Meal Support For Eating Disorders

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Last updated on November 23rd, 2023 at 02:23 am

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

Meal time with an eating disorder at the table can be very difficult. Challenges at mealtime happen to the person who has the eating disorder as well as their caregivers.  

Having an appropriate meal support routine and knowing what to say to those struggling with eating disorders will help to reduce stress for the person struggling to eat and their families.

Meal support for those with eating disorders includes

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

A person experiencing an eating disorder may have trauma, emotional outbursts, hallucinations or other extreme emotional disturbances when it is time to eat. Your job as their support person is to help them work through these challenges.

This article will help give you strategies to stay calm and stick to the plan when providing meal support. We will dig into when who should be preparing meals, tools to reduce anxiety at the table, and ways to stay grounded.

Using A Meal Plan During Meal Support

During the early stages of eating disorder recovery, a mechanical eating meal plan will be necessary until a person gets their hunger cues back and is able to meet caloric needs on their own.

An eating disorder dietitian can help you develop a custom meal plan specific to the needs of those suffering from the eating disorder. 

Some things to consider about the meal plan you use at home are:

• A residential eating disorder treatment center may look very different than the recommendations offered in the home environment. 
• Meal plans for recovery at home will likely start low and increase. This is for safety. However, you should prepare for resistance as the meal plan increases.
• Families should expect 3 meals and 2 snacks daily. If the person is experiencing hypermetabolism in eating disorder recovery, the frequency and quantity of the food will be MUCH greater.

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?

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

• Anxiety
• Panic
• Thought Disturbance
• Psychiatric Delusions 

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

To understand what they are going through, 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.

Keeping this visual in mind while providing meal support can help guide you in what the person may feel like.

Mealtime Anxiety With Eating Disorders

For people with an eating disorder, food feels like the gateway to causing them to gain weight.

The belief that food causes weight gain will spike up anxiety at the table and around mealtime.

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. 

Your role as someone providing meal support is not to negotiate with the internal voice of someone suffering from an eating disorder.

The eating disorder will likely try to negotiate a safe “middle ground” (for example, I will eat the chicken but please don’t make me have dessert).

While it might seem harmless on the surface, giving into the demands of the eating disorder during meal support will keep a person sick longer.

Urge to Binge Or Purge At Mealtime

Binging and purging can actually alter a person’s brain waves.  It can. be extremely stressful for a person to sit with the urge to binge or purge at the table.

A person who binges or purges may feel:

• satisfaction during the first few bites of the meal, but this generally declines through the meal. 
• somewhat of a “high” in response to the hormones released during binging and purging
• extreme guilt after eating or purging

Coping strategies for a binge or purge that you can support someone with at mealtime include:

• Delaying engaging in the activity for 5 minutes. 
• Using urge surfing to overcome the desire to binge or purge
• 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 when 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.  You should also offer post-meal support for someone who has a history of purging their food.

It’s important to consider that many people go through extreme hunger during eating disorder recovery. This is different than a binge.

Meal Planning With An Eating Disorder

Some tips for meal planning for those with an eating disorder include:

• Letting the person with an ED know the plan (keep a menu on hand if possible, keep regular meal times)
• Make it an expectation they will not prep their own meals
• Ask close-ended questions (would you like fish or tacos tonight?)
• Try to avoid surprises (for example I was tired after work. I hope it’s okay I stopped for take out)

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 Eating Disorder

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. 

Goals Of Meal Support For Eating Disorders

The main goals of meal support are:

• Stabilizing and normalizing eating behaviors
• Providing emotional support
• Symptom Interruption
• Modeling appropriate eating behaviors
• 100% meal completion 

Remain Calm During Meal Support

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.  

Meal Support Modeling

You can serve as a guide during meals with someone with an eating disorder by:

• Setting an appropriate pace for. how quickly a meal should be consumed
• Modeling types of food choices common at a meal
• Practicing bite for bite (you take a bite, they take a bite
• Showing the person with an eating disorder what a fork full of food should look like. 
• Eating similar foods and quantities if possible to the person with the eating disorder to show support

Meal Support Strategies In Eating Disorders

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

• Symptom interruption: This includes not allowing a person to leave the table until the 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. Let’s take this first bite together.”
• Distraction: Try talking about a funny event or playing a game during mealtime. 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. 

Setting A Timer During Meal Support

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. meal replacement shake such as a boost may be used.  However, the goal is always 100% meal consumption.  

Who Should Meal Prep

All meal prep if possible should be done by a caregiver. The reasons include:

• People with eating disorders are likely to prep meals that follow food rules and regulate fear foods in a way that makes it impossible to recover
• People with an eating disorder have structural changes in the brain
• A brain that is malnourished does not have the capacity to make meal and snack decisions that are adequate to meet nutrient needs. 
• When the brain is starving, and food is the medicine the person with an eating disorder will try to avoid
• It’s likely nothing will sound good to eat to a person with an eating disorder
• The person with an eating disorder on board will have a loud eating disorder voice constantly interrupting thoughts

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.

Meal Support Resources

Do you have a loved one with an eating disorder? 

Knowing how to find treatment for eating disorders and guidance for providing meal support can feel overwhelming.

 It can sometimes feel as though you 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 a very understandable concern that is important to resist giving into.

Additional tools to support the recovery journey include:

• Eating disorder recovery books.
• Using Body-positive journal prompts
• Keeping a list of eating disorder recovery quotes
• Using tools to stop body-checking
• Cover labels and calorie information
• Limiting opportunities to body check

You can check out my anorexia story to see some of the thought process that is likely to come up for your loved one with an eating disorder

Meal Support FAQ