malnutrition-HELP!!!

Posted by sieraweiss at 01/21/10

Hello All,
I would LOVE any and all responses to this dilemma;
I work in a residential treatment facility for adolescents with eating disorders and have a new client who is 14 and just got out of the hospital from a cardiac arrest due to malnutrition. She is vegan and refuses to eat anything on the menu that contains meat or dairy. Because research shows that there is some kind of link between vegetarianism/veganism and eating disorders (causal relationship is unknown)our program does not support this lifestyle in regards to meal planning. We respect it, but there is no way for us to know if such a lifestyle serves as an excuse to restrict calories (she says she doesn't have an eating disorder). That being said, due to her refusal to eat items that are crucial to her weight gain and subsequent recovery, she is still not getting the caloric intake necessary to improve her health. Our bottom line with her is, we respect her beliefs but sometimes people need to put aside their convictions when health is a priority and one's life is on the line. Since she has no control over the program's rules, it's not as if she has a choice when it comes to how she is getting the nutrition she needs, therefore she is not letting go of her commitment to veganism, she is temporarily putting it aside until she is healthy and knowledgeable enough to make informed decisions about her food choices on her own. I asked her what she thought members of the vegan community would have to say about her choice to refuse that which we have available that will get her healthy, and though she says others' opinions don't matter, we need as much help as possible with this one-it's life or death. Thanks in advance for all input, even if it is not in support of the program I work for.

Responses (12)

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Posted by JohnnySensible at 01/21/10 21:48:40

Not so convinced about the genuineness of your post!

Pseudonyms / anonymity are perhaps not necessary for a health professional - which you claim to be!

"I asked her what she thought members of the vegan community would have to say about her choice to refuse that which we have available that will get her healthy, and though she says others' opinions don't matter,...." a very stupid question & a very fine reply!

Suggested strategy -

Get a copy of Doug Graham's '80-10-10 Diet' book.

Keep bowls of ripe fruit in her room.

Offer big & colorful salads - with plenty of nuts & seeds every few hours.

If you do this she will be just fine very soon!

For an extra 'calorie boost' / if she likes chocolate you can stock up on - 'Righteously Raw' bars - http://www.earthsourceorganics.com/
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Posted by sieraweiss at 01/22/10 07:34:29

Thanks for your response, not sure what you mean by pseudonyms and anonymity not being necessary in the health profession...are you referring to myself? I'm guessing you meant me because disclosing names of clients is unethical. As for myself, I just joined to post this question and I guess I assumed that posting while logged in meant my username would appear. Anyhow, I think that you have a valid reply, which may work when the client is not in this treatment program: Unfortunately, as I said, we do not support vegetarianism/ veganism in regards to menu choices (for reasons stated in my previous post), except for religious reasons or in cases where one has been eating this way one's whole life, as in raised that way. This particular young woman made the choice to be vegetarian about 4 years ago, then vegan about 1.5 years ago. Again, it is unclear as to whether or not her choice had something to do with the desire to restrict her caloric intake. I agree that her response to my "stupid" question was a fine reply and appreciate your feedback.
Siera Weiss
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Posted by Tatiana at 01/22/10 11:06:47

I am not sure what type of program you have (government run, etc) and what the rules are as far as provided what the patient needs, but if this is an eating disorder clinic, don't you have a dietitian? It should be quite doable to have a dietitian work with the patient on setting up a calorie dense vegan diet to meet her needs.
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Posted by shearwater at 01/22/10 11:29:32

There are people who eat healthy and people who don't. But in no way is the choice to go vegan an eating disorder or the cause of malnutrition. There are plenty of healthy fattening foods available to vegans - nuts, avocados, vegetable oils, coconut and soy ice creams..... To force an ethical vegan to eat animal products I find both appalling and abusive.

Your approach could do more harm than good. Please come out of the dark ages of nutrition, do some research into healthy vegan diets, and work with this girl to develop a diet that respects her beliefs while providing the nourishment she needs. Instead your approach seems more likely to instill in her a sense of mistrust for the very people who she should be relying on for help. She could also develop a resentment that may last for years. Please show her the respect she deserves.

I went vegetarian 23 years ago and vegan 10 years ago and am the same weight now as I was when I was 19 and eating meat. I am also healthier and more energetic than I have ever been. Shortly after going vegetarian I even regained some weight I had lost a few years earlier due to job related heat exhaustion. This was in the days when few people accepted the health benefits of vegetarianism but even then my doctor told me going veggie helps regulate your weight whether that means adding needed pounds or reducing excess pounds. Of course you still have to eat healthy to obtain the health benefits.

I commend any 14 year old who makes the decision to go vegan. Especially one who must deal with adults in her life ignorant to the benefits of not eating animal products and who try to force her to eat against her conscience.

I was also warned by many people when I stopped eating animals that I was going to ruin my health. Today it is they who are overweight, sick all the time, and rarely far from doctors or prescriptions. I was once asked by one of them what I would do if my doctor told me I needed to eat meat. "I'd get another doctor," I said.

