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Meal Support For Eating Disorders

Meal Support For Eating Disorders

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What Is Meal Support For Eating Disorders?

Meal support for eating disorders is when a parent, caregiver, relative, or spouse provides food and/or emotional support for someone suffering from an eating disorder before during, and after mealtime.

Dining with an eating disorder at the table can be very difficult. This is true for both those who have an eating disorder and their caregivers.  Having an appropriate meal support routine for those struggling with eating disorders is critical. 

Meal support for those with eating disorders includes

  • Meal Planning
  • Meal Prep
  • Emotional support at the table
  • Support following the meal (for example, emotional support or symptom interruption). 

All of these things are often easier said than done. A person experiencing an eating disorder may have trauma, emotional outbursts, hallucinations or other extreme emotional disturbances when it is time to eat.

What should a person providing meal support for someone with an eating disorder do? Stay calm and stick to the plan. We’re going to walk through exactly how to do that step in this article.

The goal here is to reduce anxiety for both you and the person with an eating disorder when providing meal support.

Should I Use A Meal Plan When Providing Meal Support?

Yes. A haes dietitian specializing in eating disorders can help you develop a custom eating disorders recovery meal plan specific to the needs of those suffering from the eating disorder. 

It’s important to recognize, that a  meal plan provided in a residential eating disorder treatment center may look very different than the recommendations offered in the home environment. 

Residential centers are able to provide a more intensive level of care, and thus may start the meal plan at a higher caloric level than what might be recommended at home. 

Families should expect 3 meals and two snacks daily for those suffering from an eating disorder.  For those where It is deemed safe, a meal plan starting at 1600 calories a day is common.  

Meal plans increase on a weekly basis from the starting recommended level of energy intake.  Meals plan guidelines in eating disorder recovery typically consist of protein, carbohydrates, and fats at every meal. 

In rare cases, a person with an eating disorder may experience hpermetabolism in eating disorder recovery. This will increase caloric needs by 3000-5000 beyond resting energy expenditure.

While I discuss macronutrients, calories, and mealtime strategies in this article. These should NOT be discussed with the person with an eating disorder.

It is important to note that this is also NOT the time for the person with an eating disorder to practice intuitive eating.

What Should I Expect When an Eating Disorder Is At The Table?

Imagine that a plate of spiders has been placed in front of you.  

The people that love you are demanding you eat your plate of creepy crawly’s in its entirety, and within a certain amount of time. 

This is very much what someone with an eating disorder might feel like while at the table. If you can envision what this would be like- you will be able to better support your loved one. 

A good way to describe the experience might be that your loved one is eating “under the influence” of an eating disorder.  

Someone with an eating disorder may experience these symptoms while dining: 

  • Anxiety
  • Panic
  • Thought Disturbance
  • Psychiatric Delusions 

While the person is still present with healthy thoughts, values, dreams, and aspirations the eating disorder is also present. The eating disorder voice and the healthy voice of the individual will likely both be alive and well at the table.  

Mealtime Anxiety

For those with an eating disorder, food is the key substance in altering their body weight, shape, orThe noisy eating disorder brain messages will be competing with the healthy brain messages which know that the body needs nourishment to survive. 

Thus when it comes time to eat, the eating disorder may send messages like:

  • If you gain weight no one will love you.
  • You can’t do anything right, including controlling what you put into your body. 
  • If you lose me, what will you have left? 
  • If you Eat that, you will get FAT!
  • It’s no wonder your boyfriend broke up with you, you just ate way too much food. 
  • You’re disgusting. Don’t tell anyone how much you ate. 

The eating disorder will likely try to negotiate a safe “middle ground” which will allow it to provide some nourishment to the body without actually altering it. 

Your role as someone providing meal support- Don’t let it! Do not negotiate!

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Supporting Someone With the Urge to Binge Or Purge At Mealtime

When someone engages in binging and/or purging- they are trying to avoid other negative experiences. 

