Providing Meal Support at Home

By Tracy N. Welchoff, Ph.D.

Supporting your loved one through eating disorder recovery can be confusing, frustrating, and worrisome.  In some instances, meals may become a battleground as family members try to beg, bribe, cajole, threaten, or scare the ED sufferer into completing a meal.  It may be a silent, angry affair, full or arguing or tears, or empty seats as family members (including the ED sufferer) storm off or refuse to come to the table.  For the patient, meals can feel agonizingly long and stressful, feelings which are compounded by being in the “spotlight” as the rest of the family watches to see what will happen.  Other family members may resent the tension at the table, become too worried to eat, or talk about topics that are upsetting or “triggering” to the patient.  Often, families give up on eating together. 
 
If any of this sounds familiar, don’t despair.  We are here to walk you through the process of returning some normalcy to the family meal.  It may take some time, but with patience and willingness to try new ways of managing meals, improvement will come.  
 
Although it is unrealistic to run your kitchen at home as we do in our therapeutic kitchen, understanding how we handle meals at NEDC can be a helpful place to start.  First, the structure and consistency of meals are critical in containing anxiety and normalizing eating.  When meals are predictable experiences, they contribute to a set of expectations in terms of mealtime behavior, food completion, and managing emotion at the table.  Making sure that the atmosphere is supportive matters as well, perhaps even more so.  Understanding that your loved one is not deliberately being difficult helps them feel less judged, hopefully countering the self-judgment that they are undoubtedly experiencing.  In the NEDC kitchen, meals are at the same time every day, the table is set beforehand, and when food is served, everyone remains seated for the duration of the meal.  All food and drink must be completed with no exceptions.  There are no substitutions once food is served, no playing with food, and no using the bathroom during or immediately after meals.  Meal plans are made in advance to prevent last-minute indecision or negotiating about what to eat.
 
In implementing supported meals at home, please consider the following:

1. Do not encourage patients to deviate from the structure of their meal plan.  Encouraging flexibility, although well-intended, is disruptive and can hinder progress or precipitate a relapse.  Be patient… flexibility will come later in recovery.
2. It is best for patients not to eat alone for a while.  Light-hearted conversations during meals will help provide both healthy distraction and a reminder that your loved one is “more than just an eating disorder sufferer”. 
3. Do not make comments about foods being “healthy” or “unhealthy”, “good” or “bad”, or anything that judges what foods are on an individual’s meal plan.  Also refrain from commenting on food quantity, as the food prescribed is based on individual medical, nutritional, and/or psychological needs.  If you have questions or concerns about the food, please address these with the dietitian.
4. Talk to your family member and the treatment team about what kind of help is appropriate to provide.  You might offer to help meal plan, grocery shop, and/ or prepare meals.  This should be discussed in advance as everyone in different.  The amount and kind of support needed depends on a number of factors such as age, treatment stage, skill level of meal planning and food preparation, motivation for recovery, and other emotional/ developmental factors. 

 

• For older teens and adults, make sure that you are offering though; do not take over or insist on helping.  The amount and type of help your loved one wants and needs will vary from day to day; make sure you are flexible and sensitive to how challenging a particular day might be.
• For younger teens, parents may be instructed by the treatment team as to how to plan, prepare, support, and supervise meals from beginning to end.  As your teen progresses in treatment, you should discuss with the team how to slowly hand responsibility for meals over to them so that they can return to a level of involvement that fits their age and the family’s preferred way of handling meals.  For example, a teen may suggest or request certain meals be included in the family’s plan, but allowing them to decide what everyone in the family eats (or insist on eating only “special” foods themself) is not necessary or even helpful.  Again, the treatment team can walk you through these decisions until you feel comfortable making them on your own. 

 
Despite what you make think, it is not your job to “make” your loved one eat.  Your job is to gently encourage (“try your best” or “try another bite”), support (“I know this is hard”), acknowledge (“I know this is hard” or “I’m sorry you are having a rough day”), and provide positive focus (“we will get through this”).  You can never go wrong with making eye contact, giving a supportive smile, conveying an “I don’t mind this because you are SO worth it” attitude, and simply saying “I love you”.  You do not need to know the “perfect” thing to say or feel responsible for the completion of the meal.  Report to the treatment team what is and is not being eaten, and move forward from there.
 

• Check in regularly (although not constantly) to see what is and is not helpful.  If these conversations become too difficult, consider a session with the outpatient therapist or dietitian present to help stay solution-focused.
• Recovery is rarely a smooth process.  Be prepared for ups and downs, good days and bad days.  Although rough days may scare you, don’t assume a bad day means a relapse.  Also, be careful not to assume the problem is “all gone” to quickly.  Ask, listen, and try to stay positive, steady, and encouraging. 
•  As discharge from PHP approaches, it is normal to be nervous about how you will handle meals outside of the support and structure of NEDC.  Conversely, it is equally normal to be so proud and happy about your progress that you are sure that you can do well with little effort.  Either way, remember that your recovery path after PHP will not be perfect.  There will be challenges, struggles, and successes.  It is important to expect this, and your Relapse Prevention Plan can be of great help in navigating bumps in the road. 
• Meal planning after discharge is extremely important.  It is normal to want to stop meal planning after PHP/ IOP, but consistent meal planning is one of the strongest predictors of a successful recovery.  For the first month out of treatment, try to stick to the same meal schedule as you followed in program unless otherwise discussed with your outpatient dietitian.  Planning and structure are critical at this stage in recovery.  You won’t have to do this forever, but your job for now is to take the structure you have learned at NEDC and transfer it to your home environment. 
• Try to limit challenging meal situations for at least a month.  This includes eating at restaurants, parties, or other situations where you cannot have control over what, when, and with whom you eat.  If you do eat somewhere other than home/ school/ work, make sure you plan ahead, find out what food will be available, and come up with a cope-ahead plan with your therapist to manage any difficulties that may arise.  Ask your support system to help run interference if conversation becomes anxiety-producing.
• Although it is impossible to predict and plan for every scenario, keeping communication open both with your loved one and with the treatment team will go a long way toward promoting a successful recovery.  Please talk to the treatment team (both the NEDC team and the outpatient team) to problem-solve complicated situations and adapt your support to the current stage of recovery.

 
This information may seem overwhelming, but with some practice, patience, and ongoing communication, long-term recovery is absolutely possible.  No matter how worrisome, challenging, or endless this process may seem right now, the effort is worth it, so never, ever give up.