How long before we see weight gain?

[Raspberrysins]

Hi everyone. I’ve been lurking on these threads for a few weeks. My 15 y old DD is in the early stages of an ED. Her periods stopped 5 months ago and I knew she was being excessively ‘healthy’. Thought it was great to start with of course but soon saw the changes. Anyway, have had the first GP appointment who took bloods and told us to go back in 6 weeks. No mental health support offered so we have found a private lady online via the beat website who’s been great. My DD has fully accepted she has a problem and is really trying to eat more calories but it’s very stressful as she has many ‘fear’ foods. She enjoys running and the therapist has said to only do this twice a week. She said if she gets referred then CAHMs will stop all exercise immediately which has scared my daughter. She really wants to get better. The thing is I wondered how long it might take to see changes. Her pelvis is clearly visible and her shoulders and arms are so bony it breaks my heart to see it. She is healthy generally and aiming for 2000 calories a day (gp recommended). However she is struggling to eat around 1700. She eats 3 full meals a day and snacks in between. I know we are lucky that she’s accepted it straight away. The therapist thinks it may be ‘orthorexia’ instead of anorexia but I think the issues are largely similar.

They are largely similar and I think that you are jumping the gun here asking this question because your DD has not yet been put on a path to recovery she's just been given a bunch more rules to follow and there's still a long way to go. What are the qualification of the "private lady" you have found online and why are her methods so significantly different from what you know would happen with CAMHS? This is a really complex set of conditions and I am not an expert but I understand that the issue is firmly tied to monitoring and recording and counting food in amd exercise out as a way of keeping an excessively and unhealthily tight grip of control on what feels like an otherwise impossible world and the first steps to recovery are not about setting new numerical targets for food in or amount of exercise but helping the child to feel safe and supported and giving them the mental resources to cope with life without those numerical targets. What's your own relationship with food like @Raspberrysins - I'm gettimg little alarm bells that maybe you need some counselling support yourself in order to be able to provide the family landscape within which your DD can recover.

Did the GP weigh her? That will be what triggers the referral. I agree that it would make sense for all exercise to stop.

GP’s generally aren’t worried like an ED team would. Do you think she has been losing weight? Are you watching her eat all her meals and snacks? Xx

If she's into her running I'd try and support that as otherwise she'll probably get even more focused on food. Is she able to have things like yfood nutritional meal drinks? They are high in protein and 500 calories a drink, so if she's running five miles then one drink will balance out the run and give her some protein.

https://anorexiafamily.com/product/help-sheets-eating-disorder-family-fbt/

You can download these help sheets for free. They might be useful. Perhaps you need to be in charge of all the feeding and use more calorie dense foods without your daughter knowing.

Hi OP sorry to hear about your DDs struggles.
It matters not what the diagnosis is, or the reasons for her weight loss. She has an ED and the only treatment is food and weight gain. And absolutely food will be your top priority.
1700 to 2000 cals a day is not enough for weight gain. The GP has quoted the average cal intake for an adult female..not a 15 year old girl who runs. Let alone one who wants to gain weight.
The rule of thumb is 500 cals extra a day to gain 500g a week. So she needs to drastically up her intake.
If she is already eating 3 meals and 3 snacks a day (the aim in treating anorexia) then it is about calorie density and portion size. The first is often easier to achieve.
And yes CAHMS may ban exercise. My DD was allowed some exercise but it is not usual.
Get her out of the kitchen. Make all her food. Add fats such as oil to pasta, cream to mash, butter to everything you can. Lots of dairy and meat products. Bigger and richer snacks. Milk or smoothies for drinks. I made a 700 cal smoothie for evening snack for my DD with mill, full fat yog, oats, banana, strawberries, honey and double cream.
Then you provide support to get the food eaten. Eva Musby has a good book on how to help with this.
Please ignore posters who say its about dealing with their mental health first. A starved brain (the first thing to be depleted and last to be restored in an AN) is not able to do serious work.
And it has nothing to do with your attitudes to food. EDs are a biological based illness, which is triggered in people with a genetic predispostion to it, by weight loss. How and why that weight loss occurs is not relevant whilst in early recovery. Gaining weight is the only cure. Then dealing with the reasons for the intial weight loss when brain recovered enough.
Catching this quickly and acting fast are the best options.. get educated via Beat, Feast and Eva Musby and get cracking.
Its a tough road, and will be hard, she will be scared and angry, but food is her medicine, you need to push her through it with support and an iron determination to get her to eat. Being afraid of foods and livong with that anxeity will be hard for her. Not eating enough and being seriously underweight could kill her eventually. Thats the stark choice she and you face.

