We are in the process of refeeding our 16-year-old daughter according to the Maudsley approach. The weight gain is going well. My question is, how do we know when to stop the gaining and initiate a maintenance diet? Do we go mainly by the scale, a percent body fat test, or just by how she looks? Or does it happen naturally in phase II, when the patient starts to resume control over eating?
Scott Bullock, MSW, LISW-S responds:
That is an excellent question! Also, congratulations on the Phase I re-feeding process. Strong work from you as the parent! My primary warning to you and your spouse is – do not jump the gun. It can be very easy as parents, as well as professionals, to think things are great and jump into Phase II, instead of wading in slowly. To start, the pediatrician and primary therapist should discuss your child’s growth curve from before the Eating Disorder to determine where a healthy weight should be re-established. Secondly, once she has reached this weight, you need to keep in mind that there is a lag time between the body recovery and the brain recovery. The brain seems to always take longer to heal. It is also important to remember that this process is different for every patient. I would never base the refeeding process on body fat percentage, how you feel she looks, or even the weight displayed on the scale. You might find that she meets what is determined as the “goal weight”, but find that her thinking is still irrational. Always ask, “Is that the Eating Disorder talking or my daughter?” Remember, you are the parent, you know who she was before anorexia, and you will know when she has returned.
Scott Bullock, MSW, LISW-S
Mr. Bullock is a therapist at the Lindner Center of Hope. He has more than with 17 years of experience in the treatment of adolescents and adults and is undergoing certification in family-based treatment. Read more about Mr. Bullock here.