Am I right to be concerned re daughter's weight loss

[gemandjule]

This time last year my DD1, then aged 15, weighed 56kg with a BMI of 22. She had a bit of a "tummy" and decided to try and lose some weight. I wasn't too concerned initially as she loves food, was eating well and just cut out rubbish.
She slowly lost 6 kg over about 8-9 months. She then started to look thin, even DS1 aged 19 noticed and he wouldn't usually take any notice of her! I started getting more conscious of her eating habits at this stage. She seems to have cut back more although she does eat 3 meals a day. Since March though she has lost another 3 kg. Her BMI is now 18.5, so still within the normal range but low end.
She swims quite a lot, Competitively up to last year but dropped to club squad this season as she has state exams this year.
She has porridge for breakfast that she makes herself with water rather than milk, a boiled egg some salad and a wholemeal muffin for lunch and a smallish portion of whatever we are having for dinner which would always be home made from scratch so nutritionally well balanced. She still trains approx 6-8 hours/week though with her swim club,(gym and swimming.)
She hasn't had a period since March and would have been regular prior to this but has really only missed one month and this may be due to exam stress. She seems in good form, a bit stressed about exams but not excessively. Although her eating has got rigid and controlled she is still eating as described and will occasionally have a slice of cake. I really don't think she is vomiting. Do I need to be worried or should I just admire her discipline! She is my third DC, others are 19, 17 and 13 so I am used to teens, just unsure how serially to take this.

[gemandjule]

That should say, how seriously to take this.

[PurpleSwift]

Be concerned. I don't think it's totally normal for a teenager to be so concerned over losing weight, especially not if they're already at a healthy weight. Can you try talking to her? Tell her you're concerned about how much she is eating and ask her how shye feels about how much she is eating etc.

[gemandjule]

Thank you for the responses. I really need to try and get some perspective on this. We get on very well and I do talk to her about it. I'm afraid if I make too much of an issue she will start hiding things from me. I think I will challenge the milk in porridge. You are right dancingqueen, the calcium is a concern and it would increase her calorie count a bit.
We haven't eaten out for a while but certainly the last time we did she ate her main course but did not have desert. She is definitely preoccupied about food in that she is very aware of calorie content and she looks up recipes on line. She would follow fitness experts on instagram etc so is very aware of balanced diet, I think she's just worried about her caloroie intake.
I think you are right about the maintenance issue. We have discussed that. I have even gone on line with her to work out her calorie consumption needed to maintain. The problem is that when she sees 1900 calories before she adds in training she just sees this huge number that frightens her.
Thanks also for the advice not to panic, I feel as I say if I make too much of a big deal I will push her away. Do you mind if I ask what you think would have helped you early in your illness? It might give me some insight into how to stop her losing any more weight.
Thanks also purple. As i say I am trying to keep the channels open and not get on her case too much. I am unsure of the right balance though. Her exams start in 10 days and go on for 10 days. I think I am really hoping that when these are over she will relax in all areas and when she is free for the summer things will get back to normal.

[gemandjule]

I had a quick look at that forum. I am a bit freaked out by it because it seems that everyone there has a definite diagnosis and their kids are a lot farther down the line than we are. Maybe I need to get my head out of the sand though and admit to myself for a start that this needs to be taken seriously.
My plan as of this morning is to see what weight she is now, It's over a week to my knowledge since she weighed herself. I think I am hoping she may have leveled off although when you look at the maths of her calorie deficit it's hard to see how that could happen. Assuming she has lost more weight I am going to tell her the we are concerned about her and that she NEEDS to eat more. I have a work meeting tomorrow where I will meet the dietician who works with our MDT (I am a health care professional) and I will present her with the facts and see what she recommends doing next.
I am going to insist she makes her porridge with milk and that she puts mayonnaise on her muffin at lunch time. I will also serve her portion of dinner myself and insist on 2 snacks/day. One of the problems is that she feels very sick and complains of abdominal pain if she eats a bigger portion or some cake for example but hopefully if I can get her to get some extra calories as above it won't increase the volume of what she is eating much and so she will tolerate it.
Should I weigh her once/ week or not?

