DD14, suspected ED. Feeling overwhelmed.

[Whooopthereitis]

Since late summer, my active naturally slim DD has had a focus on being “healthy”. While I wouldn’t knock good intent, it’s become apparent there is more to it than that and she’s losing weight. She continues to eat breakfast, lunch and dinner - though who knows about lunch at school as hard to monitor. She has cut out snacks. I estimate eating about 1400 calories a day, which clearly isn’t enough for a girl who does a sports or dance activity 5 days of the week.

Following two teachers raising concerns about her weight loss with me I feel like I’ve been burying my head in the sand. I have made a GP appt for Friday, but feel totally overwhelmed. Should I try to stop her usual sports activities before then? We’re due to go on an active holiday next Weds - does that need to be cancelled/rethought? She’s due to go on a school ski trip in December - will that be at all safe/possible? Perhaps I’m catastrophising; but although she admits she could eat more and DH is supportive that we get GP input I feel like I’m the only one taking this seriously.

Any advice on what to expect from an initial GP appt and in the following weeks would be gratefully received.

There are many more experienced people on here but we had something similar. As the lovely people on here suggested it may be, with my sporty DD it was more a case of healthy eating being taken too far than anything more serious and we caught it before it was able to spiral into being more serious. As soon as people on here had confirmed that I was right to be worried, I spoke to a friend who specialises in ED and she emphasised how important it was to try & get calories into DD so that she was more able to make reasoned decisions. Like your DD, mine was still eating meals without any issues and so I was able to up the calorie content of those a bit and kept a demon eye of how much she was eating. I also bought various snacks which somehow seem healthy but are packed full of calories - those pastries supermarkets do in the picnic aisle which are filled with feta & spinach. We were really lucky as DD was basically incredibly naive and, as I said, was just trying to eat more healthily so I was able to get away with things like making leek & potato soup with full fat milk and saying things like “soup is so healthy and nutritious” and DD would eat a big bowl of it or make bolognase and say “I know you’ve been trying to eat more veg recently so I’ve added carrot, pepper & courgette to this. Here, have some grated cheese as it really complements the flavour” and dump and handful of cheese on hers! I also started making oat cookies, egg muffins, date & cocoa powder bells and things. The other angle I took was a sports nutrition one. Talking about making sure she was fuelled up enough to perform well, to minimise injury etc. We were in the car together a lot going to & from her training sessions and, as we chatted, I’d drop in something about nutrition or that I’d read a “day in the life” type article about a particular sports person and how I was always surprised at how much they had to eat and that sort of thing. I also got a Joe Wicks cook book and a few like that and got DD to pick the recipes she liked the look of.
We’re three years down the line now. DD still eats healthily and actually it had quite an impact on how we eat as a family with some of the Joe Wicks and other recipes becoming family favourites. For a good year or so, she didn’t eat pizza, cake or chocolate etc but that gradually relaxed. During that time, I did have to make sure I anticipated that as, if that sort of thing was the only option, she wouldn’t eat. So before she went to a friend’s sleepover where it was inevitable there would be pizza, she would have had a chicken stir fry for example. And if we were going on a day out and were going to pick up some food whilst we were out, we’d take some sandwiches for her in case it was all fried food type stuff (sports stadiums are the worst for this I found). I think she will always be conscious of what she eats but then so are most of the women I know! At the weekend, we were out with friends, stopped at the pub and she had a Diet Coke and tucked into the chips we got for the table. Later on, she had a small slice of the birthday cake.
For us, it was a blip but it could have got a lot worse and a lot worse very quickly. You are doing totally the right thing going to the GP. BEAT can be really helpful I understand. I just wanted to post as there will be a lot of scary stories but it may be possible to nip it in the bud.

I would try not to worry about the holiday next week or the ski trip for now and take it one step at a time.

