As I watched my child struggle with an eating disorder, I felt a mix of emotions. I was deeply sad and afraid of losing her. But even in the midst of my despair, my love for my child remained strong. It helped me navigate through unfamiliar territory. I found comfort in a song that I listened to over and over again. It gave me strength and sparked hope that my child could get better. The lyrics, “I will send out an army to find you,” became my creed. I was determined to fight tirelessly for her recovery. I drew strength from my own resilience, the support of our close friends and family, and the healthcare professionals who helped us. The road to recovery is difficult, but it is possible. Embrace this belief with all your heart.

Do you have a book, a movie or a song that gives you strength? I would like to hear your voice, please share it with me.

“You are not hidden
There’s never been a moment
You were forgotten
You are not hopeless
Though you have been broken
Your innocence stolen

I hear you whisper underneath your breath
I hear your SOS, your SOS

I will send out an army to find you
In the middle of the darkest night
It’s true, I will rescue you

There is no distance
That cannot be covered
Over and over
You’re not defenseless
I’ll be your shelter
I’ll be your armor

I hear you whisper underneath your breath
I hear your SOS, your SOS

I will send out an army to find you
In the middle of the darkest night
It’s true, I will rescue you
I will never stop marching to reach you
In the middle of the hardest fight
It’s true, I will rescue you

I hear the whisper underneath your breath
I hear you whisper, you have nothing left

I will send out an army to find you
In the middle of the darkest night
It’s true, I will rescue you
I will never stop marching to reach you
In the middle of the hardest fight
It’s true, I will rescue you

Oh, I will rescue you”

Parents often face uncertainty when it comes to determining the suitable calorie intake for their child, which is necessary for maintaining a healthy weight, supporting growth and development, and meeting their nutritional requirements. They may have questions about adhering to a specific number and ensuring its accuracy. This becomes even more challenging when dealing with an eating disorder.

Nutrition specialists who specialize in treating individuals suffering from eating disorders may suggest an exceptionally high calorie intake, which may seem excessive, but is actually necessary. The aim of this blog post is to provide an explanation of how to reach the correct number of calories.

To gain weight, one needs to consume more calories than their body burns. This is known as a calorie surplus. The number of required calories to gain weight depends on various factors such as age, gender, height, weight, and activity level.

The basic formula for gaining weight is:
Calories In > Calories Out
In other words, your child needs to consume more calories than their body burns each day.
To calculate daily calorie needs for weight gain, you can use the following formula:

1. Determine Basal Metabolic Rate (BMR), which is the number of calories your child burns at rest. You can use an online BMR calculator to estimate this number.
2. Multiply BMR by an activity factor, which takes into account how much your child moves around during the day. A common activity factor is 1.2 for sedentary lifestyles, 1.375 for light activity, 1.55 for moderate activity, 1.725 for heavy activity, and 1.9 for very heavy activity.
3. Add an extra 500-1,000 calories to the daily total to create a calorie surplus and promote weight gain.

For example, if your child BMR is 1,500 calories and they have a moderately active lifestyle, the daily calorie needs for weight gain would be:
1,500 x 1.55 = 2,325 calories per day (maintenance)
2,325 + 500-1,000 = 2,825-3,325 calories per day (surplus)

If your child’s growth curve displays a negative trend and they require weight gain, it’s essential to aim for a consistent and gradual increase of no more than 1-2 pounds per week (which equates to a maximum daily calorie surplus of 1,000 calories). This approach helps the body adjust to the added caloric intake, promotes the development of lean body mass, and minimizes the risk of refeeding syndrome, a potentially life-threatening condition.

Additionally, a slow and steady weight gain allows for a more sustainable and healthy approach to recovery, rather than simply trying to quickly restore weight without addressing the underlying psychological and behavioral aspects of the disorder. Remember that gaining weight on its own is insufficient, and it is crucial to ensure that your child receives the essential support and guidance to maintain their progress towards recovery.

Keep providing your loved one with nourishment and care, and persist in doing so until they reach their target weight. Don’t let discouragement take hold, as with perseverance and commitment, recovery is attainable.

No one had ever prepared me to support someone through an eating disorder. Becoming a pillar of strength for my child through her recovery from Anorexia Nervosa had been the hardest thing I had ever had to do. With my scientific, logical, and analytical mind, trying to approach my child felt like trying to enter a foreign country without a passport: impossible.