[gemandjule]

Ok, just weighed her, 46.6 kg so further 0.7 kg in past week. Have chatted with her and she has agreed to above suggestions. She insists she is not still trying to lose weight but is afraid she will gain if she eats properly. Baby steps, will aim for no further loss and then try and get her to put on a few pounds if we can stabilize for a few weeks. Am I on the right path? All advice welcome!

[littlegreengloworm]

I am not experienced enough to advise but I would get help here and you're right to be concerned op. wishing you the best an hope you get the right support.

[crazykittensmile]

I developed an eating disorder at 15 around the time of my GCSEs and my eating remains disordered now at 27. A large part of eating disorders for many people is the control, when my parents realised the extent of the problems with my eating they started trying to impose rules on me and unwittingly take away my control (eg: they dished out my portions and would insist I ate it all, wouldn't let me go to the bathroom after dinner in case I made myself sick etc). It made things worse as I started having to try and hide things from them and became even more rigid in restricting what I was eating when I wasn't at home. I became sneaky as well, hiding food on my person instead of eating it, being sick into cups in other rooms of the house rather than in the bathroom and drinking large amounts of water before my parents weighed me so that I was heavier and it didn't look like I was losing weight.

If your daughter does have the beginnings of an eating disorder (and it may be she doesn't and is just needing to increase her calories so that she is maintaining weight rather than losing it) then I think you do need to be careful as to how you approach things and to ensure that she doesn't feel she is losing the control she has tried to carve out. I do not think weighing her weekly will be helpful and may make things worse. She may find the pressure to be gaining weight coming from someone else difficult to deal with, often people who develop eating disorders are high-achieving and perfectionists in nature and put a lot of pressure on themselves. More pressure from additional sources could increase the need to be rigid and controlling around food.

It is undoubtedly necessary for your daughter to to up her calories so that her weight stays stable, but let her control where her extra calories come in. Having to increase her calories may initially be a frightening thing and she is likely to want to be in control of it. If you impose where the calories are coming from (milk in porridge, mayonnaise on muffin etc) then she is losing that control and may look for other places in which she can regain the control. I would sit down with her and have an open and honest discussion, explain that you are concerned that she isn't eating enough, especially considering the fact she does a high amount of training each week, and talk to her about nutrition. Look at how many calories (roughly) she is eating currently and how many she should be and perhaps decide together where would be good places for her to add the extra calories. Don't necessarily expect her to make all of the increases immediately. It might be that she needs to do it in small steps, so the goal may be to eat 500 extra calories a day but initially she would just increase by 100. After a few days she may increase by another 100. You could also look at the balance of her diet and agree on whether she needs to increase her intake of certain nutrients (eg: calcium) and how she should do this. By all means suggest the milk/mayonnaise etc but I wouldn't insist on them if she is able to offer and stick to reasonable alternatives and you avoid her feeling she has lost control.

All that said I am only speaking from my own experience and, if your DD does not have an eating disorder or issues around food much of that may be overly cautious/irrelevant. Even if she is developing an eating disorder her experience or need may be different and I am not a trained professional so feel free to discount what I have said - I think speaking to the dietician is a good idea and she will likely have better advice or be able to put you in touch with somebody else. Hopefully you have not spotted the signs of an eating disorder but if you have then it sounds like you have spotted them fairly early and like you have a good, open relationship with your daughter so good luck working through this and I hope whichever plan you come up with to help her to increase her calorie intake you are able to help her make those at time difficult steps together.

