Anorexia Nervosa Recovery: Meeting Elevated Nutritional Needs Through Meal Plans and Nutrition
When in Anorexia Nervosa Recovery, a foundational piece of nutrition work is easing gently up to a full meal plan for eating disorder recovery, and establishing a regular pattern of eating (eating balanced meals and snacks at regular intervals throughout the day).
What does it mean to gently ease into a full meal plan and why?
If your family is working with us within the Youth Intensive Virtual Recovery Program, we certainly don’t meet you and your child on day one and put them onto their full and complete meal plan for eating disorder recovery. That would be a quantum leap from where they are currently (fully engaged in their eating disorder), and it would be emotionally traumatic, physically uncomfortable and sometimes physically unsafe as well.
Instead, we ease into the full meal plan and complete supervised meals and snacks over a period of time. This helps prevent refeeding syndrome, allowing us to ease into significantly more calories and nutrition as safely as possible. This also helps ease physical discomforts, such as digestion, though some amount of digestive discomfort is inevitable while refeeding as the body is re-learning how to handle adequate amounts of food and enough calories are needed for our digestive tract to function optimally. What and how this looks is completely individual and unique to your child and their health, as no two people, eating disorders, or families are alike.
You will be working with me, your registered nutritionist, to ease your child and your family into their full and personalized meal plan for eating disorder recovery. I am with you every single step of the way, from in session support through the week, to text and email support in between sessions to help work through any and all questions and concerns that come up.
Within the context of what you may think a full day of balanced meals and snacks looks like, this timeline may sound unnecessary to you, however when in Anorexia Nervosa recovery, significantly more calories, food and nutrition will be required to regain health and physical stabilization than perhaps you can even conceptualize.
Individuals with Anorexia Nervosa tend to become hypermetabolic during weight restoration. As such, they need an increased caloric intake, as well as a broad and diverse diet (no dietary restrictions or food/ food group avoidance) to not only refeed successfully and become physically and medically stable, but to also maintain their health and recovery after weight stabilization.
What does it mean to become hypermetabolic and why does it happen?
Becoming hypermetabolic means that the individual in Anorexia Nervosa recovery loses weight very easily and requires significantly more calories than the average healthy person to gain weight and even to maintain weight.
When someone is sick with Anorexia Nervosa, they are actively restricting their calories and types of foods consumed. (regardless of which type of Anorexia Nervosa you have: Restrict Type or Binge/ Purge Type). Due to this restriction, their metabolism slows down significantly. With so little food being consumed, their body must ration the energy it does receive to attempt to sustain essential bodily functions such as the heart and brain. This is also why we see these individuals often lose their periods, and struggle with digestion, for example. While we need our hearts to beat to stay alive, we don’t need to reproduce to live. While we need to digest our food, it does not need to happen optimally in order to live. The body is simply trying to conserve as much energy as possible to survive and slows down to accommodate this.
Once someone begins eating disorder recovery, they will start to gently refeed and integrate more calories and nutrients into their diet. Their metabolism will respond to this and speed up. Here, there is a period of time, called hypermetabolism, where the metabolism speeds up much faster than the average healthy person. Because of this, a very large amount of food is needed to gain even a very small amount of weight (more on that soon!), and if the person in Anorexia Nervosa recovery consumed what you or I do in a day (a very adequate amount of food and nutrition for a healthy adult), they would continue to lose weight and would not be able to gain physical stability.
This is also why intuitive eating is not appropriate at this stage of eating disorder recovery. There is honestly nothing intuitive about this phase of the process (that happens much further along in the recovery journey), as the amount of food required to not continue to drop weight is not only counterintuitive, but also extremely scary to the individual (and sometimes the family as well, depending on everyones relationship with food).
Meal support at this phase of recovery can be extremely helpful and imperative to positive recovery outcomes. If you are in the Youth Intensive Virtual Recovery Program, you will be on full meal and snack support during this most intensive phase of the work, before we gently begin tapering down to more family supported meals. If you are not in our intensive eating disorder recovery program, but do have a meal plan for eating disorder recovery you are following as prescribed by your medical team, we also offer Meal Support Services to help support the individual and family in recovery during the refeeding process and throughout their recovery journey. I wrote more about what this looks like here, and if you would like to learn more about our packages and services, you can reach out here for a free call and assessment.
