13 year old daughter with anorexia nervosa was recently discharged from the
hospital. She is medically stable, but not at her target weight.On her doctor’s advice, we are aiming
for her to eat 3000 calories a day. This is difficult because she is a
vegetarian (started at the onset of the eating disorder) and so she needs to
consume large quantities of food to get that many calories. Of course, this is
not an easy task.She has just
returned to school after a 2.5 month absence and because of the routine/timing
of the school day we have found that a smaller calorie meal is about all she
has time to consume at lunch (it is a supervised lunch). This leaves a large
amount of calories to be consumed in the later part of the day.What about using products like a high
protein/high calorie powder? Is this an OK thing or a bad thing? Any other
Renee Hoste, PhD responds:
Using protein supplements is something that we often encourage parents to do, and many families have found them very helpful. It is difficult to get in the necessary amount of calories each day and protein supplements can add calories without adding a great deal of volume.
As far as the short lunch period, it may be helpful to consult with school administrators to determine whether they can allow your daughter extra time at lunch. If that is not possible, then it will be important to ensure that she is eating a high-calorie meal at lunch and having snacks during the school day. On that note, I would strongly encourage you to consider stopping the vegetarian diet, at least temporarily. It is not at all unusual for the onset of vegetarianism to occur close to the onset of an eating disorder. I do not mean to suggest that vegetarianism is akin to having an eating disorder, nor that vegetarianism causes an eating disorder, but it is not uncommon for a child who has developed or is on her way to developing an eating disorder to use vegetarianism as a way to avoid “scary” foods. Once a person has fully recovered, he or she can make the decision to become vegetarian without the eating disorder clouding his or her judgment.
Renee Hoste, PhD
Dr. Hoste is Clinical Assistant Professor and Director of Clinical Services and Research for the University of Michigan’s Comprehensive Eating Disorders Program. She serves as Clinical Advisor to Maudsley Parents. Read more about Dr. Hoste here.