[gemandjule]

crazykitten and gloworm, Once more thanks for taking the time to reply and share personal stories. I think that's what freaked me out a little about the site above as it seems like if I start posting on there I am assuming a definite diagnosis where it may not have reached that stage yet.
I do feel as I think about it more and more though that the level of control she exhibits around her eating is not normal. She seems amenable to try and increase her calorie consumption though so unless she is lying to me (which is of course possible even though I can't imagine it) I am hoping we will make progress.
Interesting about taking away control from her, one of the concepts advocated on the forum is "the magic plate" which does take away control from the patient. As far as I can see it's to try and break that psychological obsession with calorie counting.
I don't in general parent autocratically though and would much prefer to try and let her make her own assessment of what she should eat. But here I find myself, having taken the "hands off" approach for 2 months, in a situation where she has lost 16% of her body weight over the past year and 6% of that in the past 4 weeks.
Anyway she didn't want mayonnaise at lunch, asked could she have cucumber relish instead. I said no to that as it's basically cucumber and vinegar, not exactly high calorie!, and we agreed on olive oil based spread. As i said, baby steps.
I think increasing by 100 calories/day initially and going from there seems very sensible, the last thing I want to do is frighten her away.
Again thanks for the outlet. It's great to feel I'm not just turning the ideas over and over in my own head.

[crazykittensmile]

The advice on the other forum about taking away the control may be better worth listening to as my own, I suppose I am posting from my own point of view and my thinking around food and control may well still be distorted. If the magic plate is well advocated and the break in control seen as important then it may be right and don't discount it on anything I have said, I am just seeing how much I would have hated that but equally if it is an eating disorder at some point it's not unlikely you will have to treat it with methods your DD won't agree with (at least not without hindsight). An eating disorder is a mental illness and as such your daughter may not recognise what she needs (and as somebody with a history of eating disorders I too may not recognise what she needs, sorry) and I think if you find she is unable to make her own assessment of what she will eat you may be right in taking back the control.

I'll also say that I did not have a particularly positive or honest relationship with my parents - I was not willing to work with them and when they tried to help me I did everything I could to do the opposite and to keep my control. There were other issues there. It sounds like you and your daughter do have a positive relationship and that she is willing to talk to you about this and co-operate with what you suggest. As such she may welcome your intervention. For me I began to make progress when my boyfriend dished out food for me and would buy me gifts if I managed to finish what he'd served for a certain number of meals. I did appreciate his care and want to please him and it was a relief to have somebody else making the decisions (I just couldn't cope when it was my parents) so if you do have a good relationship with your daughter perhaps she will find it helpful if you are making some decisions about what she eats. Sorry to backtrack on my last post, I guess unfortunately there are no hard-fast solutions.

I think it's wise that you are recognising that progress may involve baby steps. Having only been on the other side I cannot imagine how difficult it is for a parent to feel their child is making choices that are having impacts on their physical/mental health and I think with my parents at least there was a desire to fix the problem immediately. Unfortunately the process to recovery can be slow and may not be as quick as you would wish, but if she can keep making small steps in the right direction (eg: the olive spread) then that is positive. Even a small increase in calories can seem like a massive thing if she does have an eating disorder.

Also if you are becoming more convinced there is a problem do consider seeking professional help. If she is co-operative and feels she would like to try it counselling/therapy might help her, not necessarily counselling related to whether she has an ED or not but just that person to talk with who isn't a part of her everyday life. If she isn't co-operative though at this stage I wouldn't force her into it as in my experience therapy only works when you are open to it. A visit to your GP may also be an idea, especially if your daughter isn't making progress with regards to slowing down her weight-loss or gaining weight, although you say you are speaking to the dietician tomorrow so that is a good first port of call and I hope she will be able to make better suggestions for you and maybe will know of some local services.

As I said before I wish you, your DD and the rest of your family well as you work through this and hopefully your daughter will be able to make the progress necessary towards eating normally again.

[gemandjule]

Sounds like you had a great boyfriend. I'm looking forward to talking to the dietician tomorrow. it will be interesting to see what she says.
This photo is from 16th April so has has probably lost 3.5 kg (about half a stone) since then

[Solasum]

Half a stone since that picture seems like an awful lot to me.