Thanks for the replies already. Sorry yes to clarify the GP weighed her. Said she had a low bmi and would like us to go back in six weeks. Her goal was just to “put on some weight “ and try for 2000 cals. When we got home my daughter said that’s all well and good, but it didn’t actually ‘help’ her with her thoughts. Hence why I looked on Beat and found a therapist.

I’ve had an eating disorder since I was about your daughter’s age, I ended up in inpatient care at 19. If she’s running you need to up her calories even more, 2k a day probably won’t be enough. It would take me literal hours to finish one meal, my dad/stepmum/boyfriend would have to sit with me the entire time to make sure I ate it. In the end, my stepmum would have to pack my ‘safe foods’ with extra calories that I wasn’t aware of. She would add butter and other fats to everything. They also threw away the scales so that I couldn’t weigh myself at home. I wasn’t allowed in the toilet by myself for 2 hours after meals. Therapy helped much more than anything. It was awful for years and I think I still am a bit traumatised from it all. As for how long it took me to put on weight, I’m still not technically a healthy weight for my height and I’m 34! But I don’t have disordered eating anymore.

1700 and exercise means weight gain will be slow, potentially no gain at all.
It's tough but stopping exercise is probably better. For us that was the jolt to focus on getting better. Six weeks later and exercise is gently starting again, do it doesn't have to be forever

This isn’t correct. 1700 calories on someone so emaciated and exercising twice a week will accelerate the weight loss. As a person becomes increasingly emaciated, the weight loss will increase. Op’s dd will be eating her muscles and the heart is a muscle.

There’s therefore no way on earth that your dd will put on weight with 1700 or 2000 calories. If her periods stopped 5 months ago, this is not early stages. She must have been restricting for quite some time.

It is possible that she could enter into hypermotabolism when she eats properly again and you will know when she gets her appetite back. Her sport will also be ramping up her metabolism. She should be eating at least double for very slow weight gain. Some will need more like 4000.

Most GPs know very little about ED and the 2000 calories recommendation is something you're going to need to get your dd to understand is very poor advice. Just so you understand how it works, every calorie that your dd hasn’t eaten in the past, she needs to now eat it to return to her normal size. So just eating the recommended amount for an active teen of her age will not see her gain weight and if she’s in hypermetabolism, she will continue to lose… and 2000 calories for an active non anorexic 15 year old is on the low side. I’d say it could be more like 2200/2400 depending on the person.

As for talking about calories, this isn’t to be encouraged. Talk about energy, food as fuel to your dd and intake. If you want to count calorie fine to keep a track of things, but it isn’t healthy for her to do it.

@Mummyoflittledragon your post has really stressed me out and sent me down a Google rabbit hole .. I feel really out of my depth to be honest. She hasn’t been diagnosed officially. I am scared for this hypo metabolism to happen. Maybe it already is. Thing is she’s not been skipping any meals during these past 6 months. She has just gradually become more and more rigid with avoiding unhealthy foods. She absolutely loves food and eats a full plate. But never a single biscuit or anything deemed ‘bad’ for you. Obviously the lack of periods is a big sign and her body appearance with lack of fat etc. the next gp appointment is in 10 days and she is desperate not to get referred to cahms. Maybe it’s a good thing if she is? It’s just all so scary. I thought we could do it on our own with a therapist (who is experienced)

It’s a scary place. I think the main thing to concentrate on here is probably weight to height. Do others agree?

@Mummyoflittledragon totally knows what she’s talking about.

Your daughter will be frightened.

To go back to your initial question - it can get very quick to regain some weight, but your daughter will have to eat more. Talking calories at this stage can cause more harm than good, as you then create more issues with food. There is a long weight list for ED services, but not for people who are losing weight and underweight. I would push for the referral and let them decide. If they don’t think you need the service they are experts. I would prefer them to say than for me to wish in six months time that I had seeked out more help.

This is a very stressful time. Stopping periods really is serious. Does your daughter say she wanted to lose weight?

We are here to help. At times we may sound harsh or say things you dont want to hear. We get that, but we do know more than we would like to and we are here to support you.