It could well be a blip as the previous poster says but without knowing her weight and having had her overall health checked by a doctor yet I'd err on the side of caution here. It sounds like she may not even be managing 1400 calories if you're not sure about lunch? It's also concerning that other adults have noticed her weight loss. D

Is she eating with you? I would be pushing her to eat 3 meals and snacks a day, with you so you can make sure she's eating them. Her reaction to this plan will tell you a lot. I think ideally I'd hold off on sports this week until she's had a physical check. Or at the least only allow it if she's managed to eat her 3 meals and snacks.

In terms of the doctor, GPs aren't always great with stuff like this. I would emphasise the fact that she is actively restricting - she's told you she could eat more but isn't. And raise the fact that other adults are concerned by her weight loss. A child who was slim to begin with who is now noticeably thin and actively trying to lose more weight should ring alarm bells. The first gp we saw for our daughter was useless and dismissive. The 2nd gp was great and we got referred to an eating disorder service - as we should have been, she was dangerously underweight.

So definitely don't be fobbed off by the GP. In some areas you can self refer to eating disorder services, it might be worth doing a bit of research to see if you can where you live.

I hope your story turns out the same as the previous poster I really do but as someone who's daughter has an eating disorder I do think you're right to take this seriously.

Oh and I agree with trying to get her meals as calorific as possible. Keep her out of the kitchen when you prepare them so you can beef them up.

The GP should weigh her and take her obs - pulse and blood pressure. She should be referred for blood tests too.

In this case the best thing to do is do not worry, nor should you catastrophize but support you child, help them navigate their issues and carry on with your plans as scheduled.

I would read the Eva Musby book. Helps you get ahead of this if it becomes an issue.

Go all in with healthy foods but emphasise bananas, avocado, sourdough bread, flapjack and granola. If says she wants water melon, cucumber, fish or rice cakes get worried.

Don’t be me and bury your head in the sand. I was contacted by school and her best friends mum but I was adamant there couldn’t be an issue. Wrong. We are through it now but I acted too late and will always feel guilty about that.

I became an expert liar and blackmailer as a parent of a girl that doesn’t eat enough. You develop dark arts.

”Yes darling granola is not fattening at all”

”How sad you will miss x event with your friends if you don’t eat you won’t have enough energy to go. Never mind you can watch telly with daddy and I”

Thank you all for your comments - reading and taking them in. To answer some questions. She always eats dinner with us and eats a good amount; we’ve already nipped certain habits in the bud like filling up on salad first - and any salad on the table now has an oily dressing. I’ve taken to making her breakfast and putting it in front of her when she comes downstairs so she has to deal with that before anything else (typically a couple of slices of sourdough toast with jam or peanut butter). Lunch at the weekends is eaten with us, and she’ll take something filling (beans on buttered toast; jacket potato and tuna mayo). She’s enthusiastic about food in many ways, eg enjoys eating out. But is overly controlled in others - eg age is very resistant to eating snacks between meals. And clearly with weight loss it is to the point of being a problem.

i realise we need to take it step by step - but it’s completely my nature to think through all eventualities! At least the GP is a first solid step and I can hope that speaking with a healthcare professional will help her start to think more clearly about what is “healthy” eating.

It's really good that she's eating with you. And it sounds like you've handled the initial conversation with her really well if she felt able to be honest about the fact that she is eating less on purpose.

I'm the same when it comes to thinking through all eventualities, it's going to feel like a long week waiting for Friday I'm sure. Try offering her snacks, even if she's refusing. A snack when she comes in from school and before bed.

Is she on tiktok at all? Or could she be even if not allowed? It's an absolute cesspit when it comes to eating disorders. I found a secret account of my daughter's on there and it gave me a scary insight into her mindset when I saw what she was posting, reposting and following. It helped to see where her head was at though

If she's interested in body image and healthy eating that isn't necessarily a bad thing, I wonder if she just needs a bit of steering in the right direction? What are the sports she does? I was a gymnast as a kid and a fell runner from my mid teens on. I ate a lot, nutritionally it would have been pretty poor I guess (mostly carbs) but I didn't like how I looked. I was under the impression running would tone my legs (it doesn't). I focussed on calories burnt during exercise and would make sure I ate enough to replace them because I knew I was skinny, didn't want to be skinnier but did want my body to improve and I think I just had in my head that the 'calories burned' metric was an indication of how hard I'd worked and the more hard work I put in, the better I would look. Sadly it doesn't work that way.

