400g loss  :-(     and that was with Waif drinking 2 smoothies on the way to the appointment  :-(

She has grown another 0.5cm and her overall % (wahtever that is) has gone, over the 9 months of therapy, from 77.9% to 82.5%    This is up, which is fantastic, but still within the anorexic range of sub 85% and not merely underweight.

We talked about how this might have come about.  I was totally honest about Waif's exercise - cycling to school, tennis lessons, the occasional swim and school PE and asked if we should reduce this.  The psych, surprisingly said no.  She said that Waif needs to learn how much she needs to eat whilst living a normal, active life and doesn't want her to put on weight only when sitting vegetating in front of the TV because then when she restarts normal activities, she will lose weight again.

So the only option is to increase the foodplan.  We decided to add a large piece of cake on.  I suggested lunchtime but the psych thought that tea would be better as food eaten at home seems to count as more.  Waif, surprisingly, agreed that tea would be better than lunch.

We are also adding in an additional late night snack of cheese and biscuits.

THe psych noticed that the food that Waif avoids (potatoes, including chips, mayonnaise, biscuits, cheesecake, cheese, pastry and all pies) are all the high energy foods that an anorexic might choose to avoid as perceiving that they are high calorie and advised that Waif needs to begin eating these foods normally.

I wondered whether we should be monitoring Waif's calorie intake to ensure it is over 3,000kcal a day but the psych said not.  She said that it is not good for anorexics to count calories as that makes them worse.  Of course, the first thing Waif does whenever I buy a new food is to check the packet for the calorie information and, if it is home made or I have thrown away the packaging, go on the internet for information.

THe first time I bought her cheesecake, about 3 months ago, Waif gobbled down 2 slices and I thought I had a result (as that was about 600 kcal in one snack) but the next day claimed she didn't like it.  The same thing happened in November when mince pies came back into the shops for Xmas.  Waif has always loved mince pies so I bought a couple of boxes.  Again, Waif wolfed down the first couple but by the next day (post internet searching on calorie information) claimed she no longer liked them.  So when Waif yesterday ventured that she didn't know about calories, I pointed this out and she didn't argue with me.

Instead of talking about "high calorie" food, the psych carefully talks about "high energy" food, in a positive way.  I shall try to emulate that.

In the end we decided as I have explained, on adding even more food to the meal plan.

It now reads as follows:

Breakfast

2 pieces of toast
2 fishfingers
Bowl of cereal and milk
apple juice
yoghurt

Mid morning snack

A doughnut
A juice

Lunch

sandwich
crisps
smoothie or yoghurt drink
apple
chocolate bar

Afternoon snack
cake
2 pieces of toast
hot chocolate or ice cream

Supper
50g cheese or 100g meat or 150g fish
150g carbohydrate
100g vegetables
sponge pudding and ice cream

Late night snack

200ml milk drink
2 biscuits or 2 pieces of toast (Waif always picks the toast - with no topping)
Cheese and biscuits

We have also decided to have weekly weighings.  The psych suggested we came to the Maudsley for that but it is quite a performance so I asked if we mightn't do the weighings at home.  Waif was keen on that idea too. The psych said that weighing at home can cause conflict but both aif and I thought this unlikely and want to give it a go - the psych agreed.

We are having the next 2 appointments fortnightly, then a 3 week break as the psych heads off to the Himalayas.

I am about to go online to buy a pair of accurate scales - Waif wants digital.  Waif wanted the weighings to be in the evening but the psych said they had to be first thing in the morning, which we are doing on Mondays.