I had this with my son. I had a very worrying couple of years starting in y6 when he started food restricting. he was very overweight so when he wanted to join the gym that was great/. However it soon went too far. It’s only the past 6 months that we have come out the other end of it. He didn’t get too skinny but from a 42/44” waist at 12 and 13 to a 30/32” waist at 14 it’s clear he dropped a ton. He’s also shot up massively in that time period (he’s now well over 6ft).

what helped for us was getting him a personal trainer who showed him how to work out safely and also told him how to fuel his body for workouts. I also was sneaky with certain foods. He liked chicken wings because it was protein and protein = good but he didnt realise half a pack was around 750 calories! We were eating a lot of chicken wings as you can imagine as at his lowest he was maybe eating 1000 calories a day.

i also tried to fortify foods when I could so mashed potatoes had butter and cream added to them. Tacos had chorizio and pancetta through the mince to make it more filling and calorie laden. I bought ribeye steak instead of sirloin or rump. I started home baking again and every weekend I’d make a batch of tablet (pure sugar but amazing Scottish sweet). Switched to blue milk rather than red milk (that was a struggle for me). If he had a cup of tea I’d put a bit of sugar on it just basically if I can get extra calories in then I’m going to do it.

i also let him drink some calories which was a great way to get the calories in him! I like a certain brand of protein powder, it’s not very filling as it’s not meant to be a meal replacement but it ended up being a 200/250 calorie drink without him realising it:

i did at times get VERY strict with his tech and screen time. I removed his option to use a search engine on his phone and he had to use my laptop or iPad to do homework and he wasn’t allowed to be upstairs when doing homework in case he deleted his search history as there were things he was searching that were not good (600cal a day diets). I took him off TikTok for a while and threatened him with removing snap chat. I didn’t weigh him often, but I had him on the scales every couple of months but wouldn’t let him see the number.

we’ve finally come out the other end and I now have the opposite problem in that I can fill him and struggle to keep junk and snacks in the house. Whole pack of smoked salmon gone today in 1 wrap for his lunch!

hopefully as she wants to get better that you will see some results. If she can tolerate it due to her issues with fear foods I would highly recommend her drinking some calories to try get them up.

sending love as it’s so hard and worrying to watch.

It is scary, so the more help you can get the better.
My DD also started with being focused on healthy food, and exercise. We thought she was eating all her meals but she was throwing away lunches at school, could that be happening?
My DD dislikes having to go to camhs, but it's definitely helped, so would be worth pushing for a referral

Thanks @Pearl97 weight for height is a good benchmark. That’s the red book stuff btw op so if your dd is at centiles 50 on the height, she should be about 50 centiles on weight.

I get it’s really scary. I understand the desire to deny things. I had exactly the same feelings a couple of years ago, when I was told all of this stuff on here. Of course your dd doesn’t want the referral. She’s being totally controlled by the ED.

The only positive thing here is that your dd lost the weight slowly. So did mine for the most part. However, you don’t know if her bloods are out of balance until you get the results. Did the GP do basic obvs? Heart rate, BP, oxygen sats? And temperature maybe as well?

Get the CAMHS referral. You need all the help you can get. I wouldn’t mention you’re doing private stuff. The nhs doesn’t like this. They tell you to choose. But you’re doing what you need to do for your dd. And they can’t really say anything if you’re filling in the gaps until you get a diagnosis. And just so you know, your dd can sign herself off from CAMHS at 16. Mine did that. So I’d do it now.

Idk if CAMHS will tell your dd to stop all exercise. It depends on their findings and it depends on the team. They may be great, they may not. But either way, it’s an avenue that you’ll have pursued. There is more and more understanding that some people, especially the very sporty, need to exercise for their mental health. That needs to be monitored and safe, eg low to moderate exercise once or twice a week, and for the team to decide.

As for being scared, your dd needs to get motivated to put the weight on. The idea is that she has to want to exercise more than she wants to restrict her food intake. I see she has many fear foods. Will she eat some kind of carb like bread or oatcakes, eggs, cheese, some kind of meat? Or flapjacks? These are all great things to give her the energy for exercise and to fuel her body. As her mum, you are in charge of whether or not she goes to her sport. Especially as, I presume, you’re taking her. So if she wants to go and you want her to eat, there’s room for increasing her intake right there. It’s all about opportunities for increasing intake. And you’re probably going to need to learn to parent differently to get her through this - I did. I get you’re scared.

Are you talking to the therapist too? Because they will give you the type of language you need to tackle that one. I don’t know your dd. But for mine, depending on how things are going, if she’s oppositional, it might be saying to her (just as we are about to leave) to grab something quickly and then we can get going. For your dd it might be discussing with her beforehand then reminding her to grab herself a snack when she comes home from school before you go back out again. For sport, as dd wasn’t eating enough protein, we established extra snack for dd on sports days, and that was literally a 27g slice of cheese.

