This post was originally published on November 23, 2010.

Thanksgiving is one of my favorite holidays. As is probably true for many of you, it’s all about giving thanks, and in our own family we have a lot to give thanks for this year, not least for a tiny new granddaughter (3 weeks) and a healthy, happy grandson (one year old this weekend). It’s also important, in my view, to have a holiday that focuses on gratitude, especially when life gets challenging, as it does for many of our families at Kartini Clinic.

But there’s no denying Thanksgiving is also very much about food, the traditional food of the November table in the United States: roast turkey, cranberries in many incarnations, potatoes (principally mashed and covered with gravy), sweet potatoes, bean casseroles, rolls, biscuits, and—of course—pumpkin pie. And all this food is eaten together with friends and relatives in one glorious, much advertised binge, where people sit around afterwards and invariably discuss how much they have over-eaten.

Whenever conversation swirls around food and over-eating, comments about weight, dieting and exercise are only moments away. People feel compelled to talk about their weight and that of others.

Oh well, who cares, you may ask? Our eating disordered patients, for one.

Thanksgiving week is hard for our providers too because the potential for suffering is so large and so easily misunderstood. We have discovered, over the years, a need to discuss preemptively with our families their Thanksgiving plans. Unfortunately, to suggest that the very year their child is first diagnosed with an eating disorder might not be the best year to join the whole family for a Thanksgiving dinner (a return to a sense of “normality” for many) is very close to criticizing apple pie and motherhood. People are shocked and aghast. That is, until they try it.

Kartini Clinic patients all have a meal plan, into which a Thanksgiving meal fits nicely, so that’s not the problem. But what are some of the other issues our families face?

1. Our kids are often very concerned that family members will try to comment on what they are eating, try to force them to eat or “try” things they are uncomfortable with, ask them how treatment is going and hold forth about their personal opinion of the causes of eating disorders in general and anorexia nervosa in particular. Some families have not told other family members or close friends about their child’s illness, which is sometimes obvious and sometimes not. 
2. Unless there is a plan for handling dessert, it is common for panic to set in after having eaten it, followed by attempts to restrict subsequent meals and/or to get rid of the “excess calories” by vigorous exercising or even purging. It’s a classic “trigger” for many.
3. The Thanksgiving mealtime discussions about weight and diets and calories and who cooked with butter substitute and cream or no-cream, etc. can also be very triggering and anxiety provoking for an eating disordered child.
4. Many college-aged youth with a personal history of an eating disorder come home for Thanksgiving weekend and it is the first time their parents have actually laid eyes on them since they went away to school. Often they are shocked by the weight loss. And panicked. Parents have no recourse to recoup their tuition payments should their child not return to school right away, and their young adult is almost certainly not willing to miss school for treatment. Add to that, that there is only one clinic day (Friday) after Thanksgiving before the student is scheduled to fly out to return to college; getting a doctor’s appointment at the last minute on that Friday is close to impossible. And so on. 

What to do? Well, the most important thing to do is to think ahead. In the case of an college-aged eating disordered child, parents need to decide on their stance ahead of time, before their young person ever comes home. They need to decide how they would handle a worsening of symptoms or obvious significant weight loss. Better to have a plan in place that goes unneeded than to deal with a problem in a panic. Parental unity of approach is also essential. If you are concerned that your child will not be allowed to return to school, look into tuition recovery for medical emergencies. It’s essential to think ahead.

For younger, school aged patients, discuss your plans together as parents, not primarily with your child. Our patients are good kids, many are overly conscientious and suffer intense guilt if they think that they are negatively impacting their family’s Thanksgiving. If asked, they will commonly say “please go ahead and celebrate as usual, don’t worry about me.” But be wary. Their suffering is real. If you haven’t told your relatives about treatment or you fear one or more of them will not be able to hold their tongues about your child — about eating disorders, about dieting, etc — arrange to celebrate at home with no one else except your immediate family. And make that celebration wonderful. Remember, it is ONE dinner and by the following day it is over. Next year may be different.

Then you can truly give thanks.