When someone is experiencing a binge, this can actually alter a persons brain waves.  A person engaging in a binge may feel satisfaction during the first few bites of the meal, but this generally declines through the meal. 

Feelings during a binge often transition to distress, dissatisfaction, and worry as the meal progresses.  Some helpful things to try at the table may include what is called urge surfing

Urge surfing is based on the idea that urges are like a wave.  There is a peak of intensity after which a decline occurs.  

When someone is working through urge surfing at the table, they should take note of how the intensity or the urge to binge or purge changes over time. 

Someone engaging in urge surfing should be encouraged to examine how their body feels in the process. They should note the language they are using with themselves. 

Other coping strategies for a binge or purge may include 

  • Delaying engaging in the activity for 5 minutes. 
  • Calling a friend or loved one and voicing the urge
  • Keeping a list of positive affirmations at the table. 
  • Identify and write down the most common times in the day where a binge or purge happens
  • Identify thoughts leading up to a binge or purge. Write them down. 

Helping your loved one create a plan to incorporate these skills and sitting with them during their symptoms will be helpful. You may also try some of these coping mechanisms headful when challenging fear foods. 

Post-meal support should also be offered, especially if someone has a history of purging. 

How Do You Help People Who Are Struggling to Eat?

Parents and caregivers are a great ally to the person struggling to eat before, during, and after each meal. Caregivers will provide both meals and emotional support to help the person with an eating disorder to feel safe and loved during this difficult time.

Here i’ve mapped out the process to best reduce anxiety, confrontation, and negotiation that could potentially occur before, during, and after meals.

Meal Planning With An ED

This role goes to the parents and caregivers in the initial stages of eating disorder recovery.  

Caregivers can make mealtime less anxiety-provoking for those with an eating disorder by sticking to structured meal times. Outlining the meal plans for the week can reduce anxiety for the person with an eating disorder. 

Questions to the person suffering from an eating disorder surrounding meals should be closed-ended (e.g. would you like fish or tacos tonight). 

Meal Prep With An ED

Do not involve the person with an eating disorder in meal prep. This can be overwhelming for them. Things that may cause trauma include

  • Perception of too much sodium added
  • Perception of too much fat in the food (e.g. butter or oil.)
  • Too much sugar is added to the meal.
  • Types of products used (whole grain versus refined grain). 
  • Cooking methods 

Caregivers should portion out meals and snacks to those suffering from an ED. 

What Are Some Goals Of Meal Support?

The main goals of meal support include 

  • Stabilizing and normalizing eating behaviors
  • Emotional support
  • Symptom Interruption
  • Modeling
  • 100% meal completion /

How Can I Provide Mealtime Help To Those With An Eating Disorder At The Table?

You may need to dig in and ground yourself in a calm place when providing meal support. 

You will likely want to negotiate and provide the easiest food (after all, we want to nourish our loved ones in any way possible!) Don’t do this. This can postpone progress. 

Instead, during meal support try to follow what is often referred to as the four C’s of meal support: 

  1. Remain calm- Those with an eating disorder will pick up on your anxiety. 
  2. Be Confident- The person will feel more secure if you are showing confidence. 
  3. Be consistent- Stick with what has been decided. Don’t negotiate. 
  4. Be Compassionate- Offer validation.  What the person is doing is very challenging.  

During mealtime, try to model:

  • Appropriate Pace
  • Types of food choices
  • What a fork full of food should look like. 

You should be having similar foods to the foods the person with an eating disorder is having. Otherwise, they may deem this as unfair, or begin to assign certain values to some foods over others.

For someone who is following a vegan or vegetarian diet, it should be carefully discussed whether the person should follow a vegan eating disorder recovery meal plan with the healthcare team. The decision will often stem from how long the person has been vegetarian, the ability to meet caloric needs, and reasons for being vegetarian.

What Are Some Effective Mealtime Strategies With Eating Disorders?