But what choice does a parent have when confronted by this crisis? The reality is that there is no choice but to fight. Fight for the life of your child, and do whatever it takes to save them. This situation helped me discover my inner strength, and our family became stronger; both physically and mentally.

I decided to share my daughter’s perspective, being now in fully recovered, and helping others facing mental challenges in our community. Although she was at a very low place and severely sick, she embraces the challenge she had, and demonstrates the saying “It is not in the stars to hold our destiny but in ourselves.”

The following excerpt is a portion of an essay written by my daughter, reflecting her experience through her eating disorder:

“Fifteen years old and miserable, struggling under the pressure of unattainable beauty standards. That was me. No matter what I tried, or how much of myself I changed, it was never enough. I could never be pretty enough, skinny enough— good enough. Growing up with social media influences, these became daily thoughts. I was so infatuated with the idea of perfection that nothing else seemed to matter. I stopped eating, and the constant ache of hunger served as a reminder for what I was striving for. Without the proper nutrients, my body slowly began to shut down. It started off as small changes, barely noticeable; with small strands of hair falling out, and little motivation to do the things that once brought me joy. However, it only got worse from there. After a couple of months, my brain wouldn’t function properly, and the small strands of hair that once fell had turned into giant clumps on the bathroom floor. While I had many people to support me, nobody could truly pull me out of that situation but my own self. I realized that I am the master of my fate, and that if I ever really wanted to achieve happiness, the first thing I needed to change was my mentality. I willed myself to start eating again, taking small steps that slowly built up into healthy habits for recovery. The doctors that I once ignored became my voice of reason, and I was eventually considered a “low risk” patient at the eating disorder clinic, being able to regain a lot of freedom in my life. I got my life back, and now, I was the one in control— not my eating disorder. Although my experience with anorexia changed my physical body, it changed my spirit even more. I became much more strong willed, and was able to see value in myself. Even though it was the hardest thing I’ve had to overcome, I would never undo any of it; as with this profound struggle, I discovered the importance of a strong soul.”

There are multiple reasons for the development of eating disorders. These can include genetics, family, environment, low self esteem, difficulty expressing emotions, current mental state, internalized fatphobia and social media influences.

As a parent who supported her loved one in recovery from Anorexia Nervosa, and a coacher supporting other families, I can say that identifying the reason for the development of the illness is important. Discovering the source of the eating disorder serves as a key component in recovery. It is important, as it allows the caregiver to gain insight on what needs to change, and where the focus of improvement should be.

During recovery, a common mistake many caregivers make is solely focusing on weight restoration. How many times have you heard of individuals with eating disorder relapsing, having one admission after the other? How many times have you heard: “feed, feed, feed and the brain will heal itself”? If strictly reaching weight restoration was sufficient to recover, then individuals hitting their target weight would never relapse. This demonstrates an oversight in perception and a huge gap from what is really needed to recover, and sustain recovery.

Treatment can never focus only on the physical aspects, as it neglects the equilibrium between the soul, the mind and the body. You have to listen to the soul’s needs and desires, and get it aligned with the mind and the body.

If the hidden desires of the soul were so easy to reveal, wouldn’t everyone explore them? After all, understanding who the individual is and what their gifts and unique abilities are would be amazing, right? Everyone wants to know what is so amazing about them, where they can excel and be successful. In particular, for an individual suffering from an eating disorder, this can be their way out, their way to recover.

Here is where I come in: I offer an integrated practice of soul search and human design reading. After identifying the unique traits of your child, we will collaborate on a plan to help them achieve their goals. As they start living authentically, their complexity will reveal itself, and their innate wisdom and power will awaken. They will no longer feel constrained by society’s expectations about their body, and their fear of being overweight will diminish, leading to an increase in self-esteem and confidence.

Remember, the key is the alignment and equilibrium of the soul, the mind and the body. If one component is omitted, a relapse may be expected. Do the right thing and listen to the soul.

“Anorexia is the best thing that has ever happened to me”. This was my daughter’s statement a year ago. Trying not to blink, nor to be terrified by this declaration I asked “How come?” “Because you and dad showed me that I can trust you no matter what. I now know that you will always be there for me.”

Supporting my child through her eating disorder was the hardest challenge I have ever had. Frustration, fear, guilt, tiredness and anxiety- I had them all. Obviously, her statement is true: We had been there for her! Through the illness, it was all about and around her.

Regaining trust in your child after an eating disorder is hard, but necessary; trust is the core of a healthy relationship. It represents your belief in your child, in their decision making abilities, and their honesty.

