The food pyramid categories

• Carbohydrates make up the bottom layer of the pyramid. These include bread, cereals, rice and pasta. It is recommended that you eat between six and eleven servings. Examples of a serving are one slice of bread, one ounce of ready-to-eat cereal, half a cup of cooked cereal, rice or pasta.

• Fruit and vegetables make up the next layer. It is recommended that you eat between two and four servings of fruit and between three and five servings of vegetables. Examples of a serving of fruit are one medium apple, banana or orange, half a cup of chopped, cooked, or canned fruit, three quarters of a cup of fruit juice. Examples of a serving of vegetables are one cup of raw leafy vegetables, half a cup of other vegetables, cooked or chopped raw, or three quarters of a cup of vegetable juice.

• The third layer is made up of proteins. There are two groups of equal importance. It is recommended that you eat three servings of the milk, yoghurt and cheese group and two to three servings of the meat, poultry, fish, eggs, beans and nuts group. Examples of a serving are one cup of milk or yoghurt, one and a half ounces of natural cheese, two ounces of processed cheese, two to three ounces of cooked lean meat, poultry, or fish, half a cup of cooked dry beans. One egg or two tablespoons of peanut butter count as one ounce of lean meat. It is important to trim fat off meat to stay within the guidelines.

• The top layer is made up of fats, oils and sweets. No specific serving size is given for the fats, oils, and sweets group because the message is use sparingly. However, this is still an important part of your diet and recovering anorexics should be guided to eat these in moderation. It is likely that during his illness, an anorexic boy will have excluded this group altogether.

A diet plan based on the food pyramid should provide all the nutrients, vitamins, minerals, carbohydrates and protein that a growing child needs. Anorexics are likely to be deficient in certain areas to start with and so it is important to ensure there is enough:

• protein to replace wasted muscle and encourage growth

• calcium to strengthen bones that may have been weakened through a prolonged period of starvation

• iron, as many anorexics are anaemic. If in doubt consult your doctor or a dietician.

Once a diet plan has been established the next challenge is to put it into action. There are some important things to note when trying to introduce a new eating regime for an anorexic boy:

• Every individual's calorie requirement is different and there is an element of trial and error in working out how many calories each boy needs to consume in order to gain and then to maintain his weight. As a general guide most teenagers need to consume between 1,500 and 2,500 calories a day to maintain their weight. A very active teenage boy is likely to be at the upper end of this range and some boys may need even more than this. To gain weight he will need more. An extra 1,000 calories a day is likely to lead to a weekly weight gain of around 1 kg, although again each boy will be different. Therefore a very active anorexic teenage boy may need to consume as much as 3,500 to 4,000 calories a day to gain a reasonable amount of weight.

• Build up the calories gradually. If a boy has been eating 1,000 calories a day for some time, it is unrealistic to expect him to suddenly jump to 3,000 or more in one step. Indeed it can be dangerous for a severely under nourished child to increase his food intake too quickly as it can put pressure on an already weakened heart. Try introducing a few hundred extra calories each day. If he struggles stay at the same level for a few days and then try increasing again. Taking a slow gentle approach in which the sufferer gradually gets used to eating more food is more likely to work than a fast track approach. The sufferer is likely to need lots of support and encouragement as he increases his food intake.

• To start with try to introduce foods that are gentle on the stomach. Milky drinks, yoghurt and honey and light desserts are a good way of adding calories without putting too much strain on a shrunken and sensitive stomach. If your son complains of stomach pains for more than a few days he should see a doctor.

• Anorexics tend to have a real fear of certain foods. Common examples include chocolate, chips, cheese and cream. Introduce them slowly, one at a time. If the sufferer refuses one food try to make up for it in different ways and then try again at a later stage. Explain that eating the occasional Mars bar, a bag of chips or a cheese sandwich is only going to slightly increase their total calorie intake for that day. It is not going to automatically make them gain a kg.

• Junk food has its place in a teenager's diet. It provides carbohydrate and lots of energy. Obviously a teenager shouldn't just eat junk food and those who do tend to be sickly and obese. Junk food in moderation is a useful way of providing extra calories and energy and most teenagers enjoy the occasional pizza, burger and chips, crisps, chocolate, sweets and cakes.

• Ready meals can have their place in a balanced diet. The calorific values are clearly stated, they are quick to prepare and teenagers often like them. In addition, the calories in ready meals can easily be boosted by adding extra cream to sauces, adding extra rice, potatoes or pasta and so on.

• Gaining weight is an incredibly stressful experience for an anorexic. Only weigh him once a week. Sometimes it is helpful for the sufferer if he doesn't see the scales. If you are not sure what weight your son should be contact your health visitor or GP who will be able to advise you.

• Once the sufferer has reached a reasonable weight his diet must be adjusted to ensure he doesn't gain too much weight. Try reducing his daily consumption by between 500 and 1,000 calories, and monitor his weight for several more weeks. Adjust his calorie intake as necessary to maintain his weight at a reasonable level. As the weeks go by you will find the appropriate food intake by trial and error. As the months go by the sufferer will start to be able to take some responsibility for his own food intake. Eventually he will be able to respond to his own appetite without having to really think about it.

• Learning how much to eat and how to eat healthily are huge challenges for an anorexic. There are bound to be setbacks. Some may be minor, others may be major. When they happen take a deep breath and start again. The sufferer will need lots and lots of love, support and encouragement if he is to get through in one piece.

With Joe I wasn't obsessive about the number of calories he was consuming, but we worked out an appropriate diet through trial and error. He had to eat a huge amount to maintain a healthy growth pattern. Six months after he was discharged from the specialist unit I felt I could let him have more responsibility for his own diet and I stopped watching his every move. I still kept a close eye on his attitude to food and at times he needed encouragement to have proper meals, particularly in the school holidays. A year after he was discharged I felt I could totally relax. Even if he skipped a meal in the holidays I knew he would make up for it by snacking on the move, which is something that most normal teenagers do. Now, three years later, he is still very active but we don't have to consciously watch what he is eating. His appetite is huge and it now tells him when to eat, not the anorexia!

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