Do you mind sharing her height and weight?

Lifting weights, increasing protein and dialling back the distance was game changing for me. There's a lot of what I consider positive body image stuff on Youtube, I don't mean accepting your body for what it is, I mean girls putting the work in, getting strong and lean and being proud of what they've achieved.

@Weightlossworried No, she’s not on TikTok or Instagram; she has WhatsApp and Pinterest (which I have access to, and her main focus is craft projects!). Thanks for suggestion on offering snacks. I’d kind of given up on that as I always get pushback, but will persevere gently

@JT1999 an optimistic part of me wonders if she just needs steering about health balance. She can talk rationally about fueling her body, but harder to put into practice maybe. Sports wise she plays football (so has training and matches), and also does hockey and cross country at school. I think she could buy into the idea of being strong as a positive. Height and weight wise she is 158cm and I think ~40kg; she has always (since a toddler) hovered between 9-25% quintile for weight while being ~50% for height - so naturally slim; but current weight is obviously very low.

Have her periods stopped? That’s when alarm bells started going off in my head with my dd.

My DDs ED started in a similiar way, it is common for young teens to say they are wanting to be more healthy and for that to quickly tip into anorexia.

Teens need a huge amount of calories which should include a lot of carbs and fat, my dd was also eating around 1200-1400 calories a day and loosing weight on this. For weight gain she needed 3000 plus calories and for weight maintenance it’s around 2500.

Start with a GP they need to check her obs (blood pressure and pulse lying and standing) ecg and bloods.

Keep increasing how much food your dd is eating, point out foods such as chocolate, cake, crisps etc are normal foods for teens and part of a balanced diet. Her reaction to being encouraged to eat a piece of cake will be telling.

Have you got weighing scales in the house? My DD was obsessively weighing herself which I hadn’t realised until I took the scales away and she had a complete meltdown.

Personally I would stop the exercise, if she’s already losing weight and not eating enough exercise is a no no. Again her reaction to this will be telling.

Not trying to worry you further but check that she's not going to the bathroom after eating . Good luck with GPapp .

@Girliefriendlikespuppies I think stopping the exercise will be hugely upsetting for her; so that maybe tells me something. Likewise, she wouldn’t eat a slice of cake - though would maybe share one. The only scales we have are in our en suite bathroom. We weighed her about 6 weeks ago as info was needed ahead for her ski trip. After that I noticed she’d used them as it pinged on my phone (as linked to an app); I raised it with her and she’s not used them again since.

Thanks @Momon45. no, she doesn’t go to the bathroom after meals.

My DD is also a footballer & cross country runner. I actually had a word with her football coach and he did a chat with the team about nutrition, how important carbs & fat were before training etc. Of course, DD had no idea it was aimed at her!
Do check her phone. My alarm bells got louder when I said to DD that I was going to add some biscuits to the online supermarket order and what did she want. I could see her frantically typing on her phone and the next thing she suggested was party rings. When I checked later, she had been googling what are the lowest calorie biscuits! So even if your DD doesn’t have social media, she will have access to a lot of into.
There must have been some gymnastics comp on TV as I remember watching it with DD and commenting on how strong & powerful their legs were and that sort of thing. And actively commenting on the snacks you could see them eating at the side and asking DD if she wanted to try that brand etc to take for football training. It was trying to harness positive role models and direct DD towards those

There’s definitely a problem 😕

The treatment for EDs is family based treatment (FBT) which has a good evidence base and success rate. It’s where the family takes full control of all the child’s meals and food related decisions.

You decide what dd eats (3 high calorie meals and 3 snacks a day) you plate it up and give it to her with the expectation she eats all of it.

There is a huge backlash when this is implemented as the ED comes out all guns blazing. However your dd has taught her brain to fear food and weight gain and the only way to reprogram the brain is by showing it food is not dangerous.

Feel free to join us on the carers of young people with ED thread, lots of us ED warrior mums on there.

