Tuesday, 13 September 2011

Looking back at the Eating Plan, Feb 2010

Back in February 2010 we had our first treatment appointment with CAMHS. We were presented with a 'typical eating plan' comprising 3 meals and 3 snacks a day. We were also presented with suggestions of typical foods and quantities. Over the next few weeks I made a note of exactly what Ben ate. I also made notes of his moods / food behaviour which read like this:

Friday 5th Feb 2010: Friend sleeping over and OK, but I didn’t see what they ate.

Saturday 6th Feb 2010: Lunch – first Pret a Manger, but got into state trying to choose lowest fat option. Picked up several choices, put down, got as far as till once. Panic attack. Retreated under stairs to weep. Walked out. Managed to eat at Bagel Nash (after distressing walk through town) but felt guilty at choice. Left half sweet bagel.

Sunday 7th Feb 2010: OK until teatime then panicked at portion size. Felt confused at larger than normal portion, unsure when to stop – mass panic followed by "I’m fat" – CRISIS!!! Long crisis… stretching late into evening. 2 x bashing head with fists, hating himself.
Monday 8th Feb 2010: Late into school (missed bus). Text'd from school saying felt fat and horrid.

Tuesday 9th Feb 2010: CAMHS with nurse – felt relaxed and empowered after it. Did writing exercises as asked, positive book and diagram of his mind.

Wednesday 10th Feb 2010: Teatime: panic when asked to eat half a naan he'd refused. Panic when discovered having pre-packed lamb kebabs tomorrow – said would be worrying about it all day. Crisis. I said "Give yourself a good talking to… you’re strong" etc. He did this by slapping his own face hard. Then calmed down and ate naan, saying he didn’t want to talk about it. Preparing breakfast, lunch etc = ritualistic.

Thursday 11th Feb 2010: Teatime: hysterics when given "too much choice". Swapped lamb kebabs for low fat chicken burger, but even then had panic, taking things off plate, then putting them back on again. Shouting, crying, throwing stuff around before calming self down and putting food back on plate and eating it. (Similar to yesterday.) Back at school today and up until tea had a positive day.

Evening crisis: screaming he's fat, screaming like a maniac, thumping things, saying not doing any exercise. Feels he needs to exercise to be able to eat. Insists he's eating enough with his current diet.

Friday 12th Feb 2010: Off school. Ditto re above thoughts. Feels if puts on weight without exercising he'll blob out and become like someone that’s let themselves go. Discussed ways to avoid above meal crises. Objected to "high calorie" scotch pancakes I bought for a snack @ 85 cals each.

Saturday 13th Feb 2010: All day = OK until eve when started pinching stomach "folds" and getting low.

Sunday 14th Feb 2010: Worried about carvery lunch – says typical carvery has 5,000 calories. Had more like a full English breakfast. Managed OK.

Monday 15th Feb 2010: Back to vicious circle of "getting fat", pinching stomach and waist "fat". Constant worry he’ll suddenly 'blob out', with fat, not muscle, and spiral out of control to become obese. Feels lost without exercise to "firm up" the weight gain. Itching to weigh himself.

Tuesday 16th Feb 2010: Lunch: panic attack at "being greedy" and "overeating". Threat to freak out at teatime when we have a curry. Self-hatred mode / depression. Teatime: real downer, depressed, feels ignored at school and a social outcast, self-hatred, tears, gloom, low… CRISIS. Plus says people call him fat, etc.

Wednesday 17th Feb 2010: Panic at "fat gut" he thinks he is developing. His entire happiness seems to centre around the perceived size of his belly. This always leads to the 'need to exercise it off' mindset. Evening: mega crisis – started suddenly when he looked at belly and prodded it. "Fat" – mega hysterics including banging head on wall, slapping face and locking himself in room. When eventually let me in, got a bit violent, striding around house trying to find hidden scales – I had to physically restrain him before he broke down in tears.

Thursday 18th Feb 2010: CAMHS with the psych. Rest of day = OK until panic over whether to have a snack or not.

Friday 19th Feb 2010: Managed to eat out in Pret and also latte in Starbucks. Spent a lot of time in chocolate shops, studying calories and not buying anything…

Saturday 20th Feb 2010: OK until he spotted puff pastry in Tesco shopping trolley and refused point blank to have the pastry element of our tea, so I said I wasn’t going to compromise. No pastry means I wouldn’t cook. Ended up eating at the pub.

Sunday 21st Feb 2010: OK.

After this I decided that calorie counting might be simpler than doing portion sizes.

Friday 26h Feb 2010: First day of calorie counting. Off school. OK and fairly normal with this new plan until the end of tea when he had an extreme frenzy (banging head, etc, shouting and swearing). The problem was the feeling we are feeding him too much and his portion size isn't the same as mine. Convinced that the dreaded fat would be put on 'as fat' despite the fact he was under-eating for the day. In other words, if he has fat, no matter whether he only has a few total calories in the day, he will still put on flabby fat weight.

