Written by: Judy Adams, NCC (she/her/hers)
Team Leader, The Renfrew Center of Pittsburgh
Meal support plays a critical role in eating disorder treatment, creating a structured and supportive environment to help an individual navigate their meals and learn healthier eating patterns. But how does the process work and what steps are required?
Eating disorders can be conceptualized as emotional disorders. As such, a primary objective in eating disorder treatment is to support individuals in learning therapeutic skills to build awareness of their emotional experiences and to learn how to build emotional tolerance without engaging in strategies of avoidance (e.g., eating disorder symptoms) when experiencing uncomfortable emotions or situations.
A large part of that work is around mealtimes. Everyone’s experience with eating disorder symptoms can vary drastically so it is crucial to become curious about your loved one’s personal experience with an eating disorder. This can foster connection with your loved one, allow you to build a better understanding of their lived experience and clarify what your role as their supporter can be.
This can feel like a scary and daunting objective but have no fear. We are human; we are not striving to be the perfect support person, but rather we are building tolerance to imperfection and meeting our loved ones where they are in their recovery journey.
What Is Meal Support?
Meal support can be described as emotional support that can occur before, during, and after meals. The purpose of meal support is to provide individuals with support in consistently nourishing their body to meet their individualized needs while strengthening their emotional awareness, improving emotional tolerance, and increasing the variety of foods from all food groups.
Meal support can take on many different forms depending on a lot of different factors such as what stage of recovery a person is in, their level of motivation for recovery, their age and developmental stage, and what resources they have available to them.
How to Conduct a Meal Support Session: Pre, During & Post-Meal
The supportive suggestions outlined below may be helpful for your loved one, but I encourage you to discuss them with your loved one before implementing them. As mentioned earlier, experiences of an eating disorder can vary, as does the type of support that feels helpful.
Meal Planning & Preparation
As a support, it may be helpful to gain an understanding of your loved one’s nutritional needs and what their dietary providers are recommending. Your loved one may be recommended to follow a meal plan and have established mealtime goals personalized for their treatment needs. Consistency and collaboration are very important when discussing meal planning, preparation, and timing of meals.
- Establish consistent times for when meals will occur. (e.g., breakfast will be at 8am, lunch will be at 12pm, afternoon snack will be at 3pm, and dinner will be at 5pm).
- Planning out what the meals will be in advance. You can plan breakfast, lunch, dinner, and snacks for 1-2 days at a time or planning for an entire week to support your loved one. Planning meals ahead of time can help normalize eating consistently throughout the day and reduce distressful surprises that may interfere with completion.
- Giving your loved one options can be helpful, but make sure to not overwhelm them with too many options.
- Have a conversation with your loved one about mealtime triggers from past meals that evoke eating disorder thoughts, urges, and behaviors. As a support, you can be more aware of what is helpful and what might not be helpful during future meals.
- Talk with your loved one about how involved they would like you to be in the meal preparation/cooking stages of the meal to establish identified roles and responsibilities.
During Meals
During meals, your loved one might be observed struggling with distressing emotions, experiencing difficult physical sensations, or using food rituals (e.g., ordered eating, cutting things up into tiny pieces, eating very slowly or quickly, pushing food around the plate). These food rituals serve the function of dampening or escaping unwanted aspects of their emotional experience. As a support, you can be present with them through the challenge of not engaging in these behaviors, allowing them to increase their emotional tolerance and boost confidence in their ability to do hard things.
Helpful meal support tips during mealtimes are as followed:
- Having supports eat the same meal with appropriate portions, to the best of your ability.
- Support your loved one in plating their meal to support them in normalizing appropriate meal portions for their individual nutritional needs. You can plate the meal for them and/or supervise them plating (measuring utensils can be utilized for additional support).
- Refrain from placing any judgement on foods or labeling foods as “healthy” versus “unhealthy”.
- Generate a list of safe topics to discuss to keep table discussion neutral and unrelated to food, eating disorder topics, and diet culture-related topics (e.g., newest diets, exercise, food judgments, and talk of people’s bodily appearances).
- Ask what would feel most supportive. For example, some find short, supportive phrases of encouragement and validation helpful (e.g., “I know this is really challenging. I am here for you”, “let me know what you need”, “You are doing a good job challenging your eating disorder”).
- Check-in with your loved one throughout the meal to provide opportunities for them to process their emotional experiences verbally and potentially challenge any unhelpful thoughts they may be experiencing.
Supportive Actions Post-Mealtime
It may be the case that distress continues or intensifies after the meal. There may be residual guilt, anger, anxiety, and negative-self talk after the meal. There can be physical discomfort, such as nausea, fullness, bloating, and other GI symptoms that arise post-meal. Eating disorder thoughts and urges to engage in symptoms may intensify, serving the function of altering their emotional experience and providing some temporary relief. It can be helpful to plan structured activities after meals to help your loved one tolerate their emotional and physical experiences without acting on urges in the moment. Activities that promote connection, present-focused awareness, or emotional expression/creativity can be helpful. This is something that would be beneficial to collaborate about to be sure the activity allows for mindful awareness and open expression of emotional experiences, when needed.
Post-meal activity ideas:
- Playing with a pet
- Journaling
- Watching a tv show/movie together.
- Spending time in nature
- Playing a board game/video game
- Doing some sort of creative activity (e.g., painting, coloring, crocheting, writing a poem, making a collage)
Conclusion
Compassion and empathy are so critical in the grand scheme of meal support. We may never fully understand what our loved one is going through but if we can practice empathy and display gentle kindness towards our loved one it can make a big impact. You are not here to “fix it” but to be a supportive figure throughout their journey. Emotions will rise, peak, and fall. We want to model healthy responses to our emotions and support our loved ones as they learn to lean into their own feelings. Offering this type of support helps to reduce eating disorder symptoms and other unhelpful avoidance strategies while validating and normalizing the human experience of emotions.
