. You will need all the help you can get to fight the disease.
We liken an eating disorder to a “monster” dictating your child’s every food decision. It is a powerful beast, a force to be reckoned with, and it will require the strength of your entire village to take it down. This book will teach you to challenge that monster; to stand up to its demand to eat brown rice instead of white, or plain chicken breast instead of steak. It will encourage you to reach out to the members of your “village” and ask for love, help, and support so that you can remain steadfast in the face of the eating disorder. Part of your village will be the treatment team you hire for your child. It will consist of medical providers, therapists, dietitians, and psychiatrists, among others, all working together with you on behalf of your child struggling with an eating disorder.
A New Approach
The Plate-by-Plate approach is designed for all adolescents recovering from anorexia nervosa, bulimia nervosa, avoidant/restrictive food intake disorder, other specified feeding or eating disorder, and binge eating disorder. We will discuss these diagnoses further in chapter 2. Our approach provides a visual guide to your child’s nutrition should look like and puts you in charge of all aspects of refeeding. This approach minimizes obsessiveness from the start by removing calorie counting, measuring, and meal plan exchanges from the meal-planning equation. Using just a dinner plate, you will learn how to put together balanced meals that best support your child’s nutritional goals. Through the use of colorful photos of plated meals, you will gain a visual sense of volume and balance. This book will empower you to take charge of all meal preparation and food shopping, to plate full plates, avoid diet and light foods, and challenge your child with foods they used to like but have since cut out due to the demands of their eating disorder. Inherent in this philosophy is flexibility, with an emphasis on plating “what looks normal” rather than plating a certain number of calories—eventually allowing for a seamless transition to normal eating.
This approach is complementary to family-based treatment (FBT). FBT is the leading outpatient treatment for adolescents with eating disorders. It is designed to achieve weight restoration and restore the health of your teen in the least restrictive environment, by putting you in charge of food until your teen is able to resume normal eating. In this way, you are empowered to win the food battle in the service of saving your child’s life; the more you win, the more the eating disorder loses. This sends the message to a child with an eating disorder that they are loved, need to get better, and that disordered eating behaviors will not be accommodated.
You are asked to not only plate enough volume on your child’s plate but to also challenge the rules set by your child’s eating disorder. You will be encouraged to plate a variety of foods at each meal, and to plate foods your child used to love before the onset of the eating disorder. Your child may have become fearful and scared of many foods that they used to love. Their diet may be much narrower than it used to be, and they are likely eating the same “safe” foods over and over again. Your child, who previously hated vegetables, may try to convince you that they “love salad now.” They may say that the “other” food is too unhealthy or too processed, or that they are scared that “those types of foods” will make them fat. These fears are part of the eating disorder and need to be addressed during the process of healing.
Parents Take Control
Our approach is different from the variety of nutrition approaches out there, which include calorie counting, food measuring, and dividing food intake into “exchanges.” The exchanges are based on the system used by diabetics and is the most common method used in treatment facilities today. Using an exchange approach, the individual with an eating disorder is given an allotment of servings per food group that they can then “spend” as they wish. The goal of an exchange-based meal plan is that all foods can be converted into exchanges and are therefore included in a daily meal plan. However, this method is both complicated and limiting. A slice of pizza might be two servings of grains, one dairy, one vegetable, and one fat. The fact that a bagel equals four servings of grains may scare an individual so much so that they may choose never to eat one again. The exchange approach requires a lot of counting and tallying throughout the day, which can increase obsessiveness around food and hold individuals back from eating food that doesn’t fit perfectly into their food-item checklist.
Teens will often take charge of their own meal plan, shutting out parents and giving plenty of room for their eating disorder to manipulate how they are “spending” their exchanges. This can cause a wedge between the adolescent with an eating disorder and their parents, while allowing the eating disorder to stay alive. This is directly opposed to FBT and the philosophy of this book, where parents are asked to take an active role in recovery and to take charge of the food in order to help free their child from the eating disorder.
Excerpted from How to Nourish Your Child Through an Eating Disorder by Casey Crosbie RD, CSSD and Wendy Sterling MS, RD. To learn more, read the book!
Win a Signed Book! To enter to win a copy signed by Casey Crosbie RD, CSSD and Wendy Sterling MS, RD, CSSD, please post a comment below, sharing words of wisdom to families and others whose lives have been touched by eating disorders (e.g., “Full recovery is possible.” “Listen and love.”) One winner will be selected from all who comment.