@Girliefriendlikespuppies Thanks for the honesty; I’m just feel so sad for her. Two questions if you’d not mind. How does the FBT work with school? What do you think I should do exercise wise between now and a treatment plan. Should I stop any activities?

Is she much lighter than she has been? Protein is vital for growth and health, fats likewise (particularly animal fats - sorry vegans), so make sure she gets plenty. 40kg at 5ft 2 is skinny but maybe not alarmingly so, presumably she is pretty small framed too, ribs, shoulders, hips all still small?

What's she like with food, is she a picky eater? Interested in trying new things? We do slow cooked oxtail a lot in our house with garlic, it comes out absolutely swimming in fat and I blend as much of it as I think I can get away with into a gravy. Tons of collagen in it too. For me it is my go-to superfood. Something like this is great for maximising calories. You can serve it with mash and put offensive amounts of proper butter into it, so even if she doesn't eat a huge portion you know she'll be getting plenty of calories, and highly nutritious ones at that. Does she like icecream? I love my ninja creami and have protein icecream most nights. I normally use whole milk but stevia for sweetness. But vanilla and honey is amazing, you can add a bit of cream for calories but sell it to her on health, the protein.

Does she have aspirations about how she wants to look, physique? Having a healthy and goal body can be motivational. Look at some of the Lionesses for inspiration. You won't find any of them underweight but nor are they carrying much fat. They are all lean, muscular and highly functional. You can't tell me they don't look absolutely fantastic in a bikini too.

@Girliefriendlikespuppies sorry, rereading your post… you think exercise should stop now. My reluctance tells me I know that’s an issue :(

@JT1999 yes, slim framed but now noticeably thinner. Not a picky eater, though would naturally opt for protein and veg over carbs. Fat is an issue as she doesn’t like milk, butter or cheese (on their own; I can put them in things); so will have to think about that. Great tip on the oxtail. To be fair she’ll eat stew, pies, toad in the hole etc / and now we’re into winter months seems more natural to have them on the menu with mash etc. time to get creative with the cooking.

Loading the meals with animal fats would help I think, it'll do her the world of good especially if she doesn't do loads of carbs. Get fatty sausages instead of lean ones for toad in the hole, the batter will pull up all the fat that comes off the sausages so don't drain it. Same with stewing meat, roll it in flour and brown it before stewing, or blend a potato or two and use as thickener to help stop the fat separating. Shredded suet dumplings are highly calorific. You can lose a surprising amount of butter in mash, I use half a block, approx 125g. That's getting on for a thousand calories in addition to the potatoes for what would probably do 3 normal portions or 2 big portions. And the more butter you put in, the nicer it tastes.

My last diet before I got pregnant was a bulk, I was eating 3,500kcal a day so I learned all the tricks to maximise calories without making portion sizes unmanageable. I am 5ft 5" but very lightly built and always been skinny, I went from around 53kg to 58kg ish eating like this over 6 months. For reference I was approx 47kg at uni. All my lifts in the gym improved massively, thighs finally looked muscular (its the only place I naturally seem to carry fat), I had abs, great arms, put some width on my upper back and shoulders which made my waist look smaller in comparison, pectorals added a bit more volume there. I felt on top of the world. I've never had an eating disorder but I'm sure people have looked at me and thought I did. I could imagine a young girl who likes the visual appeal of skinnyness could look at my pre-pregnancy physique and see it as something desirable. Women still told me I looked too skinny, but I would disregard the opinion of anyone who didn't look like they could run 6 miles in the fells. I have been told I need to eat more my whole life, people questioned why I liked to run, none of that ever felt good to hear, none of it ever had any impact. What had impact was positive stories from women who got lean and strong and looked great, not chubby middle aged mum and aunties telling me to eat more. If she does sports and enjoys it I don't think you should try and put her off that unless all other avenues fail, physical activity is great, she just needs to fuel appropriately for it.