Saturday 27th Feb 2010: Reasonably OK until theatre in afternoon when we took a drink and a slice of fat free tea loaf as a snack. Took a swig of the drink and didn't eat the tea loaf. At the interval was obsessed with showing me the array of cakes available in the café.Then we went to Pizza Express, having agreed in advance what he was going to have via the PE website which lists calories.

As he had tonnes of calories left he went with the suggestion of a normal pizza rather than the low calorie one he almost chose. However he left around a quarter of it, including all the outer crust. Instead of going for the agreed fruit juice he went for a diet drink.

At the end he had a frenzy about the fact the pizza was bland and he hadn't enjoyed it. This grew into a bigger frenzy which meant we had to leave the restaurant pretty quickly as Ben walked out. He ran from us, along the main road. Eventually we found him standing on the kerb edge as if he was going to run in front of a bus. There followed a MASSIVE scene as we walked home including some violence towards me. Loud screaming hysterics.

After more of this plus his dad breaking down once we got home, Ben calmed down and made one of his sundaes and watched the telly.

Sunday 28th Feb 2010: Rocky ride with new diet. Said felt bloated, faint and uncomfortable, sweating and with heartburn. Ended up in massive scene again. Unable to grasp the need to eat at least enough calories not to lose weight. Fighting against having very low fat spread in his sarnie. Claimed to have had 250ml of smoothie when it was only half this amount. His dad confronted him.

Ate tea OK and enjoyed it. Had dry bread with it. Volunteered to have a fruit juice drink with it. Problems with pudding later on - said he was bloated and wasn't hungry, felt he was being force-fed and was convinced it would make him fat. He discreetly threw some of his pudding in the bin before eating the rest in front of us. His dad discovered this.

Monday 1st March 2010: Woke up in bad mood. Dragging breakfast. I assumed he ate cereal as claimed. Took just 2 bites out of crumpets. I persuaded him to finish them. He complained of bloating, guts in cramps, etc. Said he felt his current weight was OK so he didn't see the need to eat so much. I said he wasn't eating much more than he'd been eating over the past 2 weeks and he'd LOST weight last week...

Drove him to school late. Had a word with medical centre about having supervised lunches there. Emailed them a list of what's in lunchbox. Ben texted me from school after lunch saying ate nearly all of it, but felt there were too many calories in it.

Usual argument in the evening about eating too many calories.

Tuesday 2nd March 2010: Woke up in bad mood, couldn't get him into school. But typically OK after that, despite usual argument about eating too much and horrors of standard yoghurts over fat-free ones.

Ate lunch OK, but started to freak out at thought of maybe having to eat high cal food in the future e.g. butter or low fat yoghurt, even though I said I didn't know whether CAMHS would say he has to or not. I said they might either ease it in or not at all, I don't know, I can't say.

Said would NEVER eat it, EVER. Said CAMHS don't listen to him when he explains WHY he will NEVER eat it, EVER. His main problem is saturated fats in things like low fat yoghurt. Went upstairs in a mood.

Bit of a tizz when it came to pudding for tea - couldn't choose when decided didn't want his original choice.

Wednesday 3rd March 2010: Went to school. Argument when came back - felt bloated with heartburn and said it's just how he used to feel when he "was fat", before he started to lose weight, which was why he felt better thin. Wants to give up eating plan and just focus on the psychological side of things. Feels bloated and flabby. Wants to exercise. Said I'm overfeeding him and it isn't necessary. Says he eats double what a normal boy eats. Lots of arguing - the usual vicious circle arguments. Didn't finish juice today. Also left most of 1 crumpet at breakfast.

Was sick at 6pm.

Ate tea OK.

Thursday 4th March 2010: Deliberately made it so there wasn't enough time to have his toast this morning, even though we'd arranged for him to make more time in the morning. Ended up having massive row, with him throwing toast around the kitchen saying he didn't want to do the diet plan any more and CAMHS were just trying to make him fat.

Attempted to leave lunchbox at home, then tried to leave it in the car. Went to the school bus in a terrible state. I called nurse in medical at school who later called back to say he'd been there most of the morning and hadn't done his first 3 lessons, but he was having lunch with her, she would supervise it, and he'd calmed down a lot. Got the impression he'd been a nightmare earlier...

Texts started again at lunch. "Diet plan making me lonelier than ever… can’t talk to people or friends" etc. Went to pieces at school after lunch and spent afternoon with school nurse who walked him round the grounds, talking.
Shortly after this, he 'downed tools' and refused to continue with the formal Eating Plan. Although the Eating Plan had succeeded in gaining weight (he reached a higher weight than he is currently), that's all it did.

Unfortunately once Ben was permitted by CAMHS to "take back control" and manage his own 'Eating Plan', things rapidly went pear-shaped as his weight predictably spiraled downwards and his moods and behaviours got worse.

One year on (4th February 2011) he weighed 5kg less than he'd weighed at the start of the original Eating Plan (5th Feb 2010).

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