Refeeding: calories or portion sizes? My second post from March 2010 on the ATDT forum for parents.

During those early weeks of CAMHS treatment for my son's eating disorder, I clashed with his therapists quite a few times on food-related things. One of these things was: Do we do calories or do we do portion sizes? The general rule was that we should do portion sizes but the trouble was that my son's food intake was super-low in calories i.e. virtually just salad or vegetables. So a portion of that kind of thing was, in my opinion, going to do naff all when it came to putting on weight. Quite the reverse, in fact. This is why my gut instinct told me to go for calories. This way I could be sure that he was eating enough. Or, at least that was the case as long as I was allowed to take control of his food intake. As soon as this control was passed over to him (as happened just a few months into treatment), his calorie intake went downhill. But that's another story. Here is my second post on the Around The Dinner Table Forum in March 2009 which asked the question: Re feeding: calories or portion sizes?

Our dietitian (who we see ever 3 weeks) is anti-calories and prefers portion sizes, showing us vague pictures of portions of rice on a plate (for example). But we're finding the only way to get the required food into our 16-year old son is to count calories. It's worked over the past few weeks and his weight has increased gradually. Plus he feels more in control with calories - i.e. he isn't so worried he may suddenly 'balloon out'. But I am aware that calorie counting can fuel control issues...

On the other hand, when we tried portion sizes, he ended up losing weight.

He freaks out at large portions. Also anything with fat in it which means the only way I can get the calories into him is to have loads of carbs, then he accuses me of not giving him a balanced meal (he quotes the dietitian so suddenly I'm the bad guy who he can't trust and this is all about trust, etc etc etc...)

The trouble is... I can't force feed him these things and he refuses to eat them. He won't open his mouth. And then he goes off into one of his out of control screaming / head banging sessions. Keeping him seated at the table doesn't work because he just escapes or smashes his fist down onto the food, mushing it up so it's inedible (and then escapes).

In our small house, keeping him away from the fridge is impossible and in the fridge are products covered with nutritional labelling. If I remove the labelling or try to cover it up, he knows I'm hiding fats I don't want him to see.

Occasionally I can sneak things like butter into the mashed potato, but his taste buds have become SO fine-tuned into noticing when it tastes different, he immediately knows when I've added stuff.

Our latest battle is to try to get him to eat Low Fat Yogurts (115 cals per pot) as opposed to Zero Fat Yogurts (75 cals per pot). I anticipate BIG FIGHTS about that...

I have NO IDEA how I can get him to eat higher fat things without literally force-feeding him which is impossible when he's nearly 6ft tall and pretty strong, and I'm only small. Help!!!!

I can tell him that there is evidence to suggest fats help with depression, etc until I'm blue in the face but I might as well be speaking Chinese... ESPECIALLY as his weight has just slipped through into the "safe" BMI range WITHOUT the need for these "extra fats" (as he says...) so giving him fats now at this stage, he insists, will make him balloon out into a monster... He feels they are totally unnecessary.

And...

The toys were thrown out of the pram again at lunchtime when faced with a beef sandwich, "dripping" with fat followed by a seemingly endless and pointless argument with my response consistently along the lines of "I am not arguing, this is the way it is and that's final" etc etc etc etc... then threats of what he will do when he's next weighed and has ballooned out into a ten ton monster, all my fault and all thanks to my extreme diet plan which, apparently, would horrify the dietitian and he's going to make sure she knows I'm mistreating him / fattening him up so much.... "Fine, OK, do that, see if I care" say I, etc etc etc...

Anyway fortunately it all ended with him coming down stairs afterwards and sitting quietly next to me, head on my shoulder.

Me, exhausted...

And...

... HE ATE THE DREADED 'STANDARD' YOGURT THIS MORNING with brekky which he would never (x100000) have ever (x100000) done even just a week or so ago... (and - oops - careless me accidentally binned the remaining fat-free yogurt which I found lurking at the back of the fridge so all that's left are the standard yogs...)

... and he had a (albeit it 'skinny') latte at the shopping mall yesterday...

... and he actually came back from the shop yesterday with a Cadbury's cream egg which he plans to eat on Sunday. Will he - or won't he? Watch this space, ladies...

And...

The good news is that he ate the Creme Egg. The bad news is that on Day 2 of the Standard Yogs I caught him trying to bin half a pot (I intercepted it and made him eat it) so on Day 3 when it was my husband's turn to monitor breakfast I told him to be vigilent... which he wasn't... until he looked in the bin and found a piece of kitchen paper containing most of the yog which should have been eaten with the cereal... So we are being super vigilent now, like prison warders (which is what I am normally but H hasn't been so strict; now he knows why he needs to be...)

Today Standard Yog was eaten OK...

Next weekend's "baddie" to be introduced to the diet plan will be a cake containing butter / marg (my son always liked to bake fat-free cakes... no surprises there...)

Thus so far, it looked as if we were making progress and succeeding to get our son to eat more and switch from diet foods to standard foods. But, as you will soon see, it became unsustainable. I didn't have any proper support when it came to re-feeding and eventually my son couldn't handle it any longer. So what happened? Watch this space for more excerpts from those early Around The Dinner Table forum posts.