Full recovery from an eating disorder is possible, but the recovery journey is difficult and paved with many obstacles. One of the main challenges patients with anorexia nervosa encounter is adhering to their eating disorder meal plan. The purpose of eating disorder meal plans is to help patients build a healthy relationship with food that supports their body’s needs and promotes appropriate weight gain. Understanding one’s individual dietary needs and incorporating a variety of foods from all food groups is essential to full recovery.
As human beings, we have innate hunger and fullness cues that help ensure we are meeting our daily energy requirements. Unfortunately, we live in a society inundated with diet culture filled with judgmental food rules that makes us question the amount and types of foods we eat. For someone struggling with an eating disorder, this makes meal planning and nutritional rehabilitation much more difficult. Patients begin forming strict food rules that dictate their food choices, which can lead to complex medical complications.
This is why nutrition therapy is a critical aspect of eating disorder recovery.
Nutrition Therapy for Eating Disorder Recovery
Nutrition counseling and nutritional rehabilitation is a vital aspect of eating disorder recovery and is the primary medical concern for individuals who are malnourished and require weight gain. Normalizing eating habits and meeting your body’s nutritional needs is essential for correcting medical complications related to malnutrition, regulating blood sugar, increasing energy levels, and improving mood and cognition.
A registered dietitian nutritionist (RDN) is responsible for providing nutrition counseling sessions and developing individualized meal plans that meet your body’s needs. They are a vital member of all eating disorder treatment teams and treatment programs. Full recovery from an eating disorder is impossible without appropriate nutrition therapy.
Purpose of a Meal Plan for Eating Disorder Recovery
An effective eating disorder recovery meal plan is essential for full recovery and reversal of medical conditions related to malnutrition.
The purpose of meal planning during eating disorder recovery is to:
- Normalize eating habits and deconstruct food rules
- Establish a consistent eating time for each meal and snack
- Promote a balanced diet
- Normalize hunger and fullness cues
- Nurture a healthy relationship with foods from all food groups
- Promote regular eating patterns
- Meet the body’s nutritional needs and daily energy requirement
- Speed up recovery from medical conditions related to malnutrition
- Assist with weight gain, when needed
Meal plans provide structure and predictability of food intake and promote regular eating patterns. There are many different types of meal plans that can be utilized during eating disorder recovery treatment depending on the level of care and individual needs of the patient.
High Calorie Requirements During Recovery
The initial primary goal for treatment for anorexia nervosa is weight gain to full weight restoration. This is a critical step in reestablishing physical, mental, and emotional well-being. Unfortunately, this is often one of the most difficult steps for patients.
Not only are they faced with the fear of eating 6 times per day, they are forced to deal with the physical repercussions of increasing food intake after a long period of starvation. Many patients become metabolically inefficient and require a significantly larger number of calories than usual just to maintain their weight.
For an adult woman recovering from anorexia who is hypermetabolic, this means consuming 2-5x the amount of calories compared to a healthy adult woman. Parents and caregivers are often complexed by the amount of food their loved one needs to eat during recovery.
Research shows that a patient who is hypermetabolic may require up to 5,000 – 10,000 excess kcal to gain 1kg, which equals 2.2 lbs. If there is one thing patients and loved ones should know, it is there is no normal when it comes to eating disorder meal plans. Everyone’s required energy intake is extremely individualized and based on their body’s needs as they move through treatment.
Recovery Meal Planning Styles
There is no “one-size-fits-all” approach for creating eating disorder meal plans. Many different methods can be used, but all of them should include the following similarities:
- Promote a balanced diet with foods from all food groups
- Encourage food choices based on genuine preferences rather than diet culture and food rules
- Promote a healthy relationship with food and one’s body
- Encourage repeated consumption of fear foods
- Meet the nutritional needs and energy requirements needed for optimal health
- Discourage the use of calorie counting
- Encourage regularly spaced out snack and meal times
There are four main styles of meal planning used during the eating disorder recovery process. One or all may used for a particular patient throughout recovery depending on the level of care they are in and what works best in meeting their nutritional needs. This is not an extensive list and other methods of nutrition therapy may be utilized when the registered dietitian feels it is appropriate.
Exchange System in Eating Disorder Recovery
The exchange system style of meal planning was originally developed by the American Dietetic Association in conjunction with the American Diabetes Association as a tool for managing blood sugar in individuals with diabetes. Throughout the years it has been modified and adapted for use in eating disorder treatment. This system breaks foods and beverages into 6 different food groups. These food groups include:
- Starches
- Proteins
- Fats
- Fruits
- Vegetables
- Dairy
It is called the “Exchange System” because items from within each food group can be substituted for one another depending on patient preference. Each food group has a specific nutritional value assigned to it that represents one “Exchange” from that group.
Patients are given a certain number of servings or “exchanges” from each food group they must meet on a daily basis. For example, a patient’s individualized meal plan may contain the following exchanges: 12 Starch, 10 Protein, 2 Vegetable, 3 Fruit, 3 Dairy, 10 Fat.