How can one regain trust after supporting a loved one with an eating disorder? Looking at our journey, trust had been broken multiple times during the peak of the illness: I fed her and she purged the food away. I slept and she extensively exercised. I locked the balance in the safe box and she bought one online. I got assured she is doing okay and she self harmed. I was confident that the weights at the Doctor’s clinic are accurate while her body was overly loaded with water. I bought the food she liked the most, and found it in the trash.

Although it feels difficult to move past this developed distrust, as your child goes through weight restoration, give them the opportunities to be successful in regaining your trust but remind them of boundaries and consequences. Here are a few useful tips:

• Understand that distrust is a by-product of the illness and that eating disorders are deceit. It is not your child who broke your trust, but the illness did
• Talk with your child and understand their struggles and what they do. Ensure you have an open line of communication: The more your child shares, the less you fear and worry
• Be available when your child comes to talk with you, answer their calls and text messages and reinforce that you expect the same from their end
• Forgive your child, it was not their fault. Once you do, resentment and negative emotions would be released
• Commit to rebuilding trust and be willing to fix what is broken. This will set up the ground for a healthy relationship
• Celebrate wins even if they look small. Rome wasn’t built in a day. Ensure you acknowledge the efforts they make and the outcome you see
• Spend time together and enjoy activities you both like. Ensure you provide them with undivided attention during these times

For me the time to trust has come. My daughter and I have strengthened our bond for years to come. If you need support in your journey, feel free to reach out to me.

An eating disorder (ED) is a family crisis which affects the whole family. Through these times, increase in financial, physical and emotional strain is common. It is time to navigate through this monster rather than letting it have control over you.

When ED hit my family, I was focused on understanding why it happened to us. After all, we are a loving, supporting, educated and financially secured family. We blamed ourselves for being the reason for the development of the illness. Blame that was replaced by guilt and an immense fear: the fear of losing our child. At the time, I did not know if the starvation would kill my child, or if the self-harm would; the feeling of hopelessness and loss of control did not help at all.

It is neither your fault nor your child’s. It is not your child choice to have the ED developed. Once you understand this it will be easier to put these feelings of blame and guilt aside and focus your energy on supporting your child through their journey to recovery.

Here are my 4Cs to protect your marriage:

Coordinate: Be prepared for your agenda to be fully booked. You may have appointments such as family physicians, dietitians, doctors, therapists and lab checks; while still needing to create a home environment that supports recovery. If you have other children and you are both working, time management is needed. Check out what you can cut, postpone or get assistance from other family members and trusted friends. Now it is time to work on a shared calendar, minimizing rushing around. Review the schedule as frequent as you see fit.

Communicate: women tend to talk more about their feelings compared to men. Be compassionate and make sure you listen to each others needs and respond to each other’s concerns, fears and wants. Consider the fact that the two of you may deal differently with the crisis and may have different opinions as to the right treatment plan. In the event you are unsure how to proceed, schedule a consultation with an ED professional. Check on each other- are the two of you taking care of your selves physically by getting adequate sleep, and eating properly? Are the two of you managing your stress appropriately? Be empathetic, gracious in your words and, most importantly, listen to one another.

Collaborate: You are a team, and as a team you need to succeed in the most important challenge of your life- saving your child. You already have credentials for being a successful team, and now it is time to prove it once again. Make sure that the household responsibilities are understood to both of you, and be open to adjust as needed. Neither one of you shall carry more load than the other.

Commit: Commit to each other and to your goal. Prioritize time spent together. Make time for your spouse and show them that you care of them by providing undivided attention. Have fun and embrace every opportunity to enjoy together. Do not engage in drinking, shopping, gambling, or other harmful activities to yourself or your relationship. Consider yourself as one: one solid and strong entity that is going to beat the eating disorder. By committing to each other, you will strengthen your family and marriage.

Through your journey always remember that recovery is possible.

It is well established that to have a full physiological recovery from eating disorders, weight needs to be fully restored. Goal weight is defined as the weight necessary to support puberty, growth, physical activity and psychological/social functioning.

I am often being asked: “Body Mass Index (BMI) or growth curves: what shall we follow to establish the goal weight?” The reality is that there is no consensus around this topic among health professionals. In our own journey contradicting messages were received from the family physician, the eating disorder unit at the hospital and the dietitian. There was no alignment between these bodies as to what the ultimate weight should be.

