By Laura Cohen
“We only eat healthy foods in our house.” I see this statement or similar ones all the time from parents as they start the long journey to help a child recover from an eating disorder. I believe I said the same thing.
I will never forget proudly saying to another parent, “I’m a dietitian so I have a little insight about eating disorders.” We were in our early days, and she responded, “that’s awesome that you have that knowledge, because in order to save your child’s life you are going to have to unlearn it all now.” I truly did not know what she meant. Now I do, and I help others families through this painful learning curve.
I am a dietitian. I have worked in the health and wellness sphere for over 30 years. I have worked clinically as a dietitian in a hospital, owned a personal chef business to create healthy meals for busy families, ran a huge organization with a health and wellness company and helped thousands of people create healthier lifestyles for themselves and their families.
My entire being was about “health promotion”, so I fully understand how frustrated and flustered you feel as you are being told to add heavy whipping cream and butter to all foods. To buy Pop Tarts and Oreos. I so get it.
I fully understand your confusion when you are being told that fruits and vegetables are the last thing to be offered (unless covered in cheese) . I fully understand how strange it feels to be reading labels on foods looking for the highest calorie choice. I had to do all of that and it rocked me to my core. But the thought of losing my daughter rocked me even harder.
Hit the ground running and refeed your child as fast and furious as you can (once they are refed enough that refeeding syndrome is not an issue). One of the best ways through the recovery is to run right into it. The goal is to get as many calories (and fat) as you can get in the smallest amount of food. The less volume the better. It’s very common for the person being refed to feel full VERY quickly and have stomach discomfort. That’s why we highly recommend foods with a high fat content.
I don’t think I EVER bought heavy whipping cream before my child had an eating disorder. Last summer, I was easily going through a gallon a week.
I fully understand that it feels so “wrong” to be adding so much “junk” to their diets, but no one ever overcame an eating disorder to full recovery (which is possible) by eating carrots and organic berries. It just does not have enough calories. I guess you could argue that you could eat 10 tons of carrots. Then go for it.
Why is this important? I would say for 2 separate reasons. One is nutritional and one is emotional.
From a nutritional point of view, a “healthy” diet just can’t pack the calories that are often needed to refeed someone back to being weight restored plus. So, make butter, cream, cheese and uber high fat ice cream (Ben and Jerry’s and Haagen Dazs are the highest) your friends.
From an emotional point of view we need to teach these kids (AND EVERYONE) that food is food. Food is medicine. Food is how to get out of this illness. ALL FOODS. There is no such thing as “junk” “bad” “unhealthy” “naughty” foods. And never “clean”. Food is food. That is all. Food does not have a moral value to it. They need to learn to eat ALL foods (unless there is a medical allergy or a dislike of a food more then 2 years prior to an eating disorder). If they recently turned vegan… they need meat. End of story.
You are probably wondering what to do about you? And your “healthy” home? What about the other kids in the family?
I started eating way differently than I used to. I ate all foods. I did not eat as much as my daughter, but if she had ice cream, so did I. For myself, I looked into intuitive eating and learned to eat what I wanted and not what I was “supposed to” eat according to society standards.
I had to, if you will, look in the mirror, at my own habits; and although I thought I was modeling a “healthy” lifestyle, it really was a lifestyle of some restrictions (I’ve always lived in balance but definitely watched what I ate).
I know it sounds so so scary, I questioned it so so many times. I kept looking for a “better way” and the bottom line was this was the only way.
It’s important to remember that this is not the way you will all eat forever. It may take a while and every case is different but to save your child’s life (and maybe your own) from this awful disease, you are going to have to let that “good nutrition” idea go.
I did, and through this journey I left a successful nutrition business and did a full 180 and pursued my intuitive eating practitioner certification and I’m working on becoming an eating disorder recovery coach. I have learned so much through this journey about the “anti diet” movement and how we are all so poisoned by diet rhetoric EVERYWHERE and we need to change our ways in order to be in alignment with your child’s recovery. It truly is vital.
Thank you, Laura. This message is SO important, and coming from a dietitian, it carries extra power for families who are struggling to make this paradigm shift.