As to what vegans would think of her current situation, I certainly don't blame a 14 year old forced to give up her vegan choice while at the mercy of misguided adults and authority figures. I hope she gets well soon and finds health and nutrition far from the likes of you.
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Posted by malloneek at 01/22/10 20:49:51

I think this is a major problem with being sick and vegan/vege - the nutrition programs that almost all dieticians and nutritionists go through do not focus on how to be a healthy vegn.
You do don't need to force feed her any kind of animal product to be healthy and gain wait.
I don't know what area of country you're in, but surely there must be some knowledgable resource close by, try the spiritual centers.

I'm looking for a vegn focused nurtrition program to take for myself right now and am not having a lot of luck, so little in fact that I think when I do find one I'll then start teaching my own classes on it!!
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Posted by sieraweiss at 01/23/10 10:16:08

Very interesting responses...I agree completely that my program should respect her vegan diet and offer her nutrition in a form she is willing to eat. This is a difficult situation for me because the place I work will not do this, meanwhile I have to eat meals and snacks with her and its my job to prompt and encourage her to eat whatever is front of her. I think the best point of all was that she will not respect us and will resent us, and in therapy, respect and trust are necessary for the client to open up and work on underlying issues of the disorder. I think I will take a cue from her and honor how we both feel by no longer asking her to eat things she made a commitment not to. I will keep bringing this up to the treatment team as well, unfortunately only one other coworker out of about 10 feels the same way. Thanks to everyone for the thoughtful responses!!
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Posted by sieraweiss at 01/23/10 10:17:29

And yes we have a dietitian...she does not think we should honor clients' decision to be vegan.
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Posted by Tatiana at 01/23/10 13:38:12

Wow, I'm pretty surprised that your dietitian feels that way. I guess not all dietitians feel the way many of my companions and I feel, or maybe your dietitian does not know much about vegan diets, it is definitely something you have to be interested in, it is not specifically required to become a dietitian. I do live in Northern California, maybe vegan diets are more common and accepted here.

Please give your dietitian this link for good nutrition info on vegan diets, hopefully this information will help:

www.vrg.org
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Posted by shearwater at 01/23/10 15:32:03

I'm glad to hear you're willing to work with her. That's a good sign and should help the situation.

And thank you for making the effort to learn more and listen to our responses. You'd be surprised how many non-vegetarians come in here sounding like they have genuine questions but never return to read the responses.

I hope she gets well soon. Be sure to invite her to join the Happy Cows for a chat or to just hang out.
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Posted by sieraweiss at 01/24/10 22:05:31

Thank you all so much for the valuable insight and helpful info! I will definitely let her know about Happy Cow and will offer the web address to the dietitian-it's worth shot... This has confirmed my initial "gut" feelings about how to handle the case and armed me with better reasons to debate the treatment team's point of view. Much appreciated!!
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Posted by greensheen at 03/16/10 04:39:59

I've had similar dealings with dieticians. I decided to become a vegetarian when I was 17. When I stopped eating red meat(but still ate chicken and fish, etc.) I immediately dropped about 30lbs. in thirty days (and I wasn't really overweight), and after several months I was locked up in a treatment facility where they told me my vegetarian diet was to blame( I had several arguments with the "so-called experts", but, ultimately I was forced to start eating whatever they served up in the cafeteria. I had to consume mass quantities of the meat-laden crap in order to put enough weight back on for them to reluctantly release me. After I went back to my planned course of action(giving up chicken next), I again lost the weight I'd put on, and yes, I was gaunt-looking. At no time did I attempt to starve myself or force myself to throw up, yet I was put in their treatment facility for being "annorexic." How does that make sense?

Also, I should add that almost immediately after giving up red meat, I started having problems with my intestinal tract; constipation for days on end, gas build up in my abdomen, and daily all-day-long bouts of massive flatulence. Is that normal? I've heard that Tom Cruise once made a comment about :"Who would want to be a vegetarian with all that farting?". It made me wonder if I'm not the only vegetarian with severe gastro-intestinal problems. I'm being perfectly serious, and, I've been a vegetarian for some time now (and continue to have these problems).
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Posted by Memory at 03/17/10 07:47:55

The vegan diet can be a very healthy diet. I suggest that your patient may be using veganism as a control issue. She probably fervently believes in AR and Veganism, but is using it to cloud the real issue, which is anorexia. I would also suggest working with a vegan friendly dietitian who really understands the vegan diet, its benefits and its downfalls.
If your patient can understand that she is being respected as to her vegan choices, but needs to be helped psycologically in regards to anorexia, improvements in her health can be made. Frankly, I would look first to the family and her background to try to understand her need for control. Maybe Im way off base but I just thought I'd throw that concept out to you. Best of luck to both you and your client. Cheers, Memory

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