Skills
Managing Meal Times
A young person can find eating very scary but they may also be very hungry and feel relieved that they are being supported to eat when the eating disorder is making them feel like they shouldn’t and that they have no choice but to eat. The eating disorder may make it incredibly hard for your loved one to eat for many reasons and by being there you can support your loved one through the difficult time, whilst challenging eating disordered behaviours or thoughts.
Meal times, including snacks, should be a time when your loved one is supported. You will need to be there when your loved one eats where and when possible and as often as possible. During the early stages of treatment, it would be ideal for all meals and snacks to be supported. This may mean taking time out of work in order to support meals and snacks and working with others who you trust or professionals in order to do so.
You may have to think about how this works with your loved one attending schools, college or university. Will your loved one need time out to work on recovery? Can a professional support your loved one? This is something that the clinicians working with you and your loved one can advise on.
In the early stages of establishing eating and “normal” eating routines, it’s good to eat with your loved one and often eat the same food. It’s preferable that the food you eat isn’t a lower calorie version of what your loved one is eating (i.e diet foods). This allows you to model “normal” eating for your loved one. It’s important to note that by supporting meals and snack with your loved one, a side effect may be that you also put on weight. However, always eating the same as your loved one can also be a “trap” of the eating disorder if this is maintained for too long. At some stage, you will have to introduce that it’s okay to eat different things on the road to recovery as you will have different needs due to age and likes/dislikes.
This is a short guide to help you challenge the eating disorder and support your loved one to eat normally. This is not an easy task but it is important for a person’s recovery to challenge the eating disordered behaviour displayed.
Points to note before a meal or snack
- Meal and snack times will make your loved one extremely anxious and distressed because of their fear of food and weight gain. They may well hold very distorted ideas about food and it is hard for them to see the need for food.
- It can be helpful to have your loved one use the bathroom before eating. Using the bathroom following meals should be discouraged as it may be an opportunity for your loved one to exercise or vomit.
- It can be helpful if your loved one is not in the kitchen during meal preparation, particularly during the early stages of treatment. Your loved one may find it difficult for you to be in control of food choices, portions or general cooking.
- Checking any food label (such as calories and fat) should be discouraged. This behaviour only worsens the eating disorder. Foods should not be low-fat or diet versions unless agreed with the dietitian or the clinicians involved in the care of your loved one. Normal wholesome foods are encouraged. The goal is for your loved one to be able to eat the same food as the rest of the family or their peers, as they did before they became unwell, although your loved one will likely have to eat more the before they were unwell initially if weight needs to be recovered.
- A young person should have 3 regular meals – breakfast, midday lunch and an evening meal and 3 snacks in between these meals. Never leave more than 3 hours without eating – your loved one will not know when they are hungry and they may feel discomfort after eating – this is fairly normal.
- Try to stay positive; start with the absolute expectation that your loved one will eat.
Points to note during the meal
- Those supporting meal times can be good role models. By modelling normal eating behaviour you will encourage your loved one to do the same. Eat your own snack or lunch with your loved one.
- It is best to keep meal times as relaxed as possible. In order to do this, avoid discussing feelings at meal times.
- It is also unhelpful to discuss food during meals. This is because your loved one has a distorted view of food and being drawn into discussion about portion size or food content and arguing at meal times will not change their views or persuade them to eat. Try to change the subject; distract them from the topic and stay firm and encouraging.
- Try to stay calm throughout the meal. It’s normal to find this difficult at times. You may need to find a way of managing your stress and frustration. For example, silently counting to 10. You need to be understanding while also being remaining firm. It helps your loved one to feel understood while at the same time challenging their thinking and behaviour. This is a difficult balance and takes time and practice. This is a time where you may need two people for meal support, so when one person gets tired, saturated or burned out, the other can step in before it gets to that point. If you are a single parent, you may want to explore if other family members or friends could support you with this task.
Here are some conversations that may crop up during meals and how to shut them down:
Person: “I can’t eat that! It will make me feel fat and disgusting.”
Supportive person: “It must be really hard for you. You need to sit down and take the first mouthful; I know you can do it and will be OK, come on…” Continue to distract the person, change the subject but continue to be firm and encouraging.
Hints for helpful things to say during the meal.
Chat about every day things to help make the young person less anxious and to distract them. Encourage them, but do not overpraise. Try and keep the wording positive, for example say, “I know you can do it” rather than, “Why have you not eaten it all?”.
Some examples of encouraging statements are:
“I am here for you; you know you can do it.”
“You will be OK.”
“Nothing awful is going to happen.”
“Concentrate only on now and eating this meal/snack.”
“How can I help, what can I say?”
“You can do it; your health is the most important thing.”
There is a small amount of evidence that suggests that young people will eat more during meals if they are given “direct prompts” during meal time. For example, telling the young person to pick up cutlery or eat all of the food. You can read about this research by White et al (2015) in a summarised version here at Eating Disorder Theapy LA.
Eva Musby has two videos that may be helpful to watch to support you with meal times. You can view them here, at Eva’s youtube page.
Between meals, talk to your loved ones about what they find helpful.
Points to note AFTER meal or snack
- After a meal/snack can be an anxious time as this is the point when your loved one can become overwhelmed with eating disorder thoughts. Stay with the person as long as you can. Distract and reassure them as support at this time will reduce anxiety (e.g. playing cards, going for a drive, crafts or board games, colouring in).
- Ask the young person to get into a routine of going to the toilet before meals/snacks and discourage the use of the bathroom straight after eating.
Adapted from SNDRi Inside Eating Mealtime Management leaflet