Some common goals with eating disorder support at the table include: 

  • Symptom interruption-not allowing leaving the table until meal session is complete (discourages exercising or purging). 
  • Redirection: If they are having a difficult time starting the meal you may say: ‘I can see your eating disorder is really loud right now. Lets take this first bite together.”
  • Distraction: Try talking about a funny event or playing a game during meal time. Be mindful of anxiety-provoking topics. These may include friends or school. 

You may try doing things like listening to music or watching television at the meal as well.  A great meditation tactic is lighting a candle and watching the Flame if anxiety creeps up during the meal. 

How Long Should A Meal Last In Eating Disorder Recovery

All meals should be consumed within 30 minutes.  It may be helpful to set a timer during meal support.  Check-in with your loved one after 10 minutes, and then every 5 minutes after that.  

Limit opportunity at mealtime for

  • Wiping off face, fingers, fiddling with napkin etc.
  • Eating very quickly
  • Eating very slowly
  • Cutting food into small pieces
  • Moving food around on the plate

Some practitioners may advise that if all of the portions are not consumed at the meal-a meal replacement shake such as a boost may be used.  However, the goal is always 100% meal consumption.  

When Providing Meal Support, Should the Person With An Eating Disorder Make Their Own Food Choices?

People with an eating disorder, especially in the early stages of recovery are not capable of making their own food choices. They should not be allowed to participate in meal prep or decisions about what to eat before or during a meal.

A brain that is malnourished does not have the capacity to make meal and snack decisions that are adequate to meet nutrient needs. The brain is starving, and the food is the medicine. 

It’s also important to note that someone with an eating disorder will likely be experiencing real physical symptoms when they push themselves to eat more. Check out this guide on what to expect during weight restoration for signs and symptoms that are common as someone increases their food intake.

Have you Been Supporting Someone At Meals With An Eating Disorder?

Do you have a loved one with an eating disorder? 

 Many times it can feel as though we are letting them down, making them hate us or being cruel when we insist they nourish their bodies. There is a common feeling that if we push harder we will “lose them.” 

This is exactly what the eating disorder wants from us!  It’s important to remember that it is our job to serve the needs of our loved ones, NOT the eating disorder!  

Giving just a little bit will feed the eating disorder and make it push even harder. 

If you’re looking for even more resources to support someone with an eating disorder, check out my favorite eating disorder recovery books.

Are there some grounding tools or dining techniques that you have used to make meal support easier for your loved ones? Drop a comment below and be a guiding light to others. 

Further, if you take these techniques home to try PLEASE let me know what worked well for your family.  We’re all in this together! 

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Meal Support FAQ

What Is Meal Support For Eating Disorders?

Meal support for eating disorders is when a parent, caregiver, relative, or spouse provides food and/or emotional support for someone suffering from an eating disorder before during, and after mealtime.

What Are The Four C’s of Meal Support

Remain calm (anxiety causes anxiety), Confident (let the person know you trust the process), Consistent (don’t negotiate with the eating disorder), and compassionate (let them know you understand and are with them on this journey)

How Do You Help People Who Are Struggling to Eat

Provide meal support pre, post, and during mealtime. This should include meal preperation and emotional support at the table. Provide eating disorder symptom interruption by setting time limits on meals, not negotiating on intake of foods provided, and modeling an appropriate pace of eating.

What Do You Say During Meal Support?

Have a conversation about pets, hobbies, friends, or any non-anxiety-provoking topic. Tell the person ways you are proud of them. If you’re noticing anxiety, explore it gently. Do not talk about calories or nutrients in food, appearance, or anything eating disorder outside of challenges at the table.

Shena Jaramillo. Registered Dietitian

Hi I'm Shena. I'm an eating disorders dietitian in Washington state. I hold bachelors degrees nutrition & dietetics, cultural anthropology & psychology. I believe in honoring your hunger, having your cake whenever you want it, and that critically analyzing diet culture can change the world!

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