I would love to be able to feed my dd the way @MakeMineAMilkyTea did with her ds. I can’t. Dd won’t accept to be made food with unknown ingredients. She’s very rigid and eats a lot of prepacked and beige foods. Your dd is equally rigid by the sound of it but with different food types. Cream (including the blue top milk) and butter are excellent sources of fats and the brain needs these to recover. If your dd is into healthy foods, maybe there is a way of getting her to understand how healthy and natural these are. And that they will help keep her brain healthy, learn for her exams etc. Again, I would talk to the therapist about what to say.

Just to say that food rigidity is the ED. So trying to challenge this early is def a good strategy. Its going to be painful anyway, the longer it is prolonged the harder it will be.
Or alternatively hide foods. Put blue milk in a red bottle. When cooking hide extra ingredients. Put high fat yog in low fat tubs. Hide double cream in the fridge.
It really is key to try to get her out of the kitchen so she has no control over food prep. Yes that will give her extreme anxiety, but then you support her to eat. Using her runs as the carrot as said above. Or any other leverage you have.
Btw it is quite common for sufferers to say they want to recover and eat when the ED is initially called out. It seems to me that the ED takes time to regroup and rethink its strategy from covert working to out in the open.
And I use the ED as a seperate entity here as this can help when parenting someone with an ED. I thought of it as a terrorist in my DDs head.
All the fear, anxiety, fear foods, rules, restrictions, aggression, deceit are the ED at play. So I actively tried to piss it off.
My whole parenting had to change. No collabaration with an ED= no involvement for DD in food planning, shopping or preparing.
I was saving my DDs life, and ejecting a terrorist.
It was hell for her and us. She cannot remember a thing about it. Because she was so v ill and effectively possessed. I on the other hand, will never forget.

She needs to be referred to an eating disorder service urgently - and there are strict guidelines around time to be seen https://www.england.nhs.uk/wp-content/uploads/2015/07/cyp-eating-disorders-access-waiting-time-standard-comm-guid.pdf

The advice usually given, is that parents should support a young person to eat three meals and three snacks a day, with a pint of full fat milk - and definitely no exercise. Counting calories is a big no and should be weighed weekly, with increasing meal and snack size if weight gain is not achieved. The quicker she can restore weight loss, the better chance she has of a full recovery

Eva Musby is a great place to start for sensible information https://anorexiafamily.com - but definitely go back to the GP and push for a referral. Our local service also accepts self-referrals, so google your local service as this might be possible

It sounds like she needs to eat a lot more. At a similar age my daughter was told to stop all exercise and the eating disorder clinic said she should be having 3000 calories a day. We didn’t calorie count but lunch and dinner were big portions followed by a sponge pudding or apple pie and custard. Three snacks a day, one snack would be flapjack, peanuts and smoothie, another would be cheese, crackers and juice. Lots of butter and mayo, nothing low fat. At the start it took an hour and a half to eat a meal and twenty mins to eat a snack so it felt like most of the day was spent making someone eat food they didn’t want to.

I eat 1400 calories if I’m trying to lose weight, so 1700 for someone who runs is surely not going to be gaining weight.

It’s really hard when someone doesn’t want to eat, and hates you for forcing it on them, but it has paid off for us. My daughter is now at uni, she still hates food and is in catered halls so has bf and dinner made for her, but she will make a sandwich and make herself eat snacks too. She looks thin but not unhealthily so and has bm in the healthy range, albeit low end.

Sorry didn’t really answer your question - for us it was 6 months before we really noticed a reasonable weight gain, then up with a few downs over the next 6 months then it seems to have levelled out

Well done for getting some help asap. Weight gain will be gradual. When I first got help for my eating disorder I was given “vitamins” to help with weight gain but not sure if that’s still a thing for children.
I was sent to an inpatient clinic. One of my friends there was in and out in literally 6 weeks and now does body building so she totally flipped the switch in her head. I struggled for the best part of 13 years with various treatments but I was 5 years deep before I first had any help. Another friend from clinic was in and out a few times over about 3 years but again she was a few years deep before any help.

YOU have noticed early, you have been to the gp, you have a therapist, CAMHS referral is necessary. You are doing all the right things. Clearly you are so supportive and she will get through this because of you. No one size fits all is the point you was trying to make but perseverance and support will make all the difference

If she wants to get better she could do with supplements. The drinks. Ensure compact is the best one. That's a really quick way to get in nutrition. If you buy those she might get 'scared' into eating more normal food to avoid the supplements.

They are very high calorie but tiny. And she could have like three a day on top of normal meals and snacks. If she's not eating enough.

It depends on her weight but anorexic people start slowly and then the weight gain increases as their stomach capacity does. So the scale might only move a bit in the first couple of weeks.

If it's not moving at all then you'll know she's not adhering to the amount she needs.