I have never had an eating disorder myself, but watched a close relative develop one, and now a decade later tragically am watching her desperately longing for a baby it seems she has virtually no chance of having. :( I wish we had all tried to help her at the beginning, but we were too scared.

It is very hard. Good luck to you all

[gemandjule]

Me again. I'm still here, still reading and appreciating hugely the advice and support. We had a reasonable day yesterday. I haven't worked it out fully but I estimate she may have eaten approx 1200 to 1300 calories. This is way short of what she needs to maintain (approx 1900 if not training) and obviously even farther short of what she needs to gain but I would say it's about 200 more than she had been eating typically.
Looking forward to talking to the dietician today and see what she has to say.
My big questions are; 1. Does she think it's pathological? 2. If so does she need referral or can we give it a month or so following a plan and see how she does? 3. Can she continue to train? She really loves training and has very good friends there and I would hate to take her out but we'll see. 4. Should we weigh weekly?
I'll post back this afternoon on the outcome.

[crazykittensmile]

I'm pleased to hear that you had a reasonable day yesterday. Brilliant that she's managed to increase her calorie intake by 200 calories - if she can manage a little more every day or so then that is definitely a step in the right direction.

Good luck talking to the dietician and I hope she is able to offer you the advice you need.

[gemandjule]

Ok. Had a constructive chat with dietician. 1. Pathological? possibly but not necessarily. Cannot lose anymore weight as has some warning signs and at the lowest limit of normal at the moment. Thinking does not seem disordered and seems open to increasing calories though which is good. We'll have to see if she actually does what she has committed to. 2. can we wait? She happy to give it 4 weeks as long as she is not losing anymore weight and is genuinely making an effort to gain and not just pretending to go along with it. 3. training? She feels let her continue training as long as she doesn't lose any more weight but has to be prepared to eat more to compensate for calories burnt and if she cannot do this will have to pull back on training. 4. To weigh or not to weigh? Weigh weekly at most but will be reassuring for me to see her increase and reassuring to her to see not going up too far.
First target is 50kg where she was in above photo. She is to try and eat little and often, healthy snacks e.g. full fat yoghurt, oat based cereal bars, rice brackets with cheese/peanut butter/nutella.
If we are not happy in 4 weeks will have to go down more formal referral route.
So now we have a plan, what do you all think?

[HolidayCriminal]

Sorry you're going thru this; the fear of calories is what really triggered alarm bells for me.

Keeping communication going is your best strategy, but I'm afraid what others said about loss of rationality is important. Otherwise you could just point out that food is energy & she can't be competitive at sports without energy. People with compulsive disorders stop being rational & just start being sneaky. I'd be seeking professional advice, now. Are her swim club aware of how she's shrunk?

And I wouldn't weigh at all. It's making her body size too important.

[KittyandTeal]

I've had various eating disorders since a teen and still struggle with food.

I was reading this think generally if say ok but keep an eye out. However, when you mention the 'big' calorie number to maintain frightening her that rang so many bells with me.

I use mfp app and will stew if my numbers go red for the day. Between that and spending so much time following fitness people etc if say keep a very close eye.

She really needs to start maintaining now. It could be she's being teenage obsessive about being healthy whit is good. Keep talking to her about not letting it get out of hand. Focus on eating healthily so she feels good rather than the weight loss being the good feeling iyswim.

If she won't listen maybe start gently discussing the impact of eating disorders on general living, give her additional control elsewhere in life (I'm guessing but by the sounds of things you probably give her a fair bit if freedom so not sure where this could change)

I'm sure she'll be ok though.

[Coveredinweetabix]

I caveat this suggestion with the fact that I have very limited personal experience of eating disorders but could you find some articles online from the run up to London 2012 (or any other competition) in which Rebecca Adlington or some other swimmer describes what they eat in a day? Your DD obviously isn't training as much as them but it may help her realise how much they ate & therefore be more accepting of how much she has to eat to train as much as she is & maintain her weight and remain healthy?

