What Does Meal Support Mean?
Dining with an eating disorder at the table can be very difficult. This is true for both those experiencing an eating disorder, and their caregivers. Having an appropriate meal support strategy 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 (e.g. emotional support or symptom interruption).
What Do Eating Disorder Recovery Meal Plans Look Like?
A registered dietitian specialized in eating disorders can help you develop a custom eating disorder 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, carbohydrate and fats at every meal.
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:
- Thought Disturbance
- Psychiatric Delusions
While the person is still present with healthy thoughts, values, dreams and aspiration 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.
What Is The Eating Disorder Brain Saying At The Table?
For those with an eating disorder, food is the key substance in altering their body weight, shape or size.
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 you failed that test, you just ate way too much food.
- You’re disgusting. Don’t tell anyone what you’re eating.
The noisy eating disorder brain messages will be competing with the healthy brain messages which knows that the body needs nourishment to survive.
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!
Helping Someone Cope With An Urge To Binge Or Purge
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.
Who Should Be Planning Meals For Those With Eating Disorders?
Meal Planning With An ED
This role goes to the parents and caregivers in the initial stages of eating disorder recovery.
Caregivers can make meal time 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 int he food (e.g. butter or oil.)
- Too much sugar added to the meal.
- Types of products used (whole grained 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
- 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 one in any way possible!) Don’t do this. This can postpone progress.
Instead during meal support try to follow what are often referred to as the four C’s of meal support:
- Remain calm- Those with an eating disorder will pick up on your anxiety.
- Be Confident- The person will feel more secure if you are showing confidence.
- Be consistent- Stick with what has been decided. Don’t negotiate.
- Be Compassionate- Offer validation. What the person is doing is very challenging.
- Appropriate Pace
- Types of food choices
- What a fork full of food should look like.
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 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.
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 meal time to
- Cut up food
- Move food around on the plate
- Excessively wipe fingers
- Eat very quickly or very slowly.
Some practitioners may advise that if all of the portion is not consumed at the meal-a meal replacement shake such as a boost may be used.
However, the goal is always 100% meal consumption.
Can A Person With An Eating Disorder Make Their Own Food Choices At Meals?
The simple answer here in the initial stages of eating disorder recovery is no.
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.
To put it into perspective Imagine that instead of a child with an eating disorder, you have a child with type 1 diabetes.
Your child is afraid to administer injections. What would you do? Would you ignore the condition? Would you allow them to take only half of the prescribed dosage? Probably not as that would be life threatening.
For those with an eating disorder, the food is the medicine. Not having the food will be life threatening to that person. Just as you would ensure a child with type 1 diabetes received their medication (even if it was painful and produced a lot of anxiety), we should be showing the same compassion to our loved one with an eating disorder.
What Meal Time Support Strategies Have Worked For You?
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.
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!