Guest guest Posted April 28, 2011 Report Share Posted April 28, 2011 What is her weight now? I usually am giving clients upwards to the 3000 - 3500 calorie range to see weight gain. My untechnical term I use is " hyperburn. " Just a really high metabolism once food is introduced back into their lifestyle. Which in turn means a very high caloric diet to help with weight gain. With this, you will need to expect strong physical and emotional issues arise... feeling full, sick, nauseous, etc. And the emotional aspect of eating when still full. I highly recommend some kind of supplement to help her get the calories she needs. So 2000 calories is probably not enough... especially for such a tall woman. But I do want to say that when a person IS receiving enough calories and you are not seeing weight gain... you can bet it's b/c they ARE doing some kind of eating disorder behavior. Even when they swear they are not. From: rd-usa [mailto:rd-usa ] On Behalf Of Welsh Sent: Thursday, April 28, 2011 10:49 AM To: rd-usa Subject: Anorexia I am needing some help with an outpatient I am seeing for anorexia, don't have much experience. How quickly can I expect her to gain weight. She seems to be staying within 1-2 lbs. from where she started, not vomiting nearly as much, and really seems sincere that she is consuming about 2000-2500 calories a day. She is about 5'10 " and reports to having a pretty high metabolism, having never been heavy, her parents are both tall and thin also. I believe that I need to keep increasing her calories until she is gaining, but this has been such a slow process, about two months so far. Is this what is to be expected? Thanks for any help! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2011 Report Share Posted April 28, 2011 What is her weight now? I usually am giving clients upwards to the 3000 - 3500 calorie range to see weight gain. My untechnical term I use is " hyperburn. " Just a really high metabolism once food is introduced back into their lifestyle. Which in turn means a very high caloric diet to help with weight gain. With this, you will need to expect strong physical and emotional issues arise... feeling full, sick, nauseous, etc. And the emotional aspect of eating when still full. I highly recommend some kind of supplement to help her get the calories she needs. So 2000 calories is probably not enough... especially for such a tall woman. But I do want to say that when a person IS receiving enough calories and you are not seeing weight gain... you can bet it's b/c they ARE doing some kind of eating disorder behavior. Even when they swear they are not. From: rd-usa [mailto:rd-usa ] On Behalf Of Welsh Sent: Thursday, April 28, 2011 10:49 AM To: rd-usa Subject: Anorexia I am needing some help with an outpatient I am seeing for anorexia, don't have much experience. How quickly can I expect her to gain weight. She seems to be staying within 1-2 lbs. from where she started, not vomiting nearly as much, and really seems sincere that she is consuming about 2000-2500 calories a day. She is about 5'10 " and reports to having a pretty high metabolism, having never been heavy, her parents are both tall and thin also. I believe that I need to keep increasing her calories until she is gaining, but this has been such a slow process, about two months so far. Is this what is to be expected? Thanks for any help! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2011 Report Share Posted April 28, 2011 I agree with ---sincerity can be in short supply with many anorexics. Can be very manipulative - part of the disease. On Thu, Apr 28, 2011 at 11:00 AM, Lawson < nataliel@...> wrote: > > > What is her weight now? > > I usually am giving clients upwards to the 3000 - 3500 calorie range to see > weight gain. My untechnical term I use is " hyperburn. " Just a really high > metabolism once food is introduced back into their lifestyle. Which in turn > means a very high caloric diet to help with weight gain. With this, you will > need to expect strong physical and emotional issues arise... feeling full, > sick, nauseous, etc. And the emotional aspect of eating when still full. I > highly recommend some kind of supplement to help her get the calories she > needs. > > So 2000 calories is probably not enough... especially for such a tall > woman. > > But I do want to say that when a person IS receiving enough calories and > you are not seeing weight gain... you can bet it's b/c they ARE doing some > kind of eating disorder behavior. Even when they swear they are not. > > > > From: rd-usa [mailto:rd-usa ] On Behalf Of > Welsh > Sent: Thursday, April 28, 2011 10:49 AM > To: rd-usa > Subject: Anorexia > > > I am needing some help with an outpatient I am seeing for anorexia, don't > have > much experience. How quickly can I expect her to gain weight. She seems to > be > staying within 1-2 lbs. from where she started, not vomiting nearly as > much, and > really seems sincere that she is consuming about 2000-2500 calories a day. > She > is about 5'10 " and reports to having a pretty high metabolism, having never > been > heavy, her parents are both tall and thin also. I believe that I need to > keep > increasing her calories until she is gaining, but this has been such a slow > process, about two months so far. Is this what is to be expected? Thanks > for > any help! > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2011 Report Share Posted April 28, 2011 I agree with ---sincerity can be in short supply with many anorexics. Can be very manipulative - part of the disease. On Thu, Apr 28, 2011 at 11:00 AM, Lawson < nataliel@...> wrote: > > > What is her weight now? > > I usually am giving clients upwards to the 3000 - 3500 calorie range to see > weight gain. My untechnical term I use is " hyperburn. " Just a really high > metabolism once food is introduced back into their lifestyle. Which in turn > means a very high caloric diet to help with weight gain. With this, you will > need to expect strong physical and emotional issues arise... feeling full, > sick, nauseous, etc. And the emotional aspect of eating when still full. I > highly recommend some kind of supplement to help her get the calories she > needs. > > So 2000 calories is probably not enough... especially for such a tall > woman. > > But I do want to say that when a person IS receiving enough calories and > you are not seeing weight gain... you can bet it's b/c they ARE doing some > kind of eating disorder behavior. Even when they swear they are not. > > > > From: rd-usa [mailto:rd-usa ] On Behalf Of > Welsh > Sent: Thursday, April 28, 2011 10:49 AM > To: rd-usa > Subject: Anorexia > > > I am needing some help with an outpatient I am seeing for anorexia, don't > have > much experience. How quickly can I expect her to gain weight. She seems to > be > staying within 1-2 lbs. from where she started, not vomiting nearly as > much, and > really seems sincere that she is consuming about 2000-2500 calories a day. > She > is about 5'10 " and reports to having a pretty high metabolism, having never > been > heavy, her parents are both tall and thin also. I believe that I need to > keep > increasing her calories until she is gaining, but this has been such a slow > process, about two months so far. Is this what is to be expected? Thanks > for > any help! > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2011 Report Share Posted April 28, 2011 She is at 100 lbs., I have been trying to increase her calories by 100-200 every week or 10 days, at first she was willing to increase, but not recently. Is it normal to take this long, should I keep pushing the calories by increasing them more frequently? She is willing to drink Boost and does drink one  in the morning, she will even choose foods like doughnuts to get more calories, she doesn't have many trigger foods, mainly bread. I guess I need to just stick with increasing the calories and reassure her that she is burning them rapidly. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2011 Report Share Posted April 28, 2011 Here's what you need to do... Get firm with her... don't ask her what she wants - tell her what she needs. 100 - 200 calories per week is honestly too slow. If it were me, she would get at least 2 boost plus at the next session. And if by the next week she still hasn't gained weight, she would get more. She'll fight you, she'll cry, she'll be distraught and you will walk her through every step of it... explaining why she needs this, that she can do it, etc. etc. etc. This is where you'll show her the compassion - but not in addressing her meal plan. No compassion there. It seems harsh, but eating disorder clients NEED this. They need someone to tell them how to eat or they will just continue to do only what they know. Now will she go and do it? Who knows. But if she doesn't do it this week, next week you will address the same thing until she realizes that this is what needs to be done. If she is truly wanting to get better she will eventually see the light (so to say). 5'10 " is extremely underweight. Is her fear mainly based on gaining weight? If so, you need to reassure that it IS going to happen (and go into WHY it needs to happen), so get her prepared for it. Is she seeing a counselor? If not, most definitely get her to! If she is willing to eat foods that are usually considered triggering (donuts) great... but also focus on the ones that she is triggered by. She needs to learn to incorporate those into her life and to feel comfortable with it. I guess what I'm trying to say is this... be firm, but be compassionate also. Be prepared for a backlash or some kind of manipulation/bargaining. Hold your ground. Do not show the eating disorder any weakness. But hold her hand through it all. I have had great success with this. I build a trust but I also am the hated dietitian. The way I look at that is, if I'm not the hated dietitian, then I'm not doing my job. In the end, I'm always thanked for taking the stance that I take b/c , in their words, " It was what I need at the time. " Good luck! From: rd-usa [mailto:rd-usa ] On Behalf Of Welsh Sent: Thursday, April 28, 2011 12:47 PM To: rd-usa Subject: RE: anorexia She is at 100 lbs., I have been trying to increase her calories by 100-200 every week or 10 days, at first she was willing to increase, but not recently. Is it normal to take this long, should I keep pushing the calories by increasing them more frequently? She is willing to drink Boost and does drink one in the morning, she will even choose foods like doughnuts to get more calories, she doesn't have many trigger foods, mainly bread. I guess I need to just stick with increasing the calories and reassure her that she is burning them rapidly. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2011 Report Share Posted April 28, 2011 Here's what you need to do... Get firm with her... don't ask her what she wants - tell her what she needs. 100 - 200 calories per week is honestly too slow. If it were me, she would get at least 2 boost plus at the next session. And if by the next week she still hasn't gained weight, she would get more. She'll fight you, she'll cry, she'll be distraught and you will walk her through every step of it... explaining why she needs this, that she can do it, etc. etc. etc. This is where you'll show her the compassion - but not in addressing her meal plan. No compassion there. It seems harsh, but eating disorder clients NEED this. They need someone to tell them how to eat or they will just continue to do only what they know. Now will she go and do it? Who knows. But if she doesn't do it this week, next week you will address the same thing until she realizes that this is what needs to be done. If she is truly wanting to get better she will eventually see the light (so to say). 5'10 " is extremely underweight. Is her fear mainly based on gaining weight? If so, you need to reassure that it IS going to happen (and go into WHY it needs to happen), so get her prepared for it. Is she seeing a counselor? If not, most definitely get her to! If she is willing to eat foods that are usually considered triggering (donuts) great... but also focus on the ones that she is triggered by. She needs to learn to incorporate those into her life and to feel comfortable with it. I guess what I'm trying to say is this... be firm, but be compassionate also. Be prepared for a backlash or some kind of manipulation/bargaining. Hold your ground. Do not show the eating disorder any weakness. But hold her hand through it all. I have had great success with this. I build a trust but I also am the hated dietitian. The way I look at that is, if I'm not the hated dietitian, then I'm not doing my job. In the end, I'm always thanked for taking the stance that I take b/c , in their words, " It was what I need at the time. " Good luck! From: rd-usa [mailto:rd-usa ] On Behalf Of Welsh Sent: Thursday, April 28, 2011 12:47 PM To: rd-usa Subject: RE: anorexia She is at 100 lbs., I have been trying to increase her calories by 100-200 every week or 10 days, at first she was willing to increase, but not recently. Is it normal to take this long, should I keep pushing the calories by increasing them more frequently? She is willing to drink Boost and does drink one in the morning, she will even choose foods like doughnuts to get more calories, she doesn't have many trigger foods, mainly bread. I guess I need to just stick with increasing the calories and reassure her that she is burning them rapidly. Quote Link to comment Share on other sites More sharing options...
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