Essentially, 1 serving = 1 exchange
Some examples of serving sizes that represent 1 exchange from each group include the following:
1 Starch Exchange
1 Protein Exchange
1 Fat Exchange
- ½ cup pasta
- 1 slice bread
- ½ bagel
- 1 English muffin
- 1 oz tortilla chips
- 1 oz meat
- 2 oz fish
- 1 slice cheese
- 1 egg
- ½ cup tofu
- 1 tbsp ranch
- 1/4th avocado
- ½ handful nuts
- 1 tbsp regular mayo
- 1 tbsp nut butter
1 Fruit Exchange
1 Veggie Exchange
1 Dairy Exchange
- 1 apple
- 1/4th cup dried fruit
- 1 banana
- 2 kiwis
- 2 tbsp raisins
- ½ cup cooked vegetables
- 1 cup raw vegetables
- 1 cup milk
- 2/3 cup yogurt
- 1 cup calcium-fortified orange juice
Breakfast Example Using Exchanges
1 cup milk – 1 dairy exchange
1 apple – 1 fruit exchange
Sandwich made with:
2 slices toast – 2 starch exchanges
½ avocado – 2 fat exchanges
1 egg – 1 protein exchange
2 oz deli ham – 1 protein exchange
There are many benefits for this style of meal planning. Every single food or beverage that exists fits within one or multiple of the food groups. This helps individuals build a healthy relationship with all foods and challenge their beliefs about foods being “good and bad” or “healthy and unhealthy”.
This is extremely beneficial for helping patients feel comfortable challenging their disordered food rules. It also provides consistency and structure to aid in balanced eating with foods from all food groups and teaches patients about their individual nutritional needs.
Some of the drawbacks from this style of meal planning are that is requires a lot of memorization and can be challenging to translate to the outside world. Family and friends often find it difficult and confusing to support their loved one if they are unable to remember the serving sizes for each exchange.
It can also promote the idea there is a “right amount of food” and make it difficult for patients to consume a serving size larger than what is recommended. For patients with a history of counting calories, this method of meal planning may feel restrictive and encourage rigidity with numbers.
Plate-by-Plate Approach in Eating Disorder Recovery
The Plate-by-Plate Approach® is a meal planning tool developed by a registered dietitian. It is often used in conjunction with family based therapy (FBT), but is beneficial with various treatment modalities.
It separates food into 5 food groups and uses a 10-inch plate as a visual guide.
The plate is separated into:
- ½ carbohydrates/starches
- 1/4th protein
- 1/4th fruit or vegetable
- Serving of dietary fat
- Serving of dairy.
Rather than relying on numbers and counting, it encourages the patient to focus on getting an equal ration of carbohydrates, proteins, and fats at each meal.
There are two versions of the plate depending on the patients individual dietary needs.
Benefits of this style of meal planning are that it is customizable to meet individual needs and easily translate to real life situations. It focuses on balance and moderation without relying on numbers, measuring, and counting. This can be very beneficial for individuals who find it difficult to stop calorie counting.
Rule of Threes in Eating Disorder Recovery
This style of meal planning promotes an easy to remember method for establishing regular balanced eating. It separates food into grains/starches, proteins, fats, calcium, and fruits/veggies.
The Rule of Threes stands for:
- Eating 3 meals per day
- Eating 3 snacks per day
- Going no more than 3 hours without eating
This method of meal planning is easy to understand and implement into real life situations. It promotes regularity of eating and ensures patients are consuming a balance of foods from all major food groups.
A drawback of this style of meal planning is that patients may struggle to include adequate portions of each food group into their meals and snacks. I would recommend using this meal planning method when someone is further along in recovery and actively able to challenge disordered thoughts and behaviors.
Intuitive Eating in Eating Disorder Recovery
Intuitive Eating was developed by two registered dietitians in the mid-90s. It uses an evidenced- based, weight-neutral model of eating for overall mind body health. It is designed to help get you more attuned with your body both physically and mentally.
Incorporating intuitive eating into meal planning is usually not appropriate until someone is further along in recovery. However, most patients can benefit from learning the 10 principles of intuitive eating and practicing incorporating the philosophies while following a more structured meal plan.
The 10 principles of intuitive eating include:
- Reject the diet mentality
- Honor your hunger
- Honor your fullness
- Make peace with food
- Discover the satisfaction factor
- Gentle nutrition
- Challenge the food police
- Respect your body
- Honor your feelings without food
- Gentle exercise
An important part of being able to eat intuitively is having the ability to recognize internal hunger and fullness cues. This is often difficult for patients throughout the recovery process because eating disorder behaviors such as restricting, binging, and purging disrupt one’s ability to feel these cues. As patients progress through recovery, they regain the ability to listen to their hunger and fullness cues.
Recovery Meal Planning Take Aways
After reviewing the various therapeutic interventions that can be utilized for meal planning, a great starting point is reaching out to a registered dietitian and getting set up with an eating disorder medical team.
A registered dietitian will help create a personalized meal plan for your individual body’s needs while a physician provides additional support in overseeing the treatment of your medical conditions.
The recovery process is not a linear path. It is filled with challenges related to weight gain, meal planning, and psychological distress. But you don’t need to suffer alone. Establishing an eating disorder treatment team that you feel comfortable with an supported by can help you reach full recovery.