On a personal level, I consider BMI as a crude measure. In my mind, BMI should not be used as a single tool to set up a target weight for individuals recovering from an eating disorder. This is due to many reasons, some of which include:

• Some BMI calculators neglect the sufferers gender. A female and a male of the same height and weight will have same BMI. However, this is not an accurate measure due to the fact that females will usually have a higher percentage of body fat
• It does not take into account an athlete’s body; which is strong, toned and fit. An athlete’s body usually falls within an obese BMI, even though they may have a very low fat percentage
• It does not take into account bone mass. An individual with large strong bones will have a higher BMI than an individual with small bones or a lower bone density
• It does not consider individual age
• It does not consider ethnicity. For example, an Asian man compared with a Caucasian one with the same weight and height, will have a similar BMI. However, this measurement of healthy weight will be inaccurate. This is due to the fact that genetically, people of Asian heritage, are typically considered to have a smaller bone and frame size. Due to this, if both of these individuals have the same BMI, it is likely that the Asian individual will have a higher fat percentage.

It might be that your child’s BMI is in the normal range, while in fact they are under a severe weight suppression.

Research demonstrates that whenever growth curves are available they are considered to be the best method for determining an individual’s goal weight. This is because they have been proven to be more accurate than using BMI alone.

Pediatricians plot height, weight and BMI against age-based averages to generate a unique growth curve. Negative deviation from a child or adolescents weight curve is defined as weight suppression. Even in the absence of actual weight loss, the child may fall short of their optimum weight based on their unique growth curve. A child losing “only 5 kg”, may have lost even more when we closely look at their growth curve and reveal where their expected weight should be. It has been shown that deviation from growth curve (weight and/or height) can be used as a tool for an earlier detection of an eating disorder in nearly half of the patients.

It often takes up to 12 months of being at a healthy weight, before eating disorder thoughts may start to ease. One needs to remember that eating disorders may occur in people of all body sizes: ​This is true for small and also larger bodies. In no shape or form shall an eating disorder be used as an opportunity to avoid returning to a previous higher weight as it may prevent the child from reaching a full recovery.

Here are a few easy steps to read a growth chart and establish a target weight:

• Download the applicable growth curve chart for male / female
• Based on weight and height measurements, calculate BMI
• Plot BMI for each of the ages you have
• Establish the percentile of your child: are they at 5, 10, 25, 50, 75, 90 or 95%?
• Estimate healthy BMI by drawing a line from the individual age toward the applicable percentile chart
• Establish if your child falls at the same percentile curve. If not, calculate the deviation between the expected BMI and the actual BMI
• Use the expected BMI to calculate the expected weight and consider the difference between the expected weight and actual weight as weight suppression
• Establish target weight to be 10% higher than the expected healthy weight
• Practically, the number of kilograms your child needs to gain is the difference between the healthy weight (+10%) and your child’s weight today

If you require further assistance with this process, we can establish your child growth curve and target weight during our session.

In the event historical data is unavailable, I recommend feeding to gain weight. Do not use BMI as a stand alone tool. Focus on meal plans, support your child to overcome fear from certain foods, coach your child that eating is normal, pay attention to their physical needs, and continue with this process until they get back to a healthy state.

Remember that for someone with an eating disorder, weight restoration is essential for complete physical and mental recovery. I know it is easier said than done. Keep up on steady eating habits. Do not give up on your child. Recovery is possible.

References:

TL Bazzarre, S M Kleiner &M D Litchford Nutrient intake, body fat, and lipid profiles of competitive male and female bodybuilders. Pages 136-142 Published online: 02 Sep 2013

Butryn, M. L., Juarascio, A., & Lowe, M. R. (2011). The relation of weight suppression and BMI to bulimic symptoms. The International journal of eating disorders, 44(7), 612–61

Ingemar Swenne Weight and growth requirements for menarche in teenage girls with eating disorders, weight loss and primary amenorrhea Hormone Research in Paediatrics 2008;69(3):146-51.

Lebow, Jocelyn, Leslie A. Sim & Erin C. Accurso Is there clinical consensus in defining weight restoration for adolescents with anorexia nervosa?, Eating Disorders 2018 May-Jun;26(3):270-277. 

Morgane Marion, Sylvie Lacroix, Marylène Caquard, Laurence Dreno, Pauline Scherdel, Christèle Gras Le Guen, Emmanuelle Caldagues & Elise Launay Earlier diagnosis in anorexia nervosa: better watch growth charts! Journal of Eating Disorders (2020) 8:42

Mark L. Norris, Jacqueline D. Hiebert, Debra K. Katzman; Canadian Paediatric Society, Adolescent Health Committee. Determining treatment goal weights for children and adolescents with anorexia nervosa Paediatr Child Health 2018 23(8):551 

Swenne I. Weight requirements for catch-up growth in girls with eating disorders and onset of weight loss before menarche. Int J Eat Disord 2005;38(4):340-5.

