Thank you for responding. I cannot say he is 100% compliant. I know he is when at home, but I am not sure how closely he follow his diet while out. I know that he is smoking and that can be a factor as well. The GI doctor recommended 3000+ calories a day a year ago. He had gained 9 lbs. but then worked last summer in construction 10 hours a day in the heat. He lost all the weight he had gained and has not been able to put it back on. He says now if he tries to eat larger meals his stomach hurts. I can see that he is not eating enough to make a young adult full. I try to have him drink 3 serving of Ensure or Boost a day, but he does not always comply. When I hug him I can feel all his bones protruding, it is breaking my heart. He has not had a follow up endoscopy and refuses to go back to the GI.