Individuals with eating disorders frequently employ a meal plan developed with the help of their dietitian. This plan provides structure and supports a person in having the type and amount of food their body needs, divided over consistently timed meals and snacks.
The level of structure provided by a meal plan can vary from a highly detailed exchange-based plan to a more general entrée-sides plan to more of an intuitive eating-based approach. No meal plan style is necessarily better than another; what is important is that it provides the right level of support for that person at that time. As a person’s ability to manage food intake changes, their meal plan is often adjusted as well. Let’s look at some of the different styles of meal plans in a bit more detail.
In this style of meal planning, a person works with their dietitian to create a “meal pattern,” which outlines the timing, type, and amount of each food category over the course of the day.
The meal plan is organized using a system of exchange lists. These lists contain foods grouped together because they are nutritionally similar. The seven exchange lists include grains, protein, fruits, vegetables, calcium/milk, fats, and desserts. The eighth category is called other, and it is generally used for supplements to the meal plan. Here is an example of what a section of the grain exchange list looks like. The full list is much longer and contains many other food options.
In the above example, a person can fulfill a one-grain serving by having a slice of bread, ½ cup of pasta, or ¼ cup of lentils. The three are nutritionally equivalent and one can be “exchanged” for another.
If a person is new to this type of system, it can take time to learn and get comfortable with, but it has proven to be invaluable in helping to re-regulate the eating process and support weight restoration and/or stabilization.
Working closely with an experienced eating disorder dietitian is essential to develop and help put into action an individualized meal plan. While this style of meal plan can be highly effective, sometimes there are reasons a dietitian might choose not to use it. Often individuals with a history of weight-loss dieting, for example, find that such a plan looks too much like restrictive diets they followed in the past, making their use counterproductive.
Another approach, the entrée-sides meal plan, has features of the exchange-based meal plan but with more general categories for food and less exact portion sizes.
In this style of meal plan, there is still an emphasis on eating regularly spaced meals and snacks. However, instead of breaking meals down by various exchanges, there are just two categories, entrées and sides. Here is an example.
The advantage of this approach is that simplifies food choices and uses everyday language we typically hear when thinking about meals. Snacks are similar; the lists of snack options include commonly consumed snacks but in differing quantities and combinations in order to provide the needed nutritional level. This plan is our front-line approach for adolescent clients as it is family-friendly and easy to adapt to family meals. However, it lacks the level of precision many individuals need when the eating disorder is more in control, which is why it is frequently a step-down method for adult clients once an exchange-based meal plan is no longer required.
Intuitive eating focuses less on creating an external framework by which to make eating decisions and more on reconnecting with the body’s physical hunger and fullness signals to guide the timing and amount of food chosen. Below is an example of a hunger/fullness scale that can be used to help identify varying levels of sensation associated with the body’s physical state.
Getting in touch with internal cues for hunger and fullness is then paired with developing, or reclaiming, a sense of what the person is truly hungry for and/or what they know their body needs to balance out their intake for the day. Intuitive eating is often used interchangeably with “mindful eating,” though subtle differences exist. The term “attuned eating” is sometimes preferred, as it incorporates the idea that we are likely to be influenced by a host of factors that prevent us from being truly intuitive eaters. Instead, we might be “attuned” to our body’s needs but also aware that food and eating choices are going to be influenced by what else is going on in our world.
As appealing as intuitive eating may seem, a fair amount to work needs to go into being able to follow body cues to lead food and eating decisions. Those active in their eating disorders often find physical signals of hunger and fullness either unavailable to them or that these signals have been hijacked by disordered thoughts, judgments, or associations. Eating disorders are masters at using approaches such as intuitive eating to justify over/undereating or to avoid certain foods out of “preference,” when in reality it just serves as a way to legitimize disordered eating behaviors. Those dealing with, or who have a history of, an eating disorder need to work closely with an eating disorder specialist to explore how to transition to this style while not inadvertently slipping back into disordered patterns.
In addition to the meal plan styles listed above, there are numerous variations of other meal plans designed to meet either specific food/eating objectives or to act as building blocks toward more structured plans. One example is generally known as the “3 by 3” or “rule of threes” meal plan. In this approach, the person focuses on building meal patterns in which they eat three meals per day, each meal including something from three different food groups or macronutrient categories. It is also possible that the meal plan will include recommendations for fluid intake. Each person’s needs are taken into account when determining what meal plan is right for them right now.
No matter what meal plan you follow to bring structure and logic to your food and eating choices, consider taking a minute to see if it is truly meeting your body’s nutritional and food satisfaction needs. Talking with your treatment team about the above approaches could also be helpful. Regardless of which approach you take, the goal is to support you in regaining your ability to nourish yourself in a way that brings joy, satisfaction, and optimal well-being to your life.
Hilmar Wagner is a Registered Dietitian/Nutritionist (RDN) and Certified Dietitian (CD) in the state of Washington. Hilmar joined the Emily Program in 2006, and currently serves as the Training Coordinator for Nutrition Services and Clinical Outreach Specialist. In this role he initiates and coordinates training of new dietetic staff, dietetic interns and continuing education for nutrition services for all Emily Program locations. He has presented on a wide range of nutrition topics at local, regional and national conferences. Hilmar received his Bachelor’s degree in Nutrition/Dietetics and Master’s in Public Health Nutrition from the University of Minnesota. He has worked in the field of eating disorders for the past 12 years. Hilmar has extensive experience working with clients of all eating disorder diagnoses in both individual and group settings. He has a particular interest in mindfulness and body-centered approaches to eating disorder recovery.
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