Meal Support in Eating Disorder Treatment: Helping to Build Healthy Eating Habits at Home
Written by CCTC Staff Writer
When it comes to eating disorders, adequate meals at regular intervals are not in the equation. One of the key goals of eating disorder treatment programs is to change that. This is done by sitting patients down every few hours for meals and snacks that meet an individualized meal plan. But actually sitting at the table is very hard, which is why treatment programs have meal support in place at every meal and snack.
In this article, we will discuss:
What meal support is
The purposes of meal support
How meal support is used in the eating disorder treatment setting
Mealtime coping skills
How to take the skills you learn from meal support and turn them into healthy eating habits
Recovery is hard — you don’t have to do it all alone.
What is meal support? Why is it an essential part of eating disorder treatment programs?
The overall purpose of meal support is to help you complete your meal plan in times when you can’t complete it yourself, whether it’s because it’s emotionally difficult, you need to be held accountable for completing your meal plan, or you need to be made aware of behaviors you subconsciously engage in.
Meal support is given by treatment center staff in two parts: during the meal, and then after.
Meal Support During Meals and Snacks
During meals and snacks, you will eat with other patients in the program, as well as staff. Meal support is offered by staff, with the purpose being to:
Support the completion of meals and snacks during an allotted time frame (30-45 minutes, and 15-30 minutes) that is consistent with a reasonable time frame of eating outside of treatment
Provide a calming environment for patients to eat in, which includes engaging in regular conversation to distract from emotional distress (although this is not done in all treatment settings)
Provide empathetic support to patients during the meal, validating their struggle and encouraging them to complete their meal
Bringing a patient’s attention to eating disorder behaviors at the table (cutting up food into very small pieces, disassembling food, etc.) and gently directing them away from it
Provide time updates to encourage pacing of the meal (so as to not eat too quickly or too slowly)
Ensure meal plan completion by checking plates/trays for meal plan completion, and check for food hiding, hoarding, etc.
Dispense supplemental nutrition if an entire meal/snack has not been finished (depending on treatment level and model)
While this seems like a lot, your mind and body will eventually get into the rhythm of eating a variety of foods every couple of hours.
Meal Support After Mealtime
After mealtime in the treatment setting, you are supervised by staff for a certain amount of time (usually 45-60 minutes after meals and snacks). This is done for two reasons:
To make sure you do not act on any eating disorder urges
Have someone to talk to when you’re dealing with distress and anxiety after eating
After a while, you will get used to not acting on eating disorder urges to compensate for a meal.
And each time you sit down for a meal and snack is also like an exposure. Each time you get up from the table having completed some (hopefully all) of your meal/snack, it will get a little easier. You will also be better equipped to deal with emotions, so you will need less support (and can start eating on your own.)
How does mealtime support work in practice?
In the treatment setting, you will have a specific meal plan requirement to adhere to for every meal and snack. There are a variety of meal plan approaches, and a variety of ways you can satisfy your meal plan requirements.
Not all treatment programs have the same mealtime structure or practices. For example:
Not all residential treatment programs follow a 3 meals/3 snacks schedule. This may just be a scheduling thing, or how a meal delivery system works.
Not all partial hospitalization programs or intensive outpatient programs meet the same amount of hours/days a week.
Not all treatment centers have mealtimes set at a certain hour.
Not all treatment centers give you the same amount of time to complete a meal. Some give you 45 minutes for meals, some give you 30, and some give you 60.
Not all treatment centers allow you to fill your own plate. Many do, as it teaches you about normal portions.
Not all treatment centers allow you to pick your meals and snacks. In many, meals and snacks are decided for the group.
Not all treatment centers allow you to bring items like cell phones to the table.
Many, but not all, treatment centers have “outings,” where you go to a local restaurant or order takeout to practice eating out with others. (Obviously, sitting down at a restaurant would not happen during COVID-19 restrictions.)
In every treatment setting and at every level of care, you sit down with your peers and have your meal. A certain number of staff members sit with you at your table. In some treatment settings, staff members will have meals and snacks with you to make the experience feel more normal.
You are given a meal start time and end time, and you are reminded of how much time you have remaining throughout the meal.
Staff will engage in light conversation, or often they will play games with the table to help ease anxiety and take your mind off of the meal or snack. Talking or engaging in activities with others is normal, and something you will do often with family and friends outside of treatment.
Some treatment centers allow you to bring books, phones, journals, music, etc., as distraction tools to help get your mind off of the task at hand. This is common practice for treatment centers who teach dialectical behavioral therapy (DBT) skills to patients.
Related: Want to learn more about dialectical behavioral therapy for eating disorders? Click here.
If you are having difficulty completing your meal or snack at the table, staff are there to help you through your struggles. Staff members often encourage patients to try and be open and honest about what’s going on for them during the meal.
Patients are not allowed to go to the bathroom during post-meal supervision. Depending on the treatment center’s rules/practices, you may not be able to leave the sight of staff after a meal or snack. Other treatment settings allow you to be on your own after eating, depending on where you are in your treatment experience and recovery.
After post-meal supervision, patients are able to go to the bathroom and get ready for the next part of the day’s programming schedule.
Related: Click here for a sample treatment program schedule, which includes therapeutic meal support.
How to Take Your New Healthy Eating Habits and Apply Them at Home
Having meals and snacks in treatment is obviously very different than having meals and snacks at home.
But everything you learn from having meals in treatment, from proper meal portioning to proper meal timing to meeting adequate nutritional needs with a variety of foods, can all be taken home.
At home, try to keep a similar eating schedule as you had in treatment when reasonable. You can vary the specific times that you eat, but eating every few hours is ideal. If you are not able to eat at a certain time, you will have to “make up” the meal or snack at other times of the day to meet your entire meal plan.
Lean on the same coping mechanisms you’ve learned in treatment, when meals and snacks feel overwhelming. Call one of your supports to talk if you need, or use distraction tools — whatever works best.
You may also need to rely on a meal plan for a while after leaving treatment. This is okay, and often very normal. But the ultimate goal is intuitive eating, which means full food freedom. It also means you’re one step closer to making a full recovery.
Related: Maintaining healthy habits at the table is important. Your sleep habits are, too. Here is how to tell whether you’re getting quality sleep, and what to do if you’re not.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.