Expert: Ryan Hale - 4/8/2010

Question
My daughter has just started to try to eat. She has not had a what I would call a full day of food since last August. Yesterday she finally agreed that she would try eating small meals throughout the day. She is 14 her BMI is 16.8. She is showing many signs of malnutrition and we are under several doctors care. But today she woke up feeling shaky, dizzy and weak, she is agreeing to still eat small amounts of food every couple of hours. I was wondering if this is her psychological response to "Oh my gosh I am doing something I don't want to do." or also a physical response of her body saying, "I hardly have the ability to stay alive and now you want me to digest food too?" I don't want to make her food aversion worse but I also want to help her beat this thing and get healthy. Do you have any thoughts?

Last week she was loosing about .5lbs a day. The docs say in order to stay out of the treatment center she needs to gain 2 lbs. We are trying to work on that goal.
Thank you

Answer
Penny- your daughter's BMI is near starvation level.  There are many medical reasons for her to be dizzy and weak, and the most serious involve her heart and its ability to function.  Most deaths due to eating disorders are due to heart failure.  There is no way for me to know if your daughter is eating now because she wants to get better, or is eating small amounts that she feels will make everyone happy and still not allow her to gain much weight.  The most immediate concern with a eating disorder are the potential medical complications, however, if she is out of immediate danger, she'll need plenty of help from the mental health folks on the team.  Without all aspects of the condition getting help, full recovery is difficult and unlikely.  At some point, family therapy would be good as well.  Help her keep up the re-feeding, but it needs to be enough so be in constant contact with her medical providers.  I know you don't want to be too pushy and mess up the delicate balance between being helpful and causing her to not want to eat.