Meal Support in the Treatment of Eating Disorders

How Meal Support Can Help Eating Disorder Recovery

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Eating disorders present a conundrum. Across the spectrum of anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified eating disorder, they all involve conditioned abnormal eating behaviors. Individuals with eating disorders are often terrified of eating or of eating certain foods. This leads to an avoidance response:  many people with eating disorders avoid meals or foods they consider dangerous.

However, the body must be renourished to recover, and therefore treatment requires new eating habits that will reduce the effects of malnourishment and habituate the eating disorder sufferer to a broader spectrum of foods. Often, the sufferer must make these changes despite persistent eating disordered thoughts and intense anxiety. Meal support is one tool that can ease the transition.​

What Is Meal Support?

Meal support is the provision of emotional support during meal times, focused specifically on helping the patient to consume the food on their meal plan and redirecting behaviors that sabotage eating and recovery. Meal support can be provided individually or in a group setting. Treatment team members, family members, and friends may all provide meal support.

Meal Support in Traditional Settings

Traditionally, many patients attended residential treatment for eating disorders. Meal support has, for many years, been a major component of hospital and residential treatment for eating disorders.

In the residential setting, all meals and snacks are supervised. Typically, they are highly structured and closely supervised in order to confront eating disorder behaviors and ensure clients are eating. 

Recently, treatment options have expanded to include partial hospitalization and intensive outpatient treatment programs where supervision of some meals plays a central role.

However, in an era of cost-containment, many individuals with eating disorders are treated in the outpatient setting. All too often, in my experience, individual outpatient therapy (consisting of 1 or 2 sessions per week with a therapist and/or dietitian) does not take the place of meal supervision in encouraging changed mealtime behaviors. Significant recovery work takes place during meals, including exposure to fear foods and the unlearning of conditioned eating disorder behaviors (restriction, slow eating, deconstructing food, cutting food into tiny pieces, etc.). During meals, irrational thoughts about food and how it works with one’s body can be confronted with reality-based ideas, again confronting the eating disorder.

Innovative Newer Options

In growing recognition of the centrality of food and eating to the recovery process, an emerging trend is the provision of meal support in additional settings. Recently, there have been several innovative developments in the realm of meal support for eating disorders, making this much-needed support more accessible.

In Family Based Treatment (FBT), a newer evidence-based outpatient treatment for adolescents with anorexia nervosa and bulimia nervosa, parents are charged with supervising their adolescent at family meals.

The therapist or other trained health professional coaches the parents to help their adolescent to eat the foods that will nourish them back to health. Parents learn to stay calm in the face of an adolescent’s anxiety attacks and angry outbursts, supporting them through meals including foods they fear.

Additionally, there are now outpatient providers who specialize in providing meal support to individuals in recovery.  Below are some examples: 

  • Dine Monte Nido was established by providers who recognized a lack of “real-life” meal support to help clients work through anxiety associated with eating within the outpatient setting. This service provides an adjunctive weekly supervised group meal.
  • Joie Meal Support is another program that offers individual meal support via “meal companions,” who are trained professionals that prepare and eat meals alongside clients in their home, school or workplace. They will also help with grocery shopping, cooking, and eating meals out.

In my own practice, the dietitian frequently eats meals with clients in different settings and is involved with tasks such as grocery shopping, cooking, and planning menus. I notice that this support during meal-related activities allows clients to face feared situations with support and facilitates both understanding their difficulties and the recovery process.

As there is greater recognition that eating disorders affect individuals of all socioeconomic statuses, including many individuals who are uninsured, I believe that additional options for meal support will become available. For example, some community organizers are currently discussing the provision of therapeutic meals in the community. Other providers are considering a potential training program as well as a credential for “meal companions.” Schools may have a teacher or other school personnel trained to provide meal support to students who need it and who can access school support for their disorder via IEPs (individual educational plans).

According to Brooke Glazer, RD, Co-founder of Joie Meal Support, “Outpatient meal support is helpful at any stage of recovery. It can be used as prevention to keep one in one's life and out of treatment, used in conjunction with traditional outpatient team, or used as aftercare to ensure continued success after discharge from a treatment program.  We have had success helping clients at all of these stages."