Swenne I. Weight requirements for return of menstruations in teenage girls with eating disorders, weight loss and secondary amenorrhoea. Acta Paediatr 2004;93(11):1449-55.

How many of you gained weight during your child’s journey to recovery?

In my experience, in an attempt to demonstrate good eating behaviors, releasing control around food and the obsession around how we look, I gained weight. I wish I could tell you by how much, but the scale is locked in our safe box, as ironic as that may sound. My best estimate is that I went up by three sizes.

One year after our journey started, I decided to take a pause, and ask myself if this was the right strategy. By all means, the answer is, “Yes!” . Some people may argue that each individual has their own dietary needs. Therefore, a diet suitable for a teen is not a diet suitable for their middle-aged parents. This is all true, but when dealing with an eating disorder, role modelling is more powerful than empty words.

I realized that by being a role model, the eating disorder can be alleviated to some extent by taking the following actions:

• Exhibiting self-care, and self-love
• Establishing three meals a day as a life standard
• Showing that good health can be achieved without food restriction
• Not labelling food as “good” or “bad.” Eating foods like brownies, ice cream, or pizza is allowed.
• Not feeling guilty after eating, or needing to exercise to earn or burn food or calories
• Accepting others in all body shapes and all body sizes – fat is not an insult
• Not complaining about excessive food, weight gain, or diets

Learning to feel secure in your own body, no matter its state, can assist your child in their recovery.

No, no and no.

Early in journey of supporting my loved one who suffered from Anorexia Nervosa, I felt that I could not imagine what she is going through, what it feels like, and what she really needs to fight against. I could not resonate with not fulfilling the basic need of getting the right nutrition in order to sustain all body functions, and be a healthy individual. The whole thing was illogical, and against any belief I had.

The mother in me thought, by pairing my child up with someone that struggles with the same illness, they can better support each other. It was true to a certain extent.

They were a great support system for each other before and during family vacations, prior to hospital appointments, during school hours, or just sharing their emotions around eating. With that being said, keep in mind that EDs, and anorexia in particular, are competitive illnesses. You may find that your child and their friend are in competition with who restricts more, who loses more weight, who has better strategies in purging, exercising, and fooling others. This is not in the best interest of the sufferer.

So as hard as it sounds, even if you as parents have not suffered from an eating disorder yourself, you are still the best support system for your child. Stay strong, and be confident that you can do it. Recovery is possible and you will get there.

Sun, sea, sand, road trip, Disney, camping…they all sound exciting, right? From what I have often seen, for individuals coping with an eating disorder, this excitement is often masked by fear, anxiety, and over thinking.

Certain parents feel the need to be spontaneous during vacations. But, having a child enduring an eating disorder or any unhealthy relationship with body and food requires a solid plan and consideration a head of time. Your role as a parent is to reduce and even eliminate the anxiety around the trip

• Ensure that your child packs their own suitcase beforehand. Consider comforting items such as a stuffed animal, a heavy blanket, coloring pages, books, and their preferred music as essential.
• Share with your child what the food choices will be, and agree in advance the type of restaurants you will visit. You know your child the most – would they prefer a restaurant, or would they  prefer a picnic in nature? It is not required to get into the fine details with an exact restaurant name, but you both need to agree – will it be Chinese? French? Italian? Maybe a soup and salad bar? Make it very clear that 3 meals and 3 snacks are mandatory, and there will be no negotiation around it. Be prepared with high energy snacks, available at all times.
• Anxiety can be significantly reduced by offering your child’s best friend to join your trip. Be certain that this friend is aware of the struggles your child is facing, and is on board with supporting him. This friend can assist in getting your child to eat, avoid skipping meals, and eliminate over exercising or walking.
• Consider carefully your destination. Vacations involving sea and pools might be stressful, as there are expectations around swimming and wearing less clothing than usual. This usually frightens individuals with an eating disorder. If you are confident this is the destination you would like, offer to your child the option of bringing loose clothes that are slightly less than what they would usually wear.
• As the trip progresses, ask your child how they feel. Assure them you acknowledge the efforts they are making, and are proud of how they are coping. Reward them for their efforts with a souvenir from where you visit.