The dilemma

I am concerned about my 17-year-old daughter's nutritional intake. She's a binge/purge anorexic struggling to control her own diet and health, with lots of determination and some success. She insists on doing her own cooking and generally has one grapefruit, one apple, one orange, one banana, some dates and at least five veg, but her only protein is baked beans, tofu or lentils. She's trying to introduce new foods (eg. vegan date loaf), but eats no fats or nuts, and won't take supplements. She uses too much salt and vinegar to give her food taste, and complains of stomach pains and wind. I'm worried about her future health and energy levels for her A-levels. Given her refusal to eat fat, can you suggest other vegan additions to her diet?

The psychologist
Barbara Douglas

Your daughter is trying hard to take responsibility for her eating, so don't put all your focus on her nutritional intake. Doing so can mirror the eating disorder and draw you further into the problem. It is likely that your daughter knows a great deal about food and nutrition. Instead of offering advice, ask her what support she'd find most helpful from you. If you can listen without offering suggestions - hard as that can be - she may be able to discuss this.

People with eating disorders often have low self-esteem and yet very high expectations of themselves, so focusing on achievement in A-levels could be counterproductive. It may be helpful simply to acknowledge that you are proud of her, regardless of exam grades. If your daughter is willing, her GP may refer her to an eating disorders unit for psychological, medical and dietetic support. Many offer family sessions that can be very helpful, especially when the young person is living at home.

· Barbara Douglas is a psychologist specialising in eating disorders (www.counselling-psychology-in-exeter.com)

The mother
Jo Kingsley

As a mother whose own daughter has battled anorexia, I understand your anxiety. Alice ended up eating only 100 calories a day and was hospitalised for six months. Even years after her recovery, it's impossible to get her to eat any fat. Keep putting your side of things without being confrontational. I had some luck suggesting yogurt, which is low fat but contains calcium. You're fortunate that your daughter is under 18 - you still have some say in her treatment.

Take her to an eating disorders specialist, who will stress the importance of varying her diet. Be around for her meals so she can't hide the food, or be sick, but negotiate in other ways. Alice would walk for miles to lose weight, so we compromised and did 20 minutes before school and 20 minutes after. Concentrate on being strong for your daughter, and find a support group through the Eating Disorders Association (0845 634 1414; www.edauk.com) for when you need propping up yourself.

· Jo Kingsley is co-author of Alice in the Looking Glass: a Mother and Daughter's Experience of Anorexia (Piatkus)

The nutritionist

Dr John Briffa

Those who binge and purge usually have unstable levels of sugar in their blood. Low blood sugar is believed to be an underlying factor in a desire to binge. Purging may then lower blood sugar, and so the cycle repeats. If your daughter eats mainly fruit and vegetables, her diet is likely to be deficient in protein, which is important for blood sugar stability. Tofu and pulses are reasonable sources of protein for vegans, but she is likely to do even better through the addition of other protein-rich foods such as nuts, seeds and avocado.

These foods are not just packed with protein, they contain healthy fats in which she is likely to be deficient. Your daughter may be wanting to control her eating pattern, but I suspect that she will not find this easy unless she starts consuming more of these protein- and fat-rich foods. Appropriate psychological support may help here, perhaps with the aid of a nutritionist experienced in eating disorders.

· John Briffa is a holistic doctor specialising in nutritional medicine (www.drbriffa.com)

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