In our house, we joked that we went from cooking like Dean Ornish to Paula Deen. All foods fit–all the way!
This resonates so much to me. I’m also an RD and I had ro make a 180 change in my like and my child’s life. I agree with you that the only way to defeat this illness is by learning that ALL food are foods and to avoid suing moral values in food. I also remember buying the first heavy cream carton and understanding that it will save my child and it did. So thank you for your writing, I felt so ashamed for so many months because I’m and RD. Now I using it to support the anti diet movement and support people to develop a better relationship with food
Thank you. It’s been a professional grieving process…. I’m sure you understand that. And one that I’ve lost a few friends bc I had to lean into what I was living and learning and they want to stay entrenched in diet culture. I get it. I was there. As a profession we have work to do! I’m thankful to have other messengers on this journey together
This is really resonating with me. a part of me thinks that our ‘eating healthy and clean’ caused my daughter’s ED. we are close to her weight goal and seeing glimpses of my real daughter back. everytime we see or even complement her on progress, the ED just surfaces again. My D only eats small portions so yes, using heavy cream, olive oil and cheese in every meal is our strategy. I am still uncomfortable doing this but seeing these posts on ATDT continue to remind me that we are doing this to save my daughter’s life. This is such a horrible illness. it has no place in anyone’s life.
Hi Maria,
I was reading your comment and saw that your daughter is not able to eat larger portions. Neither is our daughter. That has been a struggle got us .
Would you mind sending me a pm?
All dieticians SHOULD be I turned of ED’s
Our dietician that we saw a few times did so much damage it’s not even funny
My d who at the onset of her AN could not even drink a glass of water (who I managed to get drinking 3 glasses of full cream milk with breakfast, lunch and tea -NO easy task mind you!!!!!) was told by this dietician she “did not need to be drinking that milk”
are you freaking serious???????
We stopped seeing her after this
She was NOT ED specialised
After this appt my d refused milk altogether
My d eventually was admitted to a specialised physciatrist/ED hospital and 5 years down the tracks she still struggles
The other worrying thing is the ED specialised physcologist asked her to eat “intuiatively” after one of her hospital discharges (she had 3 IP admittances in the course of her treatment)
This was outrages to me as this kid had starved herself to near on deaths doorstep and now your asking her to eat intuatively???
Seriously
This took another year or so to rebound from
Why is good help so hard to get we all know they need to eat a calorie rich meal plan to get well and the weight on, NOT eat intuitively
Intuitively for my kid is either nothing or carrot sticks
I recently have had 2 bowel surgeries I can’t eat intuitively I have to eat what agrees with my gut and what is going to keep me alive
The cost financially/emotionally to families the burden on hospitals etc because of some NON INFORMED dieticians IMO is disgracefull
Dont advise if you don’t know refer onto specialised services!!!
In my profession we are expected to upskill if we are not knowledgeable in an area why are t these professionals doing the same
It’s criminal
And until you’ve seen your kid loose 5 years of their life plus the effects on family/friends/career etc etc etc you have no idea
And yes my cupboard is full on chocolates, biscuits, chips, sweets and everything and anything that is NOT healthy
Bravo, Laura Cohen! It moves me to imagine the 180 degree turn you took. And it’s great to hear from a dietitian.
For fellow UK readers, ‘heavy cream’ is, I think, pretty much the same as ‘double cream’. I think it’s anything that whips up easily.
I wonder what bit of your text you’re referring to when you write “It’s important to remember that this is not the way you will all eat forever.” Because it sounds like you are going to keep the joy of ice cream!
Thank you for this article — I’ll be referring loads of people to it!
Thank you. And yes, I’ll be eating ice cream forever. It’s a staple. I was referring to the extreme High volume that is needed during refeeding. That’s not forever, yet for some a long long time. Finding that maintenance phase takes time for sure and more monitoring then a hawk!
