The significance of the Meal Plan in the treatment of eating disorders
The Meal Plan is the unavoidable and most avoided part of Eating Disorder recovery. In my opinion, a an eating disorder therapist would do well to be 1/3 dietitian and 2/3 therapist and the dietitian , 2/3 dietitian and 1/3 therapist to cover the overlap between food and feelings, while working with a client. Compartmentalization on the part of the clinicians has significant disadvantages to the treatment process. Or , put another way, this way of working provides a seamless experience where the eating disorder has lesser cracks and crevices to hide in. As a therapist, having a partnership with a dietitian who understands this is crucial to the process of supporting a client towards recovery. This partnership is a “working” one, with joint meetings when necessary, ongoing consults and overlapping content.
The Meal Plan has a number of functions that are not often well-understood in their complexity -
The Meal Plan introduces the individual to a baseline of normalized eating that sees food not just as nutrition but also a source of satisfaction and delight. People do not usually talk about food as “fuel”. People tend to respond to the feelings of hunger and taste. Choosing to eat things we want to taste, to satisfy the feeling of hunger without calculating interruptions would be a simple description of normalized eating.
The Meal Plan is a template against which we start identifying the pattern of the individual’s disordered beliefs and behaviours and the connection the behaviours have to their emotional landscape - “ I skipped my snack today because I had a test I was anxious about”.
The Meal Plan helps the dietitian and therapist identify, in collaboration with the individual, the emotional significance of ‘safe’ and ‘fear’ foods
Mechanical adherence to the Meal Plan (over time) facilitates the individual’s capacity to gradually disengage from the incessant bargaining that preoccupies the mind. It is a non-negotiable that the person ( and family members) stop all monitoring with numbers once medical stability is achieved.
The Meal Plan is a very effective tool to practice the skills of trying new things, facing fears, expanding the capacity for delight and flexibility and experiencing what true “balance” looks like. In this way, the Meal Plan is not just about food but skills for Life.
Mechanical eating works on the slow disengagement of the individual from the compulsive and exhausting bargaining, calculating and montoring that they rely on to feel in control. The person gradually learns to live in their body with more ease and deal with their feelings separate from manipulating food. It is helpful to understand that the individual is never “in control”, their anxiety is.
Ultimately, the Meal Plan supports the movement out of a rigid formulaic way of eating to a flexible, fluid way that includes satisfaction and delight in the relationship with food and therefore, life.
It is good to understand that the Meal Plan , ideally , is not a fixed formula. It is crafted with the dietitian beginning at where the individual is at and what they “can” do as opposed to what they “should” do. The Meal Plan is a living document that moves with the progress of the individual. Most individuals see the Meal Plan as an eating disorder “recovery” tool. Often I take the time to explain that the Meal Plan is actually a reflection of a sustainable way of eating for the rest of your life. In the beginning , the Meal Plan has many non-negotiable elements because the individual is a victim of the compulsive bargaining provoked by their anxiety. As the bargaining and anxiety lessens and the individual learns to listen to their hunger and fullness cues, the Meal Plan becomes a way of life. Sometimes people feel limited by their meal plan. This is because the rigidity of the ED has now engulfed the meal plan and the meal plan is now part of the ED. Not the way to go.
A word about “Intuitive Eating”.
It is good to understand that the Eating Disorder is a ‘formula’ that the individual desperately holds on to, to manage their anxiety. The greater the anxiety, the greater the rigidity in the eating disorder. When we look around, we realize that all ‘diets’ are formulas that actually take us away from the conversation between the self and the body. People follow diets to achieve a goal and are left confused when the diet ends, gradually returning to the old way of eating. People are often “cheating” in their diets because diets do not acknowledge that hunger matters.
Intuitive eating simply means eating in a way that responds to the messages that your particular body is sending you. Intuitive eating is not another formula. As we can see, it requires a capacity to listen to the body without interrupting it with thoughts of “should” and not being afraid of the body. We live in families that do not trust the body and in a global culture that inundates us with images of symmetrical bodies. The idea that the body can be controlled and has to be, is everywhere. As my dietitian friend says, our idealized body is often not in agreement with our real body. The many apps that are freely available simplify the bodies’ reality to a few numbers and a convincing sense of control.
The sign that you are ready for intuitive eating is when you are able to think of your body as a ‘friend’ and can respond to it with compassion. As one would when a child is hungry and asks for food. Without interruption, without substitution, without judgement, without fear. Ask for a muffin and you get a muffin.