Hi everyone thanks for all the tips. I’ve started reading the EM book now. Feeling a bit emotional. I really thought we could ‘nip it in the bud’ when I started noticing the red flags. But all of a sudden she has ‘fear’ foods and massive feelings of guilt after certain dinners. Some things I say apparently make it worse so I’m trying my best to encourage gently and be strong. We’ve got some of those drinks for if she runs. Today she was brave and ate a brioche bread snack after school. Usually it’s just fruit and a small bit of sour dough. She won’t drink milk or have cream as she’s decided she’s dairy intolerant. She hates cheese except mozzarella. No butter in sandwiches either. Do I need to insist on these things? Also we’ve recently switched to brown rice and pasta- is that ok? I can see there are lots of things she is micromanaging. Problem is I think she’s high functioning Asd - which makes it more complicated. She adores cooking and baking, but maybe that’s just her trying to control? It’s so hard because cooking and running are about the only things that bring her joy !

The ED team would say no to brown rice and pasta. No to sweet potato fries etc. We are refeeding so it’s the highest calorie food.

Hopefully they will be in touch soon to help you.

I totally get what you are saying about cooking and running being the only things that give her joy. She has admitted to restricting eating when she is underweight. You really need to keep going with the high calories and see how much weight she gains when you weigh her.

This is really tough for you all, but you are doing great job of helping your daughter xx

I would advise going straight back to the GP now - if her periods have stopped this shouldn’t be managed by a GP and she needs to be under an eating disorder service.

They will likely advise to immediately start Family Based Treatment, as this is first line - most GPs do not have the experience to manage eating disorders and should refer as soon as identified.

Definitely also check whether you can self-refer to the local service - as you can where I am based. The quicker she starts treatment, the better chance for full recovery

I am surprised at what you’re saying about sweet potato fries and brown rice / pasta. Dd signed herself off from CAMHS before diagnosis - she was unable to engage. We are using an ED coach privately, extensive inpatient experience, mental health nurse of over 25 years etc. It may be that advice is different because dd won’t be directed by what she eats. She can only be nudged. And dd doesn’t just have anorexia, she also has ARFID (avoidant, restrictive, food intake disorder), so once she restarted eating, her diet has always been very beige. Consequently the coach is actively trying to get dd to eat these things. Brown for the fibre and the sweet potato fries for the nutrients.

My advice op would be to vary things if you are able. The most important is that your dd eats. You should try the Musby book to see what you can get your dd to eat. It may get worse before it gets better. Please don’t tell her she can’t eat any foods at this stage. You may plant seeds that may make this process harder, especially with the ASD. At this stage, you want your dd to eat even if it is for example what my dd has in the past eaten in big quantities, such as whole load of bread and ketchup.

If your dd isn’t eating butter, you can make her sandwiches. She seems to be quite aware of the issues and it may be that you making her the sandwich will work, whereas she simply cannot. I can’t do this with my dd but she’s still in denial 2.5 years on. Ditto the cream if you’re able.

My dd isn’t diagnosed with ASD but she has a lot of traits and has an assessment booked. She has recently been dial with dyslexia. She also has a lot of PDA traits and possible ADHD too so I’ve had to go very softly as it becomes a lot more complicated when the sufferer is neurodivergent.

I think I said upthread, Musby doesn’t work for dd but it is definitely worth doing this with your dd. She will scream, she will go ballistic. We have had it all. The most vile things said repeatedly, running off, trying to escape, violence, threats of moving out. It’s all part of the illness unfortunately. Dd is a very angry anorexic. Some are.

Deciding she is dairy intolerant is the ED. If she ate dairy quite happily pre illness, then it is the ED talking.
Ditto brown rice and pasta (if this was her idea), she has probably read it is healthy and fills one up. Requring less to be eaten.
Instead of banning brown rice and pasta, it may be a good idea to 'have run out and all the shop had was white'. Cook the whote pasta matter of factly, present it and support to get it eaten. Its partly exposure therapy.
If brown rice etc was a family decision then the family can decide no one likes it and move back to white!.
No butter on sandwiches is a classic AN thing! Thats how I realised finally that my DD was really ill, when I buttered a sandwich and she totally lost it.
How about making toasties, with lots of butter on outside, that helps in the toastie machine give a crispy outside.and 'disappears' the butter. Or fillings where butter is not as obvious.
To start with I made my own meal and snack plan of things she would tolerate, got her out of the kitchen and hid calories. And then every 2 weeks or so introduced harder things for her to eat, once or twice a week.
And carried on until she was eating 3000-3500 cals a day on average. Only then did she gain any weight.