The smart use of rewards in working with your anorexic child

Often Marcia works with young anorexic patients who are struggling to reach the healthy goal weight that the family, the doctor, and Marcia have agreed upon. Typically little gains are followed by losses, often caused by a stressful goings on in the adolescent or young adult’s life, power struggles between the patient and her (or his) parents, or ambivalence about recovery.

Marcia's patient Zoe came to her last appointment down 1.3 pounds, to 118.6 pounds. It was only 1.4 pounds away from her goal weight of 120 pounds, and yet that 1.4 pounds represents a huge psychic leap for Zoe, one that is incredibly difficult for her to make.

"We talked about possible explanations for Zoe's weight loss," says Marcia. "There are a number of factors involved: Zoe's anxiety about weight gain; mom's anxiety that maybe Zoe is gaining too fast and a backlash is occurring (Zoe picks up on this hesitation on mom's part, and may use it to justify not eating); Zoe's tendency to wake up too late for a good breakfast, and unproductive arguing between Zoe and her mom about whether she's eating enough. Sometimes the arguing with mom prompts Zoe to want to 'win' by getting away with eating less than she knows she should," explains Marcia.

One way around these obstacles is the reward for positive change. The idea is to reward Zoe with something desirable if she maintains her goal weight of 120 pounds for two weeks in a row. If her weight dips below the goal weight, the reward is taken away. Zoe suggested a pair of boots she likes at a local boutique. Zoe will get the boots if she meets her goal. If her weight dips below her goal weight, however, her parents can take the boots away until the goal is attained and maintained again.

There is good discussion of the use of rewards in our book.  We can summarize by telling you that research shows that rewarding weight gain in anorexia works.  If you decide try this at home with your children, it is essential that you carry through and never waiver in delivering promised rewards when weight is gained. Parents need to be just as firm about withdrawing rewards if your child loses the weight again. Caveat: Never, ever reward weight loss in bulimic or binge-eating children. Parents who do this risk sending the message that love and acceptance is dependent on weight.

Take care,

Marcia and Nancy