[jan2014]

hi there, i haven't read every thread but am really sorry to hear what you are going through with your dd. just wanted to say i have had eating disorders for years, and i also agree with dancingqueen about the magic plate and about knowing about her weight (she doesn't have to know)
the thing about eating disorders is i believe, when the weight goes on and she is better nutritionally, this will heal her mind. when the weight is lost, she can't see straight and the ed behaviours are worse. the weight on FIRST helps her get better. a lot of people think it is the other way round (your mind has to get better first)
i think for sure you need to tell her she has to have the calcium and take that control away from her. i have severe osteoperosis now and am 32, the most bone building is done from teens to twenties, you have the opportunity to prevent this.
i know this all must be very confusing to you, reading so much conflicting advice. i hope you find your way and wish you and dd all the best - i think its fantastic you have spotted this early enough to help her now before it gets worse.

[gemandjule]

I'm sounding like a stuck record now but I really want to thank everyone for taking the time and trouble to read and advise. Yes, some of the advice is conflicting but that's actually fine because it allows me some leeway. I can't beat myself up for choosing one way over another if there isn't consensus. Does that make sense?
She did ok again today, ate 2 chocolate coated rice cakes as an afternoon snack but did the complain for feeling sick after her dinner. She did however eat it. It is very hard not to find myself saying to take it easy is she's not feeling well. Trying to get our child to eat when they insist they are full goes against the grain!
It's also hard for me to adjust to having to micromanage her food. My kids are 19,17,15 (nearly 16) and 13. Apart from evening meals and the fact that I do the weekly shop and so have control over what food is in the house, I haven't much to do with their diet. I mean I am in the kitchen in the morning when they are having breakfast and I make sure they eat, but one might have cereal, another toast and peanut butter, another eggs. I don't dictate what they eat. Trying to stop the 19 and 17 year old DS's from emptying the cupboards the day I do the shopping is my usual preoccupation, not making sure one of them has had a snack. Anyway, enough of the pity party. It is what it is and hopefully we can turn this around and she'll be ok. I really just want her to know how much we love her and think she is fantastic.
As always advice form everyone, especially those who have been there themselves or with their kids, is very welcome.

[gemandjule]

Oh, as regards her coach, he's great. I spoke to him a few weeks ago, ironically at a sponsored swim where she had just swam 6.5k in 2 hours. Because she had been able to do this, and this was a few weeks ago so she was heavier, I wasn't too concerned at the time. He had noticed her weight loss (you'd have to be blind not to, especially in a swimsuit/gym gear which is when he sees her). He also felt she had lost speed but was happy to let her train at her own pace and pick up again when she feels better so he is genuinely not putting any pressure on. She hasn't had much training recently as there have been weekend galas that she has chosen not to enter because of her exams. Although she is not competitive as such at the moment she was at a 2 day regional long course gala about 8 weeks ago and did reasonably well but again that was before she really accelerated in her weight loss.
I might have another word to him but as I say I'm very confident that he is aware and isn't pressurizing her

[lelia]

Hi , I have a daughter who sounds very similar to yours . Her bmi was 18 before Christmas and through discussion she realized she needed help and was very willing to work with dietician and councillor . However very quickly it became clear that she had a real problem and was anorexic - voices telling her not to eat , shaking and crying while eating , her BMW dropped to 16 . To cut a long story short we followed the Maudsley approach which basically means family therapy and getting her weight up as soon as possible . She was off school for 4 weeks , dh worked from home for 4 weeks , and the pair of us sat with her for every meal - but it worked !
She had to stop swimming which was very hard for her , starting back was a great incentive to put on weight .
How is your daughter socially ? Dd did become very introverted which was a real sign that something was wrong .
On the plus side this absolute nightmare made us get to know our daughter even better, and even though before I would have said we had a good relationship it is definitely even better now . Have 4 kids too and dd was always the one whom I thought I would never have to worry about .....
I'm sure you are not at this stage yet but everyone has said to us her super recovery , though we will always have to keep an close eye on her, is down to early intervention which is exactly what you are doing .Thinking about you .