Carefully stepping towards the next stage in recovery

Exams are over and social life is improving. Ben is also feeling more relaxed, and we've recently completed a handful of sessions with a lovely dietitian who provided Ben with a load of 'body science' i.e. why the body does what it does, especially as it emerges from an eating disorder like anorexia. Although most people love the photos of Ben at the school ball, almost everyone has commented on the fact that he still looks very thin and child-like. Some of this will be due to the starvation period stunting his physical development, no doubt, but I believe we are getting to the stage where we need to nudge forwards a bit. Importantly, I believe his mindset is in the right place to accept this...


Our dietitian sent us a printout which included the following facts (most of which I knew anyway, but having it 'in print' will make it easier to convince Ben):

A slightly higher percentage body fat than is usual at maintenance body weight (roughly 10% higher). This is just the body’s response to ensure there is buffer in case the body becomes under threat of starvation again. If you persist with regular eating and adequate calories across the year then this excess fat will gradually go and muscle may increase. Remember that muscle weights 4 x as much as body fat gram for gram, so weight may continue to creep up over the year post recovery, but body composition and image will improve - so do not misinterpret this weight gain.

So (with some trepidation, I must add), I want to focus on this.

Today I will (very carefully and diplomatically) be talking to Ben about this. I know how hard it is for him to push his weight any higher, but it has to be done. The trick is for me to be ultra-subtle about the way I position it. I need to gradually bring him round to this way of thinking rather than instantly alienating him.

Basically I need to get him to work towards increasing his weight by another 10 per cent for him to be in a comfortable place for his age, height and build. In my mind this isn't the finishing point, because he is still developing into a man, but it's a fantastic half-way house as we work on changing his mindset to realising that, actually, it's OK to be a bit heavier. Most of that will be muscle, at any rate. And he can't possibly want to remain with a boy's physique as he approaches his twenties.

Most importantly, people will love Ben for WHO he is, not what he looks like. A bonus is that Ben looks fantastic (and I know he will look even better with a bit more bulk on him!) I just need to get Ben to see this too.

Today I talked about a bunch of Ben's friends who are by no means skinny or even thin. Yet each of them is tremendously popular and each has a boy or girlfriend (which is what he wants!)

I also talked to him about the way that, in your teens, looks (unfortunately) play a huge role in how you feel about yourself and maybe even your popularity, but as you mature physically and emotionally into a young adult, you come to realise that people like you for who you are, as a personality.

As a mature young adult you choose your friends and partners not solely for their looks, but because you love them as people. Ben is in a win-win situation because, as I explained to him, not only does he have a lovely personality but he is incredibly good-looking, too. And he will be even more good-looking with extra bulk on him as he leaves the boy physique behind and turns into a fine young man.

In addition I talked about the way that his friends and peers have already grown out of the looks-are-everything obsession, but he still needs to catch up with this development because, for the past three years, he's been standing still. He is, in many ways, three years younger than his peers.

"XXXX's girlfriend didn't go for XXXXX because of his looks," I commented, and Ben agreed. "Nor did YYYYY's girlfriend, or ZZZZZZ's. And if it was about being super-thin, then NNNNNN wouldn't have any friends at all. As it is, she's one of the most popular girls in the school - she radiates personality."

The problem I know I will have is that Ben thinks my aim is to make him "too fat". Although the CAMHS psychiatrist said that Ben will need to put on weight between the pages of 21 and 25, she wasn't terribly specific. And Ben preferred to latch onto the triangulation that went on earlier when CAMHS asked him to choose a target weight he was happy with and could cope with. Because this weight was borderline, just over the minimum healthy weight on NHS charts, they said "There isn't a doctor in the land who would argue with that weight." Or something along those lines.

This damage is still taking a long time to repair. But having the dietitian explain so many excellent scientific facts to Ben, may just help.

Even so the above conversation is going to be tricky, and may need several drip-fed conversations.

Wish me luck...