What does an anorexic eat?
No, that’s not the first line of a joke. Or a stupid question. The answer isn’t “nothing”, and it isn’t what you think.
When Ollie first became ill, he was eating like any healthy 11-year old. He was just eating less of everything. It was subtle; you had to squint to see it. In December he was still eating the odd Christmas sweet, the odd packet of crisps. In January, he had fruit instead. By February, he was missing lunch completely and only eating a little dinner. In March, with a firm diagnosis in place, he was slipping further away from food, towards the dreaded NGT and a diet of Ensure. April and May were entirely Ensure and Fortisip. No food passed his lips, at all. At that point, the answer to the title question really was “nothing”. That was, thankfully, only a short phase.
On the day of his admission to the unit, we were shown around. Like rabbits in headlights, we were dazed and confused. Ollie wasn’t with us when we were shown into the dining room, which was set up for afternoon snack. The tables had placemats with patients’ names, and everyone seemed to have something different on their plates. I don’t know what I had expected to see in an eating disorders unit, but it was not chocolate bars and biscuits. There were Kettle chips. In the kitchen I could see Coco Pops and Nesquick. What about the healthy diet that the NHS was always telling us about? I could only see sugar and fat and processed carbs.
We only saw one snack, and it was a part of a carefully thought-out meal plan. The patients ate three meals and three snacks daily, with lots of salad and cooked vegetables, the right amounts of protein and carbs, all under the supervision of a dietitian. All of the healthy stuff was there, but so was the “unhealthy” stuff, and it took me a while to work out why.
The patients were all, like Ollie, underweight. As far as I know, all had a target weight that they - or at least their medical team - were aiming for. Just eating three healthy meals wasn’t going to be enough for sustained weight gain. Snacks were a necessary part of the programme. The basic maths was straightforward: these patients needed calories. Lots of calories. Snack food is great for this: a chocolate bar packs a lot of energy into a small item. When eating is the very definition of horror, it makes sense to eat high-value items.
The calorie content is only one aspect. More important is variety, and the concept of “fear foods”. Ollie was very unusual in that his illness progressed so very quickly. He hadn’t been hiding his condition for months or years, he hadn’t started avoiding specific foods, he quite simply crashed. Most of the patients had been fighting their illness for much longer, and many were fearful of high calorie foods. Cheese, pastry, chocolate or sugary cereal - all of these are obviously “bad”. In order to recover, the patients had to overcome these fears.
The treatment for anorexia is brutal in its simplicity. Eat. You have to eat. And you have to eat “normal” foods, because just eating salad isn’t going to be sustainable. You have to be able to face the challenge of a doughnut. You can’t opt out.
Of course it’s not actually simple. And it’s by no means easy: I wrote a blog where I likened an anorexic person eating to someone terrified of heights jumping out of a plane: http://www.elevenandanorexic.com/2017/05/jump.html?m=1
What I hadn’t considered was the choice of actual food for this leap - chocolate will be even scarier than a sandwich.
There were all kinds of rules on the unit that have come home with Ollie. There was a different cereal for breakfast every day of the week, with Coco Pops on a Wednesday (I will always remember that, as it was the hardest breakfast). The meals were rotated on a four-week timetable, and were planned so that things like carbs weren’t repeated from one day to the next. We still do this: we can’t have pasta two days in a row, for example, so I plan the meals to be pasta, then rice, then potatoes, etc.
As an inpatient, Ollie eventually ate everything he was given. That meant his three main meals, but also a regimen of snacks that has stuck with him until now. It may surprise you to see our food cupboards full of crisps and biscuits, popcorn and cereal bars. But these are the things that our recovering anorexic eats.
The answer to the question at the start of the post, then, is everything that a healthy person eats, and more. What that means for the rest of our family will be a topic for another post.