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It is very common when restoring your child’s weight for her to try to negotiate with you. “I’ll eat this but not that; I can’t eat now, I just ate 2 hours ago; I’ll add something at supper tonight.” Any of these kinds of comments sound familiar?

This can be very frustrating for parents. One thing to keep in mind when this happens is the goal is to feed your child whatever you believe is going to help her gain weight and recover. So when she tries to negotiate you ask yourself, “If I allow her to not eat this snack, will that help her get better?” “If she wants to put low-fat dressing on her salad, is that going to help her get better?”

The obvious answer to these questions is no. And you stick with whatever you already decided she needs to eat. You don’t argue or discuss why you are having her eat a particular food. When she begs or yells and swears because she has to eat the higher fat dressing you calmly stand your ground.

Sometimes families make progress and then stall out with little to no more weight gain. What can happen is when progress is made parents get lulled into a false sense of security and may not be as vigilant.

Another possibility is there may be some foods she won’t yet eat that parents have not added back into her diet. Most likely these are going to be foods higher in fat and adding them to her meals may jump start weight gain again.

What does recovery from anorexia look like? We talk a lot about the signs and symptoms of anorexia but don’t spend enough time exploring recovery.

Tonight I challenged myself to sit down and think of as many indicators of recovery that I could and make a list. These are in no particular order and there are probably more. Here is the list and I hope it helps.

• Weight restored (within a weight range established by treatment team)
• Is menstruating naturally
• No obsessive thoughts about food, weight, a number on a scale
• Can eat anything you put in front of her (pre-eating disorder behavior)
• Can exercise and get enough calories in to maintain her weight
• Can make her own food decisions and maintain her weight
• Can allow others to choose restaurant without prior notice, order for herself from the menu and eat with no anxiety
• Has preferences but no forbidden or dangerous foods (pre-eating disorder preferences)
• Displays no ritualistic behavior around food (move food around on plate, cut meat into tiny bites)
• Able to eat normally without you present like at school or with friends
• Has re-established friendships and is back on track socially
• Does not feel compelled to compensate in some way when she eats a healthy amount of food or calories
• Does not purge
• Does not over-exercise
• Does not argue or negotiate about food
• Able to eat at different times during the day (no rigidity as to times)
• Able to eat a variety of foods instead of relying on one or two meals she is comfortable with (pre-eating disorder behavior)
• Feels as good about herself if not better than other girls her age (few women ever feel completely satisfied with their appearance so we would not expect that of her)
• Able to see her body accurately (thighs or arms not larger than they are for example)
• Decrease of depression and anxiety related to lack of nutrition, food, obsessive thoughts; fewer mood swings other than “normal” adolescence
• Able to have a voice and put words to thoughts and feelings that perhaps she was not able to before the eating disorder
• Enjoys activities and events where food is present
• Able to identify red flags that might signal she is vulnerable to relapse
• Able to ask for help and make progress regarding perfectionism if present

If you are new to Maudsley you might be thinking, “This separating ED from my child seems a bit hokey. Is this some sort of multiple personality thing?” The answer to this is no and I’ll tell you why.

In reality separating the ED from your child is the same thing you do when your child exhibits inappropriate behavior like hitting a sibling. You separate your child from his behavior. Your child’s behavior is “bad” so to speak, but your child is not “bad.”

The same is true when your child has an eating disorder. You learn to observe and identify your child’s anorexic thinking and behavior. She comes to the table grumpy and refusing to eat anything but salad. This is eating disorder thinking and behavior. This is not your child’s normal thinking and behavior.

You see a change in your child in a variety of situations.
• During a meal
• Before or after a meal
• At a restaurant
• At a friend’s house

Over time you get really adept at identifying ED behavior. Okay so you can identify it, now what? Once you are able to sense the behavior changes you are better able to keep your own emotions in check.

You can say to yourself, “He is not doing this on purpose or to be difficult. He is under the influence of the ED. The ED is dictating what he can and cannot eat.” He is hearing in his mind things like, “You can’t eat that, it has too much fat in it. If you eat that you have to do 500 sit ups tonight. They just want you to be fat so don’t eat that.”

One of the things that frighten parents is possible relapse when their child is recovered. The best way to prevent or catch relapse quickly is to use what you learned about her eating disorder thoughts and behavior when she was ill.

When your child was ill with an eating disorder she said and did things that signaled to you this was the illness and not your daughter. All girls have eating disorder thoughts and behaviors in common. Your child, however, probably exhibited things that were unique to her and her illness.

Part of the reason your child got better from anorexia is because over time you got to know the ED. You learned the kinds of things that your daughter would say when under the influence of the eating disorder.

Things like, “I’m not eating that! I’ll eat half of it but that’s it! You can’t make me eat this! What did you put in this muffin? Did you make it with butter? That has too much fat in it.” I know these statements sound familiar to you.

You began to recognize the things she would do when the ED was raising its ugly head. You knew whether or not the ED was at the dinner table with you by her body posture, facial expression, and her reactions when you put the plate in front of her.

Because of the busy work and high pace of life, modern people pay less and less attention to their daily diet. Over time, they will easily form some bad habits in dieting. These bad habits are not only very harmful to their body, but may also cause premature senility.

The first bad habit: eating instant noodles for breakfast.
Often eating instant noodles for breakfast is very harmful to the health and development of human body. Because the human body needs six categories of nutrients to maintain its normal physiological metabolism, but the main component of instant noodles is carbohydrate. It lacks of other essential nutrients. As a result, if you eat instant noodles as breakfast for a long time, it will cause dizziness, lack of energy, palpitation, and so on. If it is severe, it can even cause weight loss, muscle atrophy and other symptoms of malnutrition.

The second bad habit: drinking mineral water instead of plain boiled water.
Many people think that mineral water contains a large number of minerals, so they can replace plain boiled water by mineral water. However, they rarely know that mineral water may also be contaminated by the harmful substances in the land. Recently, the Dutch scientists find out that mineral water is more vulnerable to the contamination of harmful microbes and bacteria. Although these bacteria may not cause great threat on human body, but for those whose immunity is relatively weak, the bacteria contained in bottled mineral water may cause serious danger on their body.