In this post, Miami psychologist Amy Boyers highlights a practical list of foods you can buy to help your loved one struggling with anorexia gain weight. These foods were purchased at Trader Joes.
One of the most difficult aspects of anorexia treatment is helping a person with anorexia restore their weight to a healthy level. I visited Trader Joe’s and put together a practical list of foods for a person struggling with anorexia to gain weight and “get across the finish line.”
One of the main focuses during recovery from anorexia nervosa is refeeding so that a patient’s weight can be restored to a healthy level. While recovering emotionally is an important part of anorexia recovery, gaining weight is always the first step. There are a number of extremely dangerous medical conditions that often emerge in a patient who is malnourished and underweight that must be addressed first and foremost. As a patient starts to gain weight back, their body can struggle to stay in balance so it’s critical that regular medical evaluations take place to monitor this process.
Behavioral Changes as a Result of Starvation: The Minnesota Starvation Experiment
Another reason why weight gain should be the first focus with anorexia (as opposed to treating underlying psychological factors) is that many behaviors associated in patients with anorexia are common in behaviors of someone who is starving. In 1944, Ancel Keys conducted an experiment on men who volunteered to participate instead of going to war. This experiment took place over 24 weeks and was designed to produce a roughly 25% weight loss over the course of a 24-week period. Here are some behavioral changes that resulted:
1) Dramatic Increase in Food Preoccupations
In this study, one of the most striking changes was the dramatic increase in food preoccupations in the men. This included:
- Difficulty concentrating on normal activities
- “Toying” with food
- Making “weird concoctions”
- Eating in long, drawn-out rituals
- New interest in reading and discussing cookbooks, menus, etc
- Vicarious pleasure from watching others eat
- Spending much of the day planning how they would eat the day’s allotment of food
2) Binge Eating in a Subgroup
Another behavioral change that resulted was binge eating in a subgroup of men. Some key observations:
- Serious binge eating developed in a subgroup
- Binges were followed by self-blame for having lost control
- Even during the refeeding phase with access to food, some continued to binge and reported being hungry after a large meal
- For some, bingeing continued for 6 months or longer
It is important to note that the fact that binge eating was experimentally produced in some of these normal young men suggests that dietary restriction may have been responsible for the binge eating and not emotional problems. In addition, the degree of dietary restriction seen in many anorexic or bulimic individuals is not necessary to produce binge eating. Research has demonstrated that chronic dieters display “marked overcompensation” in eating behavior that is similar to the binge eating seen in ED pts.
3) Emotional / Personality Changes
While all participants were psychologically healthy before the study started, most experienced significant emotional deterioration as a result of the 24 weeks of semi-starvation. Some severe emotional changes that occurred include:
- Anxiety and nervousness
- Irritability and outbursts of anger
- Mood swings
- Neglecting their personal hygiene
- Some instances of psychotic symptoms (including 2 participants who required hospitalization in a psych ward)
- Emotional disturbances that often persisted during the initial weeks of refeeding
4) Social Changes
Although participants were initially sociable, they became progressively more withdrawn and isolated as the study continued. Other social changes included:
- Strained relationships
- Drastically reduced sexual interest and decreased sexual contacts
- Sexual interest was slow to return during refeeding process
- Decreased humor
- Feelings of being socially inadequate
- Decreased participation in activities
5) Cognitive Changes
Subjects of this experiment were noted to have impairments in the following:
6) Physical Changes
Physical changes were noted for participants including:
- A decreased need / desire for sleep
- Feelings of dizziness
- Gastrointestinal discomfort
- Hypersensitivity to noise and/or light
- Strength reduction, lessened motor control
- Swelling in the limbs
- Hair loss
- Lowered tolerance to cold temperatures
- Feelings of pain in the eyes, seeing “spots”
- Hearing a “ringing” noise
- Slowed metabolism
- Feeling low energy, tired, weak
- Voluntary movements slowed
- Reduced level of activity (for most)
During the anorexia refeeding process, those who ate the most showed the largest increase in metabolism.
Conclusions to this Study
- Many of the symptoms perhaps thought to have been specific to anorexia or bulimia nervosa are actually the result of starvation and poor nutrition.
- These symptoms are not specific to food and weight, but rather, involve virtually all areas of psychological and social functioning.
- The human being becomes more oriented towards food when starved. Other pursuits important to the survival of the species (such as social and sexual functioning) become subordinate to the primary drive towards food.
- The results of this study seem to suggest that one cannot “will themselves” to be a particular weight without great physical and emotional costs. The study demonstrated that the body has certain weight level it’s meant to be at (set point theory).
Foods for Gaining Weight with Anorexia Nervosa
One of the most challenging aspects of treating anorexia nervosa is helping the patient restore weight. Even with a patient is willing to participate in this process (not always the case), the amount of weight needed to get back to a healthy weight is more than many realize.
I thought I’d share some ideas for parents searching for foods that can help their child “cross the finish line” to regain weight during a battle with anorexia. The key in anorexia weight gain is high density, low volume. This means that you need to find foods that are high calorie while not being too filling. On a trip to Trader Joe’s, I took photos of 13 foods that can be helpful for anorexia weight gain. It’s important to note that these suggestions are specifically for weight restoration, so the food choices and portions will be different once a healthy weight is reached and maintenance is required.
