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COUNTING THE CALORIES AND KEEPING A FOOD DIARY

As I have already explained, we took the unusual step of involving Helen in her own recovery; it wasn’t just done to her, but also done with her. Of course, there was a very high degree of compulsion. But where possible, we would allow her choices as the more in control she felt of her recovery, the less panicky she was likely to be and, therefore, the more control we had over her. She was afraid of re-establishing an eating habit for a number of reasons but one of the more subtle ones was her fear of being hungry and thus losing control over what she ate. By completely shutting down her appetite - which she had done by March 2003 - she had overcome hunger. By forcing her to eat, we had reawakened that perceived threat and made her feel very insecure. Therefore, in negotiation with Helen‘s dietician, Fiona prepared main meals for Helen which were filling but low in calories such as quorn and root vegetable stew. There was never any meat in Helen’s diet because she was (and still is) a vegetarian. Helen’s dietician had given us initial guidelines regarding the types of foods she wanted Helen to eat on a daily basis. We would then devise a diet for the day which would incorporate the required number of calories and would largely consist of safe foods. However, there was also a fair smattering of what Helen might consider to be the more dangerous foods.

In order to do this as accurately as possible, we would use an old exercise book and divide the day up into regular meals. Each element of every meal was weighed in front of Helen - or by Helen in front of us. The food type, weight and number of calories were detailed in separate columns. In order to estimate the number of calories in a particular food we consulted a book entitled “FOOD AND DIET COUNTER” published by Hamlyn. Helen was involved in this process until she eventually learnt to trust us again. This took about five months, by which time she no longer felt the need to supervise the preparation of her meals. By this time, we had demonstrated to her that we had kept all of our promises, i.e. that weight gain would be gradual, that food would not be allowed to become a threat to her and that, above all, we would not allow her to become fat. Even to this day, I remind her of the promises she made us keep and when she craves sweet things - as all kids do - I strongly discourage it and make her eat fruit or a yoghurt instead.

Again, both Helen’s dietician and psychiatrist had reservations about this aspect of our programme because of their concern that calorie counting would become an unhealthy obsession but, just as with the exercise, once Helen had learnt what foods she could safely and healthily eat, the desire to weigh everything simply disappeared. To be truthful, it was too much bother. So, by September 2003, this also had become a thing of the past. Below is an example of the type of diet sheet which we prepared for Helen on a daily basis.


MEAL FOOD WEIGHT CALORIES RUNNING TOTAL
BREAKFAST Kellogs Fruit and Fibre 47g 165 165
         
LUNCH Bread roll 41g 119 284
  Cheese spread 14g 32 316
  Fruit salad 389g 156 472
  Diet Coke 500 ml 2 474
  Onion soup 389g 97 571
         
TEA Quorn mince 150g 141 712
  Pasta 100g 89 801
  Vegetables 100g 50 851
  Tomato soup 287g 184 1035
  Diet ice cream 256g 320 1355
         
SUPPER Chocolate muffin 119g 310 1665
  Diet ice cream 300g 375 2040

The overall calorie target for this particular day (Sunday 18/5/03) was 2,100 calories. This figure would have included the calories added on as a result of the day’s exercises which would most likely have been a one hour walk and, therefore, about 200 calories. It is also important to add that Helen would also have consumed a considerable amount of water during the day. Initially, the amounts of water were prescribed by Helen’s dietician, though by this time Helen was drinking water freely as she had learnt that pure water does not contain calories. Therefore, we were not monitoring her water intake and so had discontinued detailing prescribed amounts of it in her daily eating plan. The last entry in Helen’s food diary is dated Saturday 24/8/03, after which date Helen had once more become a free eater and, therefore, the anorexia had been broken!


MEAL
FOOD
WEIGHT
CALORIES