Meal Support for Eating Disorders: Exploring HOW we Eat vs What

When someone shows up to their first session for virtual one on one meal support for eating disorders with us, they assume the extent of our role will be to sit there with them while they eat, provide emotional support, perhaps eat with them when appropriate, and watch to ensure that they eat their planned meal or snack as prescribed in their meal plan. 

And yes, this is certainly part of what we do in our virtual meal support for eating disorders, and an important part, but there is SO much more to it. 

When in eating disorder recovery, what you eat is one part of your nutrition work, but how you eat is another. 

We often put so much emphasis on what someone is consuming in eating disorder recovery:

• How much food is on their plate

• Ensuring adequate serving sizes

• Making sure there is a good amount of variety of foods and food groups in their meal plan/ on their plate

• Making sure there isn’t avoidance and restriction with food choices, and ensuring a balanced plate

And yes, this is an incredibly important component to becoming healthy and physically stable.  It is foundational to eating disorder recovery, although of course, the food we eat is only one piece to a much larger puzzle.  

What can often get overlooked is the way the person in eating disorder recovery is eating the food presented to them/ prescribed to them, and what behaviors are showing up for them when they try to show up to their plate.  There is a big difference in how someone eats when they are engaging with an eating disorder, and how someone eats who does not have any disordered eating patterns.  What we often notice is that the person in recovery is not fully aware of the extent to which they show up to food in a way that indicates engagement with an eating disorder.  This is a very important piece of the work to address in the recovery process.  Someone can, for example, be showing up to much of the food prescribed to them, but still be eating it in a way that keeps them very much aligned with the eating disorder. 

Meal support sessions are the ideal place to see what is happening on someone's plate, how they are engaging with their food, and gently work through those eating disorder behaviors and tendencies.  

There are many ways the eating disorder shows up in how we eat our meals and snacks, all of which are supported and worked through in our virtual meal support for eating disorders sessions.  Below, I wanted to share some of the ways we see the eating disorder reflected in how someone is showing up to their food during meal and snack times.

Ways we see the eating disorder show up in HOW one eats:

(Note, this is not an exclusive list, but rather includes many of the most common ones that we see).  

• Organizing foods into categories on the plate, and ensuring that one section doesn’t touch the other.  So for example, this could look like keeping chicken, rice, and vegetables completely separate from one another and not combining these foods on the plate, or in bites.  This could also look like fear and avoidance of one bowl or one pot meals where all foods are cooked and combined together (such as a stir fry, crockpot meal or pasta salad). 

• Eating components of their plate methodologically, one at a time.  So in the chicken, rice and vegetable example above, this would mean eating all the vegetables, before moving onto the rice, before moving onto the chicken.  

• Eating foods in ways that are uncommon.  Some examples we have seen recently include: using a fork and knife when eating a granola bar and cutting it into small bite size pieces, peeling chicken into small shreds to eat one bite at a time, dissecting a sandwich and picking at the inside components while leaving the bread, spreading the yogurt all around the bowl as they eat it to ensure they don’t have to eat as much of it/ more will be left behind, breaking apart the bread and placing pieces of it all over the plate, peeling the skin off almonds before eating them.    

• Eating foods in extremely tiny bites and/ or cutting the food into as small pieces as possible.  Some examples we have seen recently include: eating grains of rice one at a time, eating cereal one bite at a time, cutting pasta into smaller pieces, picking each granola grain out of the granola bar, and in general eating food as slowly as possible and trying to make the meal last much longer than would be perceived as typical. 

• Hiding or discarding food during the meal.  For example, hiding food under the plate, spitting food into napkins when they wipe their mouth, hiding food in napkins, spitting out backwash into the cup when taking a “sip”, hiding food in sleeves/ socks/ pockets and more, dropping food on the ground, tossing food aside when no one is looking, stashing food into crevices of furniture such as chairs/ chair cushions/ couches/ plants and more, pushing food into cheeks so that they can discard it after, hiding food under the tongue. 

• Fidgeting a lot during the meal, struggling to make eye contact with those you are eating with and being disengaged from conversation and others at the table. 

• Body checking while eating.  This may look like touching cheeks, waist and belly, and wrapping hands around their wrist and/ or arms.  Body discomfort during a meal often also shows up as tugging on clothes frequently such as pulling up pants, tugging at the waist of pants, pulling at the neck of their shirt.  

• Avoiding drinking water or other fluids during the meal and in general at any time of day.  

• Playing with the food on their plate and moving it around more often than actually taking bites. This makes it appear as though they are busier eating than they actually are and is often paired with some of the methods of hiding and discarding food we mentioned above.  

• Pushing food to edges of the plate so it can more easily and discreetly fall off the side and be left behind at the end of the meal.  

• Constant movement during the meal. This may look like getting up frequently, pacing, or standing while eating.  

• Eating foods out of packages instead of plating and tabling it.  More comfortable with “grazing” or picking at foods throughout the day then having set meals and meal times.  
  

Many heightened emotions, sensations, and urges can also show up during, and after, the meal. These are important to bring awareness to, process, and safety plan accordingly, and is something addressed in our virtual meal support sessions. 

Ways the eating disorder shows up emotionally during meals:

• Crying and upset at having to finish the meal, or eat any of it at all. And often feeling too emotional to eat.  

• Emotionally shutting down during or after the meal.  This could look like not wanting to engage in conversation, not giving an honest check in about where they are at and what they are feeling, simply saying “I’m fine”, avoiding eye contact.  

• Struggling emotioanlly with the physical sensations of eating and digesting food, and feeling like this is a hurdle to completing the meal or snack.  

• Heightened body image discomfort and dysmorphia.  Feeling like the meal has instantaneously shifted how they look.  

• Negotiations about what and how much to eat.  This happens with family often, and less so with a practitioner.  When the individual and family are being supported at the meal time, the family has space to plate the meal after the individual has logged onto session, so that any arguments or pushback happen with us and not you! 

• Always expressing fullness (and demonstarting emotional distress around it), but never expressing hunger. And always expressing dislikes, but never expressing likes.  There is an awareness that must be brought to this; we cannot honor one without the other.  Especially when one appeases the eating disorder, and the other challenges it.  

• Heightened thoughts at how to “make up for the meal” later through things like purging, exercise, restriction, laxatives.  And the absolute need to process these thoughts as they come up and safety plan accordingly with the individual and the family if needed.  This may look like planning to be with family for an hour after meals that are more triggering and increase urges to engage in any of the above, for example.  
  

In our one on one virtual meal support for eating disorders sessions, we work through ALL of the above, creating a structured and supportive environment where the individual can navigate their meals and process the emotional responses they experience as a result of nourishing themselves.  This increases eating disorder recovery outcomes and the probability of adherence to the prescribed meal plan, as well as providing a break for the family and some space to be the parent or caregiver, and not the food police.  This space can be a game changer for not only recovery outcomes, but also family dynamics in the recovery process. 

If you are interested in learning more about our one on one virtual meal support services and packages, please don’t hesitate to reach out here! We offer free assessments, and are always happy to connect and support.