1) Belgian Chocolate Pudding
A serving of this chocolate pudding is only 2/3 of a cup so this can easily be increased to a full cup for a snack or dessert that will be adequately caloric.
2) Greek Whole Milk Yogurt
This whole mild Greek yogurt packs a lot of punch with a serving size only being 3/4 of a cup. The key here is that this is whole milk yogurt which can be a little tricky to find sometimes. Again, this can easily be boosted to a full cup, add some granola and honey and you’ve got yourself a quick and easy snack!
3) Brioche French Toast
This is a great option for a quick breakfast before school when time is limited. 2 slices of this French Toast plus 2 tablespoons of maple syrup and a banana can start the day off right so you aren’t falling behind before you even get to lunch.
4) Butter Croissants
I love these croissants! They are light and you can add a multitude of options to them to make them to your taste. You can scramble 2 eggs in 1 tbsp butter, add a slice of cheese, maybe even some ham or bacon, and make a quick breakfast sandwich that won’t take too long to finish. You can do a sweet version with Nutella, ham and cheese with mayo and mustard, tuna salad made with regular mayo, or turkey with avocado, or try brie cheese with apple slices and honey.
5) Lace Cookies
These lace cookies are fantastic because a serving size is only 2 relatively small cookies. This can easily be increased to 3 or 4 to meet your caloric requirements for a snack. Add a glass of milk or juice and you are well on your way.
These quiches are great. They are actually quite small, about 5 inches across and come in a few flavors. Have a quiche with a small salad with at least 1 tbsp of dressing and a slice of crusty bread with butter and you’ve made a pretty fancy meal very quickly! What I also like about these is that they can be kept in th freezer for when you maybe don’t have time to cook something. They can also be used as “alternate meals” meaning that if your child refuses to have what is being served, you can create a plan where sometimes he or she can ask for an alternate meal instead that will be calorically appropriate and also be relatively challenging.
7) Veggie Burgers and Angus Beef Burgers
Both of these burger options are appropriate choices but they cannot be eaten alone. Put on a regular bun, add maybe some cheese or mayonnaise in addition to whatever else you like to top you burger with and you’ve created a reasonably dense component of a meal. Add a couple sides like chips, fries, baked beans, or even a shake (if you are feeling brave!) and you are good to go.
These burritos are an excellent option. They are frozen so they can be kept as alternate meals or for a day when you are short on time and they are quite flavorful. The serving size is 1 burrito but they are not big and eating 2 pretty much fulfills your needs for most lunches or dinners, depending on your meal plan. The tray appears to be a single portion so it will not be visually overwhelming to your child. If this falls a little short calorically, you can add a caloric beverage such as milk, juice, or gatorade, some beans and rice, or some tortilla chips with guacamole.
9) Ice Cream
OK, here are some fun options. The serving size of this ice cream is only a half cup so it’s pretty easy to increase the portion to a cup and not appear to be too much. Add 2 tablespoons of the fudge sauce to this ice cream or any ice cream you have to pack a little more punch without it becoming more filling. These are particularly good options for when you need to do some food challenges. Also a bonus is that they are frozen and won’t go bad quickly.
10) Maple Syrup
Let’s talk about syrup. It is something that many people with eating disorders say they “don’t like” although most people use it when eating certain breakfast foods. If you child used to use syrup prior to the eating disorder, it’s important to add it back into the appropriate meals. Make your food challenge more meaningful by having your child eat it in the way he or she used to eat it. Don’t allow the eating disorder to feel any sense of victory by allowing your child to eat dry pancakes. The good news is that just 2 tablespoons makes a really nice contribution calorically without making the meal more voluminous. Adding this to oatmeal, pancakes and waffles will be really helpful.
11) Mango Juice
This mango juice is a lifesaver. Each can is only 8.4 ounces so it’s a great addition to any meal or snack. They are highly portable so they can be used when you are on the run or mixed into a smoothie for extra flavor and caloric density.
12) Trail Mix
This trail mix is individually portioned so it’s great to send to school or have in the car for after school. The packages are quite small, just 1.5 ounces each and come in a variety of flavors. A single packet probably won’t be enough for most weight restoration meal plans but add a mango juice or a whole milk yogurt and you are probably where you need to be.
13) Chocolate Peanut Candy and Wafer Cookies
Both of these dessert options are excellent choices. They are small portions and alone, are nearly enough for a snack depending on your meal plan. If you need to add some to this snack, you could add a caloric beverage, perhaps even a frozen coffee drink, to meet your meal plan requirements. These are also great because they can be thrown into a bag when you are traveling and often can serve as excellent food challenges.
Getting Help with Anorexia Weight Gain and Treatment
A note from Amy: “Thank you for reading my post on anorexia weight gain. I hope that these suggestions are helpful to you. It is easy to become overwhelmed by the refeeding process and it’s important to think of some shortcuts that reduce stress for the entire family.”
Dr. Amy Boyers is a licensed psychologist and has been in private practice in South Miami since 2001. She provides therapy to adolescents and adults, with a focus on women’s health, eating disorders, anxiety and mood disorders, and behavioral medicine.
Visit Amy’s practice listing: Amy Boyers, Ph.D.