Thank you Laura for a very interesting piece. After my husband’s quadruple heart bypass “healthy eating “ became quite the catchphrase in our home. Of course he needed to eat less saturated fats, less meat, no cheese, more veg- you get the picture! What we couldn’t have foreseen was that our anxiety prone daughter was soaking up these messages in a different way. A few years later, a bumpy start to high school and her Grandfathers passing, her anxiety was rocketing and morphed into Anorexia. I’m trying every day to let go of any guilt I feel for these particular set of circumstances. My girl is doing really well now thanks to medication, an incredible dietician and psychotherapy. Love to all A x
“They need to learn to eat ALL foods (unless there is a medical allergy or a dislike of a food more then 2 years prior to an eating disorder). ” is the reason we are now taking our 15 year old daughter out of what is apparently the best ED pediatric inpatient unit in Israel. Her dietician, who has the full support of all the professionals involved (though I suspect at least one by coercion), insists on my daughter eating all milk products which she has never done since the age of one. Apparently this is one of the core reasons for her anorexia, and has caused so much damage with our daughter’s progress and relationship with us, as we are letting them do this to her.. If you have any sources for this I would appreciate it to pass on so maybe they will listen to other parents in the future.
But what if you other child gets seriously ill from eating all the high sugar high fat food?
Thank you Laura! ❤️ I wish everyone could read your article – family physicians, family friends and society in general.
Not only did our immediate family have to rethink our meals and snacks. We had to convince extended family and friends that our new eating habits were actually healthy and lifesaving!
As a family we also love to hike and bike together. It has always been our favourite family time activities, we love being out in nature and love being active. Plus exercise is a great way for everyone to manage stress. Unfortunately at the height of my eldest daughter’s illness we had to rethink what healthy living was for us. And for a long time it was NO exercise at all, not even walking. It was essentially « bed rest » at home. And we had to find new ways to relieve stress . We learned to play games together again and do puzzles and watch movies and temporarily let go of our traditional ways of spending time together.
We are now at a new place where eating is more balanced and we can start to slowly incorporate hikes and biking back into our lives.
Wonderful article! My daughter is 8 years out from the beginning of her anorexia and about 5 years fully restored. When anxiety got the best of her recently and she had her annual doctor visit, she mentioned to this new female doctor that she is in therapy and has a history of eating disorder. So what notes does this doctor put on her bloodwork? ” High cholesterol- so avoid milk products, especially sour cream, ice cream. Best to go on a low-fat diet”. She cried all morning and it was hard to console her. It’s taken her years to love sour cream again! I did call the doctors office and speak with the office manager. She had no sympathy for the matter. I wanted this to not happen to another child, maybe a younger, more vulnerable one. My daughter is pushing 30 and I still have to look out for her. Should I report the doctor? I feel I’ll get nowhere because they just don’t get it. We are looking for another doctor and I will prescreen her this time.
We had a GP who asked her if she had eaten since the last visit as she had no weight gain!! I wasn’t there, a friend had dropped her, she was 16 years old. I had requested that he didn’t weigh during the visits as we did our own home weighs, this was during lockdown. So he completely defied my advice, she was on her own distressed. I was at work an hour away (midwife) trying to console her. He also stated she was too unwell and he wasn’t prepared to look after her in the surgery…..on another visit…..even though CAHMS have the say in that matter. He is on the Mental Health GP team, new position for him, unbelievable and scary that he has a say in the public’s mental health welfare. We live in a village, I still go to the same practice, she sees a nice female GP now.
I didn’t report him as I do not believe the Medical Board would do anything in this country. Unfortunately he is a next door neighbour to a good friend of mine and they are good friends, sometimes these things are difficult to address. He knows I was very cross.
HI Laura,
Thank you for sharing the story from an RD perspective – it’s a very difficult concept for many of us to grasp. Diet culture runs DEEP – I have told other moms in our support group about the miraculous properties of heavy cream and full fat yogurt, only to watch horrified expressions rise on their faces. It is important to hear this message coming from an expert and for new moms/dads, will no doubt add validity to the concept of food is medicine.
I really believe all this techniques to increment the calories, I don’t know how to introduce the heavy cream and full fat yogurt in my cooking and refrigerator when my 17 year old daughter has always been part of the cooking and grocery shopping?