Stage 2: tackling problem eating and challenging compensatory behaviours
Encouraging patients to eat in a structured but ﬂexible way (Figure 7.1) is an essential goal of treatment, and this should be introduced early, ideally in session 1 or 2.
With underweight patients, the initial emphasis is on both structure and content, and there should be a high expectation that children will need to make changes to both from the outset in order to reverse weight loss and start to tackle their fears about eating and weight gain. To some extent, where to start will depend on the individual. For example, a child who has eaten nothing but a small breakfast for a month will ﬁnd it very diﬃcult to introduce two extra meals and three snacks all at once, regardless of content, whereas a child who has been eating regularly but only very small amounts will need to start increasing the actual food intake.