Nutrition Stages and Normalizing Fear Foods in Eating Disorder Recovery
Embarking on the journey of eating disorder recovery involves more than just physical nourishment; it's about confronting fears, breaking down barriers, and rediscovering a healthy relationship with food. In this article, we delve into the vital process of integrating and normalizing fear foods—a pivotal step towards reclaiming freedom and empowerment in one's recovery journey.
Before someone is ready to normlize fear foods, there are some foundational stages to nutrition for eating disorder recovery we must work on.
Physical Stabilization & Establishing a Regular Pattern of Eating:
When we first begin the nutrition for recovery work, our goal is physical stabilization and establishing a regular pattern of eating. This is the foundation of eating disorder recovery.
This may look like:
Gently increasing the individuals nutrition, working from where they are currently is at (everyone is different here in that everyone is currently consuming a different amount of food, has different safe and unsafe foods, has different food rules and rituals, and different eating disorder symptoms). We do this nice and slow to ensure safe refeeding.
And if your child is working with us in the Youth Intensive Virtual Recovery Program, this makes up Phase 1 of the program, or the first 4 weeks of our work together as we ease into full nutrition and meal support.
Building up to regular meal and snack times at regular intervals of time. For example, 3 meals and 3 snacks a day, spaced out nicely so that the person in recovery is never going too long without food.
Gradually introducing more foods, food groups and diversity of foods.
Working on consuming a balanced plate inclusive of enough carbs, fats and protein sources at each meal.
Ensuring energy rich snack choices.
Working on consistency with all of the above.
Symptom Interruption:
We also work on symptom interrupting in the early stages of the work. When I say symptoms here, I mean interupting the urge to binge, purge, restrict, use laxatives, chew and spit, over-exercise, and/ or other eating disorder symptoms.
Symptom interruption may look like:
Supervision after meals: having a structure and plan in place for family or clinician supervision for a duration of time after meals and snacks to ensure there is no purging.
Learning how to “urge surf” when the urge to purge, exercise, take laxatives, exercise, or restrict comes up.
Learning how to build a toolbox of alternate activities to utilize when urges to engage in eating disorder symptoms arise.
Learning how to get ahead of the urge by beginning to identify triggers. Some examples of triggers could be: certain people (family members, friends, a partner), places (home, school, teams, work), social situations (social anxiety, parties, lunchtime at school, camp, work), social media, bullying, certain emotions (anger, sadness, guilt, shame, lack, feeling like a victim, not feeling worthy, not feeling smart enough), events, seasons, holiday’s, travel, conversations, trauma, etc.
Family Education & Support:
Integrating family into nutrition for eating disorder recovery is integral to ones’ recovery success.
We are working with the family on the following:
Education on what a balanced plate looks like and what food groups and components need to always be included.
Introducing the food philosophies of addition nutrition (focusing on what we add in, and not what we take away), as well as the idea that all foods fit and that we don’t label foods as good or bad.
Working with the family to plan weekly meals and snacks and help choose what to shop for.
Teaching you how to navigate meal times, and how not to engage in the eating disorder here (we don’t negotiate with ED!).
Teaching you what to look for at meal times to ensure that there is no space for eating disorder behaviors. As well as what to do and how to navigate it if you notice these behaviors showing up (which they of course will, frequently!).
Teaching you how to support your loved one after the meal. We also have an entire article (and free resource to download within that article) on how to support your loved one in eating disorder recovery- check it out here.
Normalizing Fear Foods:
In readiness, after we have built a strong foundation for eating disorder recovery with all of the above (refeeding, physical stabilization, establishing a regular pattern of eating, demonstrating consistency at showing up to full plates and all meals and snacks, symptom interruption and symptom reduction, and family education and support), we are ready to begin the work of fear food normalization.
*and note that the above work doesn’t stop- all phases overlap one another and all work is continually supported and integrated throughout the entire recovery process.
What is Fear Food Normalization?
Food normalization in eating disorder recovery is where we begin to normalize fear foods and fearful food situations. These are foods, or food situations, that the individual in recovery feels most triggered around and would still engage in eating disorder symptoms (or have increased urges to engage) if faced with them.
Some examples include:
Foods the person has labeled as “bad” (perhaps these are packaged foods, or fast foods, sweets or treats, or certain food groups).
Amounts of food that feel more scary. For example, maybe the individual in eating disorder recovery can easily have one slice of pizza, but would have the urge to purge or restrict if they ate 2 or 3 slices. Or maybe they are OK consuming foods you cook at home, in serving sizes you usually provide, but restaurant meals in restaurant serving sizes feel extremely scary and triggering.
Having a hierarchy of foods, such as being OK with sprouted grain bread only, but feeling very triggered if served white bread. Or being OK with a homemade sandwich, but not yet able to eat a sandwich out at a restaurant or cafe without having urges to engage in the eating disorder.
