This is a difficult time of the year for our patients and, I imagine, for eating disordered patients everywhere. All over the country people are making plans for family to gather and to frequently do what can only be described as “binge” together. Why do I say binge? Well, because on Thanksgiving day people frequently eat more, sometimes much more, than they ordinarily do, which triggers a lot of “regret” style talk, which triggers a lot of discussion of everyone’s diets, weight goals, food preferences and beliefs.
“I didn’t eat all day so I could pig out tonight”
“I’m going to break my diet today. Usually I only eat 1600 calories since I’ve been enrolled in the X diet ”
“Did you know there are xxx calories in a piece of pumpkin pie?
“Don’t worry, my cousin brought a pie made with no cream and no eggs and no sugar.”
“Did you see how much she ate?”
“Wow, this is a lot of food!”
“Let’s eat early so all that food doesn’t just sit in our stomachs and make us fat.”
“I’m so full I’m not going to eat for two days”
And then imagine the young eating disordered patient whose grandmother/father/aunt/uncle/cousin/neighbor says “Honey, you look so great. Finally you have a little meat on your bones.”
Or (to the actively eating disordered child) “I wish I had your will power and just a small dose of anorexia myself….hehheh.”
How do we deal with this potential stress at Kartini Clinic? Well, it depends on where the person is in their treatment. If they are at a very early stage, say the first six months, we recommend that the family take a break from the Thanksgiving tradition of the past and plan a quiet family time with food, of course, but also with games and distractions and no food related comments. Remember, tensions are likely to run high and it’s just not possible to “control the infield chatter” with a large group of well-intended people who may not understand what you and your child have been going through.
Our kids stay on the meal plan on Thanksgiving, and it’s not difficult to do so. The meal plan perfectly accommodates turkey; mashed potatoes or sweet potatoes or stuffing or rolls; gravy; vegetables and salads. There is, however, one notable exception to this: the tradition of pumpkin pie.
Let’s talk about pumpkin pie. Every year, without exception, I have been asked about having a piece of pumpkin pie (not on the meal plan). But here’s the rub. It’s almost never the kids who ask me, it’s almost always the parents. I always say “sure, if he/she wants to. But remember, it is extra, not a replacement for something else. And no meals can be skipped because he/she ate a piece of pie” (also known as compensatory restricting). Then I turn to the child and ask “Would you like to eat a piece of pie?” Contrary to what you might think, they nearly always say “not interested.” I then let the parents know that the child can change her/his mind at the last minute, but that they should not be pressured to eat pie if they do not want to. No one should make them feel bad because “not to eat dessert is not normal” or because “Grandma made it especially for you.”
Remember, everything we know about managing eating disorders the kids taught us.To reduce tension, make a plan. Make a plan and then stick to it in a spirit of quiet family unity and gratitude.
It’s supposed to be thanks giving, right?
