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Mealtimes are a big part of the eating disorder recovery process. Eating disorders and disordered eating tend to disrupt mealtimes. This can take many forms, including:
- Increased interest in grocery shopping and preparing foods separate from the meal offered
- Complete food refusal or decreased interest in food already available
- Increased negative food comments
- Increased emotionality at mealtimes (irritable, stressed, sad, crying, angry, etc)
When eating consistent meals and snacks is the nutrition prescription this can make mealtimes feel daunting, chaotic, and never-ending.
Do mealtimes have to be so hard?
Yes, but not forever.
When the concept of consistent meals and snacks, usually in the form of a meal plan, is first introduced this is going to feel hard. Eating disorders, even those characterized by binge behavior, usually have some level of restricting involved. This can make eating consistent meals very physically challenging.
When we understand the role that the eating disorder plays, we understand how it may be emotionally challenging as well.
As an example, I want you to think about yourself as a child (or if you have children you can think about them instead). Can you remember a security item that you had? Maybe it helped you at daycare meeting new people. Maybe it kept you company as you fell asleep each night. Now I want you to think about if someone had taken that security item away from you. It likely would have made those situations that you felt capable to face suddenly seem worrisome or even impossible.
An eating disorder is that security item. It is a maladaptive (or hurtful) coping mechanism to help the person deal with things going on in their world. Even though it’s critical that we do take away eating disorder behaviors because they are harmful to the individual, it doesn’t make it any less painful for that person.
How do mealtimes get better over time?
There will be an ebb and flow – recovery is not linear!
However, there are things that support persons can do to help with mealtimes.
1. Be a part of the treatment team. A good eating disorder treatment team has many players (therapist, dietitian, psychiatrist, coaches, and support people). It is important to have consistent messaging across all treatment team members.
2. Have consistent mealtime boundaries. These should be established with the treatment team. Some examples include: what goes on your child’s plate, the necessary amount to be completed, supplement protocol for incomplete meals/snacks, rules for bathroom use after meals, etc. While someone may not like the mealtime boundaries, if we are consistently enforcing them there is communicated safety in what happens if they use their eating disorder.
3. Keep mealtime conversation light. It’s a good idea to keep mealtime conversation off contentious topics. This includes not having prolonged conversation about food and certainly no negative food or body talk. Try asking questions, such as: “what was your favorite part about today?”
4. Encourage the use of coping skills.
What are coping skills?
Coping skills are skills or techniques that a person can use when experiencing a heightened level of emotion to bring down the emotion to a more manageable level. Coping skills are taught in eating disorder recovery because, as discussed earlier, eating disorders are very real physical and mental conditions AND function as a maladaptive coping mechanism. So, when we remove the eating disorder, this leaves a person with heightened emotions without other techniques to defuse the emotions. Enter education on coping skills.
Therapists take the lead on teaching coping skills within a unified treatment plan. This may include coping skills from Dialectical Behavioral Therapy, Cognitive Behavioral Therapy, or Acceptance and Commitment Therapy to name a few. As a dietitian, what I help my clients with is applying the coping skills they learn with their therapist before, during, and after mealtime.
What are some helpful mealtime coping skills?
done Successful coping skills vary by person. That being said, I try to help my clients focus on coping skills that are discrete and effective.
Pre-Meal Coping skills are completed 15-20 minutes prior to a meal, specifically when someone is not involved in preparing food. These are primarily cope ahead strategies to reduce the level of emotion before getting to the table. As part of these skills, you will see it say “set a timer and do …” It is important to set a timer so that the coping skill doesn’t allow the individual to avoid the mealtime.
Set a timer and complete a mindful activity.
Coloring books
Playing cards/games
Puzzle
Listen/Play music
Do homework
Journal
Set a timer and do something distracting.
Watch TV
Play with your sibling
Play with your pet
Set a timer and do something active (as allowed in the treatment plan)
Sit outside
Meditate
Do sport skills work (dribbling a soccer ball, shooting free throws)
Help set the table (as allowed in the treatment plan) and place yourself next to your best support person
Ask to talk with a support person about your emotions before sitting down to a meal and receive support/comfort.
During Mealtime Coping Skills are those that are completed at the table during the actual meal. These are skills that should not take away from the person’s ability to engage in the meal.
Deep breathing
Box breathing: Inhale for 4 counts, hold for 4 counts, exhale for 4 counts, and hold for 4 counts. Repeat 5 times
Diaphragmatic breathing: Put one hand on your chest and one hand on your stomach. Try to fill your stomach with air during breathing.
Grounding skills
5 Senses: Look for 5 things around the room. Feel 4 sensations (shirt sleeve on your arm, chair your sitting on). Listen for 3 sounds. Smell 2 scents (or think of your 2 favorite smells). Taste one flavor.
Touch something cold.
Play “I Spy” by noticing everything in the room that matches your favorite color.
Positive Affirmations – you can check out my affirmation series on my social media
My body knows what to do with the food I eat
Food is fuel
I used to enjoy this food
I can do hard things
Post Mealtime Coping Skills are those that are completed after a meal. This is especially important after an exposure meal and for those that engage in purging/compensatory behaviors. I encourage my clients to pick 3-4 coping skills and do each of them for 15-20 minutes (or something they really like for longer periods of time) to get to an hour post-meal.
Complete a mindful activity.
Coloring books
Playing cards
Puzzle
Listen/Play music
Do homework
Journal
Complete a supervised chore (clearing table, washing dishes, putting away food).
Do something distracting.
Watch TV
Play with your sibling
Play with your pet
In Summary
Mealtimes are a huge part of the recovery process. While at the start mealtimes can feel exhausting, having consistent boundaries around meals can help an individual diagnosed with an eating disorder understand expectations and natural consequences to eating disorder behaviors. We can encourage our loved one in their recovery process by helping them find coping skills to improve emotion regulation and reduce eating disorder behaviors.
If you find that you need more help in your eating disorder recovery journey, please contact me for individual nutrition counseling.