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Monica Derevjanik/MEDILL

Milkshakes that are high in calories and calcium can help an anorexic patient overcome their illness, according to some local nutritionists.


Milkshakes shake up a debate on fast weight gain for anorexic teens

by Monica Derevjanik
April 14, 2009


Milkshakes and macaroni and cheese actually may help cure an acute illness that strikes many teenage girls.

Some doctors believe that these high-calorie comfort foods can help young girls with anorexia nervosa, an eating disorder characterized by exceptionally low body weight, body-image distortion and a fear of weight gain.

“It is difficult to eat large amounts of low-calorie foods and get the calories needed to restore health, so turning to milkshakes and macaroni and cheese can be quite helpful,” said Dr. Angela Celio Doyle, a University of Chicago clinical associate. “Many individuals attempting to gain weight after a period of malnourishment will need anywhere between 3,000 and 5,000 calories a day.”

For eating disorder experts, the goal is to not only to restore the patient to a healthy weight, but also to treat any related psychological issues. Many experts try to nourish their patients as quickly as possible so they can get to the underlying psychological issues that lead to the disorder.

That’s why Oehme Soule, a registered dietician at Nutrition Perspectives in Evanston, recites the same introduction to her patients each time she begins therapy.

“I say to them, ‘First we’ll get you nourished so you can think because I can’t teach you to eat on a starving brain,’” Soule said. “Fats have twice as many calories as protein or carbohydrates so it’s a much faster route to nourishing. And if they can’t eat, I can’t teach them how to eat.”

Soule then begins treatment by evaluating the patient and creating a step-wise meal plan for the patient.

Nutritionists often suggest that their anorexic patients have three meals and three snacks a day, so a patient’s stomach capacity becomes a concern when deciding on a meal plan.

“Since it’s largely a younger population, we’re also very concerned about calcium needs because any damage to bones before they’re 30 is going to be there forever,” Soule added. “That’s why the focus is on milk and cheese. You could eat 32 cups of broccoli but, if you’re anorexic, you can’t stand that much volume.”

Still, the high-cal dairy approach may do more harm than good according to some local nutritionists, such as nutrition therapist Colleen Takagishi. The high-calorie meals – often high in fat, sugar and cholesterol – can affect a patient both physically and emotionally, she said.

“When you feed people who haven’t been feeding adequately or in a normal way and give them a lot of protein and sugar, it just throws them off,” Takagishi said. “It’s not particularly helpful in early recovery to be throwing in foods that send them spinning when they don’t have their feet on the ground yet.”

Instead, Takagishi uses another frosted beverage to nourish her patients – a 500- to 800-calorie smoothie with soy milk, whey powder, peanut butter and fruits, which keeps the calories high but also boosts nutrition.

“This is a person who has an eating disorder and may be at risk for other diseases,” Takagishi said.

Sometimes the disorder leads to muscle wasting and heart disease. Individuals with anorexia are up to 10 times more likely to die compared to people without the disorder, according to the National Institute of Mental Health.

“As nutrition therapists we need to provide calorically dense foods from the onset of therapy in order to get movement in the psychological area, but we can do this is a healthy way,” Takagishi added.

While Takagishi often instructs her patients to avoid food high in fat or sugar, Doyle said there are no foods that are “harmful” to a recovering anorexic.

Yet Doyle added that refeeding syndrome, a condition that can lead to seizures or cardiac failure, can occur when a patient takes on too many calories too quickly after drastically restricting calories intake, but is usually rare.

Ultimately, it is up to the patient and the family to decide on the best treatment for overcoming the illness.

“Certainly a doctor can help steer a patient to choose the right treatment. But you can't force people to do things against their will,” Soule said. “Usually, by the time a client comes to the office, they're ready to explore options and a doctor can help. But it's up to them to decide on what they think will work best for them.”