This was first a post in a closed Facebook community, International Eating Disorder Family Support; I am taking it public as it was very well received and a lightbulb moment for several people, with several others happy to put a name to the successful path they had navigated by trial and error.
Adaptive Eating: I mentioned this on another post and have been asked to elaborate on this concept . . .
After full weight/brain restoration to 110% of her personal growth curve, our 18-year old daughter worked with her RD on intuitive eating. After a few months, we had to pull the plug because though she was not restricting, she was losing weight at a slow pace of about 1 pound per month. The reason for this is that her natural appetite, or intuition, did not match her calorie needs.
The solution arrived at is one my friend, psychologist Tara Deliberto*, calls ADAPTIVE EATING (AE). In AE, there is the recognition that it's best for someone in recovery from anorexia never to have an empty stomach, so breakfast should happen soon upon waking, eating should happen every 3 hours or so, and a snack before bedtime is important. Within the framework of regular snack/mealtimes, the person is free to choose what they want to eat, AND it matters that they keep in mind that their metabolism requires higher fat/calorie choices. This worked great for where she was in recovery - motivated to stay well, just not hungry enough to make it happen naturally.
This all feeds into, for me, the idea of relapse prevention. Our kids are not normal - they have specific wiring issues related to food, weight, exercise, temperament that have to be factored in. Their metabolisms are often higher than most people's. Recognizing the reality they have a medical condition that requires mindfulness around food and movement need not be seen as a negative - it simply is what is.
What AE looks like for my daughter at 24 is that she has now wired herself to "intuitively" about 6 times a day, to wake early enough that she can have a good, hearty breakfast shortly after waking, that she's always got a couple of Kind bars or bags of nuts in her bag for snack, that she plans ahead for where she'll be having lunch or packs something, etc. She doesn't LIMIT herself by this eating plan, she just ensures she meets the minimums needed to meet her energy needs, avoid weight loss, and to keep her brain in a healthy space. She eats freely of all types of food - "healthy" and "junk" foods both have their place in maintaining her physical and mental health and not much thought goes into it - she has effectively wired her "intuition" to give her what she needs.
It’s my hope the reconceptualizing of anorexia nervosa (and presumably and potentially other eating disorders) metabo-psychiatric disorders will provide more interest and space for the ideas that brain restoration and relapse prevention require more intake, more weight, more time for healing, more relapse prevention protocols and research-based on these concepts. There’s no guarantee this will work for everyone, and I have seen it work for many and count myself beyond lucky to have had access to this level of forward-thinking clinical guidance and support, and that it was successful.
*You should definitely read her book.