Exactly how much food is needed to weight restore in Anorexia Nervosa recovery?
Though I often steer clear from talking numbers, as it tends to be more triggering than helpful, in this case I really feel like, for the family, knowing what it will take nutritionally to refeed and physically stabilize can help substantially to understand why their loved ones meal plans for eating disorder recovery will need to look they way they do, and why individuals in Anorexia Nervosa recovery need to eat meals and snacks at the frequency they do (for example three meals and three snacks each day).
Anorexia Nervosa patients need anywhere from 5,000- 10,000 excess calories to gain even 2 pounds of weight. And yes, this is quite a big range. Like I said, every single person is different and no two eating disorders and eating disorder recovery journeys are the same. Some reasons for this wide range include: physical activity (while no one should be engaging in physical activity during the refeeding phase of Anorexia Nervosa recovery, some do so in secret, and others attempt to constantly move through the day by fidgeting, pacing, standing, etc.), individual variations in energy efficiency, health and weight history, age, and thermoregulation.
Working together in our nutrition for eating disorder recovery sessions each week, we will find the correct amount of nutrition required for your child and their unique body and health and we very gradually work up to the full amount needed which allows us to do so safely and also more accurately find the correct range.
I share this to emphasize that yes, your child will need to eat more than you, and no, this is not too much food (a question we get asked ALL the time!) but rather exactly what they need to get well and stay well.
They must treat their meal plan like their medication.
What you need nutritionally and what they need nutritionally will look different. What they need to eat to be healthy will also look different from their siblings and peers. This is very challenging for them (and perhaps the family) to comprehend, but imperative, as anything less than what they need will result in a drop in body weight and health.
Once we find the correct calorie and nutrient range, are we able to remain there for the duration of refeeding?
This is another challenging component of this initial refeeding phase of Anorexia Nervosa recovery. Most Anorexia Nervosa patients will need to continue to increase their calories and vary their nutrients in order to continue to gain weight even after initial weight gain has begun. This is one of the reasons why we (or your healthcare team) must continue to monitor weight each week during this phase of recovery (learn more about why we recommend blind weigh-ins here).
We continue to monitor and adjust nutrition and calories in regular intervals during this refeeding phase of eating disorder recovery, managing not only the individuals physical health and weight but also their mental health as this phase of the work is extremely difficult (and quite honestly terrifying) for the person in recovery. This is why a multidisciplinary team working in a circle of care is essential.
Once my child is at a healthy body weight can we reduce their caloric intake?
Once your child has achieved weight restoration and they are physically healthy again, you all may feel eager to reduce calories to what most perceive as a “normal” amount of food (put intentionally in quotations, as the honest truth is no two bodies are alike and everyone will need a different amount of food and nutrition to be healthy, regardless of what is perceived as normal or average).
This is a difficult time, however, because your child is still physically quite vulnerable and reducing food too soon after weight restoration may result in a quick and/or steady drop in weight (and health) even after a year or more of working to regain weight and health in recovery.
Their bodies are still quite energy inefficient at this stage of the recovery process and as such they will still require an increase in calories to maintain the weight that they (and you all) have worked so hard to restore.
This is one of the reasons why there is a high rate of relapse in Anorexia Nervosa recovery and also why in the Youth Intensive Virtual Recovery Program we do not simply weight restore and then close the work. Instead, just as we gradually increase into full meal support, nutrition support, coaching support, naturopathic medicine support and family support, we then gradually phase out support in appropriate intervals. Going slow keeps things safe and effective not only at the beginning of recovery as the individual eases into a full meal plan and refeeding, but also at the tail end of the recovery process as they ease back out into a full and healthy life. This allows time and space for the family to see how they manage doing more of the meals without meal support from us, how the individual in recovery manages in making more food choices for their healthy self vs the eating disorder (how they are able to apply all they have learned in their nutrition work while still being nutritionally supported and guided), and how they navigate all of the challenges that arise as they reintegrate back more into their life and must learn to balance that (social life, relationships, school, work) while maintaining and prioritizing health and recovery above all else.
My motto with eating disorder recovery is:
The slower you go, the faster you get there.
I know we all want it to be done as quickly as possible, but there is no race here. It simply takes time and is so much more complex than just food and body, though that is the first piece needed to build a foundation for the rest of the recovery work. Afterall, an eating disorder is mental health.