I think you can be tactical with how you talk about it to her, maybe avoid talking about weight and calories just tell her you don't think she's getting enough protein, tell her how important it is for muscle development, recovery from sports, growth, bone density, avoiding injury, hormones. If she is food conscious, she likely knows about calories etc, she'll know protein is only 4kcal per gram like carbs, and fat is 9g per kcal. Talking about protein isn't going to be as scary as telling her she needs to eat more.

This is the kind of positive content I'm talking about as an example

https://www.youtube.com/shorts/MC0Ra6ChtqI

Thank you @JT1999 I appreciate you taking the time to post! It’s so helpful. It helps remind me of things I know she likes and can add to things that I know will be calorie dense (like stuffing and dumplings).

When you say teachers. Do you mean school or dance / sport? If it’s the dance / sport teacher, they may tell her they’re not happy for her to continue in class right now because of her weight loss. And that will be a decision made for you.

In any case, if she wants to continue her sport, she’s going to need to fuel up beforehand to have the energy to do whatever it is. Do you drive her there? I’d make that a prerequisite and say to her eat this (whatever snack she will eat) really quickly and we can get going. Then ensure she has something decent afterwards as well.

I think firstly, I would talk to her and tell her you’ve noticed she’s not currently eating enough at the moment. She’s a strong, sporty girl and it’s important to have enough energy to continue doing the things she loves. And because of this, you’re now going to be asking her to have snacks between her meals and a snack before bed. She will probably really object as she’s not used to this. And then you can explain this is just what all sports people do.

You’ve has a few suggestions on how to make her food more calorific. Even things like making hot chocolate with cream all adds up. She does also need carbohydrates. If she’s eating carbs daily, like the dumplings, stuffing, potato, all well and good. If not, you can explain carbs give you energy. And after a while if she cuts down on food and cut things out, she will eventually not be as strong and won’t have the energy to do all the things she loves. I’m betting right now she’s not feeling that way. It isn’t uncommon to have oodles of energy until you suddenly don’t. And the sudden drop in energy will come if this isn’t turned around.

Whilst 1400 calories won’t see super fast weight reduction, it is about half what she needs to be eating to just maintain weight on that much exercise. So it isn’t safe to be doing this amount of sport. At some stage really soon, she’s going to start breaking down muscle mass for energy. And the heart is a muscle. This process may have already started, as it doesn’t sound as if she had much fat to begin with. As Girlie said, she probably needs to be eating more like 3000 to gain. So if she refuses to eat more, then yes, you need to stop sport. And if that happens, I would then say you’re going to need a rethink about the holiday next week, because it’s going to be too much.

Idk how helpful the GP will be. Hopefully they will. It isn’t at all uncommon for dads to be in denial. And mums as well. I was for a while. And dh far far longer than me, including when dd was really very poorly. As for the ski trip, that’s 2 months out. A lot can change. She can’t go having just what she is right now. But one step at a time.

Sorry you’re going through this. I thought I’d share my recent experience so you have an idea of what might happen.

My very sporty DD started restricting probably about Easter time, always eating dinner with us but when they’re teenagers they have autonomy with breakfast and lunch. She started to look noticeable thinner late June. She was slight to begin with but muscly as did lots of exercise. After a chat with her I took her to the GP and her Heart rate was very low. I’d check that and blood pressure if you can, and she had lost about 7kg from the last time I’d known her weight.

I had a call from the MH team the next day, she was assessed and put on a meal plan within a week. Unfortunately she refused all efforts and ended up hospitalised for refeeding.

She’s home now but every day is a battle and I know it’s a long road but for her, I think the thought of going back to hospital is her driving force to eat the meal plan. It’s 3 meals and 3 snacks. Lots of biscuits and milk!

So I guess what I’m trying to say is absolutely get that help from the GP because for us it was so scarily quick. From being healthy and sporty to being in hospital. If you have any questions feel free to PM me. I hope your daughter can recover quickly and get her life back.

@Mummyoflittledragon one of the teachers was her dance teacher; the other her form teacher - and both contacted me separately at the start of the week. And I agree with your approach for now until we get a proper plan in place - snacks before sports.

@Fizzyjeff thank you for sharing and so sorry to hear what you and your daughter are going through. I really hope she makes steady progress at home.