Having rules around certain foods or food situations. For example a rule against eating any appetizers, not allowing themselves to have any drinks except water (for example not allowing soda, juice, milk, etc.), not allowing themselves to have an evening snack if having dessert with dinner, etc.
Why is Fear Food Normalization Important to Eating Disorder Recovery?
We cannot recover part of the way. By the time we get to the place in the nutrition for eating disorder recovery work where we are safe to begin the process of fear food normalization and integration, the individual in recovery has come a long way. They are more physically stable (more weight stable, have better labs, less physical symptoms), are showing up to their meals and snacks more consistently, and perhaps beginning to engage in more of their life outside of the eating disorder (school, social, family, etc.).
However, at this point, they still have a lot of boundaries and restrictions created by the eating disorder:
For example:
They may feel uncomfortable eating out with friends and choose to not eat when out of the house or eat much less than is required of them to continue to stay physically well.
They may not have flexibility with their food choices yet. For example maybe they are OK with one food order at the local coffee shop or restaurant chain, but today they are out of that option. Someone who does not have an eating disorder would easily be able to demonstrate flexibility, by pivoting and making a different choice based on what is available. Someone with an eating disorder would be very upset by this, and either make a choice but have a big emotional reaction to it, or not be able to make another choice.
They struggle to participate in eating that is special, celebratory, or out of the ordinary rhythm or routine. For example birthday cake, Christmas dinner (and dessert!), chocolates on Easter, a special meal and dessert at a restaurant, food consumed while traveling (different cuisines, food on the airplane or at the airport, etc.).
They may still have a list of foods they are avoidant of (for many different reasons) and as such, in spite of doing so much better with their nutrition and what they have now added in, there is still active restriction.
We need to be able to normalize all aspects of life and food or else there will be so many moments and spaces where the eating disorder still resides. Without fear food normalization, one may be OK in a very specific and safe environment (for example, at home with home cooked meals that are predictable and controlled), but triggered and at risk of engaging with the eating disorder in many other food and life situations (such as unexpected changes of plans, travel, celebrations, or certain social settings).
What Does the Process of Fear Food Normalization Look Like?
This process will look different for everyone, as no two people or eating disorders are alike. What fear foods and food situations we normalize, and how, will be completely dependent on where the fear, triggers and discomforts are arising for the individual in eating disorder recovery.
That said, the first step is doing just that: identifying what foods and food situations need to be normalized.
Once we have a good working list (that is always growing and changing), we begin with a food on that list that is easier than some of the others. We never start with the hardest food or food situation.
From there, we determine what that normalization will look like and how it will be implemented in the most safe and supported way.
Let’s look at some examples:
(Note that names are changed for privacy).
Brittany’s Fear Food Normalization Journey:
Brittany struggled with binge eating disorder and exercise bulimia. She followed a vegan diet, but always binged on dairy products and knew that if she was able to integrate more animal foods into her diet, she would feel more balanced, full and satisfied and have less urges to binge.
We made a list of foods that she felt fearful of, restricted, binged on, and felt the need to “get rid of” if consumed. And then we ranked them from easiest to most difficult.
She picked an easier one to start: yogurt. It was very frightening for her but she also knew her body craved it and was able to easily see how it could be part of balanced diet. She added it to either her breakfast or dessert each day for a few weeks and over time, it simply became a food that she could integrate as needed into her diet. It became normalized and “no big deal”. We also safety planned accordingly, ensuring there was no space for any eating disorder symptoms around these meals and that she was eating them with safe people (her family in this circumstance) and at the most safe times of day for her.
Over the months, we worked on that fear foods list list integrating and normalizing foods like cheese, chocolate, ice cream and more. Some foods she integrated in the house, some she went out to eat, and some she ate with people who were important to include in her recovery journey.
She worked on foods that felt scary and triggering, ate at places that she would normally only buy binge foods at, and we safety planned her day to ensure she could not over-exercise after these meals.
Jade’s Fear Food Normalization Journey:
Jade recovered from Anorexia Nervosa. She had a lot of food rules around what is healthy and not, and what foods are allowed or not. She felt fearful of eating foods containing sugar, baked goods, fats, foods containing gluten, and more.
Again, we made a list together when she was ready. Actually, the really cool thing here was that Jade already had made a list by herself of all the foods she missed and wanted to eat but felt scared to. It was tucked away in her journal and when I told her what we would be working on together, she chose to share it with me. I am still smiling from ear to ear as I write this, because that is exactly the kind of self ownership required to be well.
Each week we integrated something new to normalize. As always, we started with some of the “easier” ones (in quotations because of course they are all quite difficult!) and moved to more challenging ones in readiness.
Some weeks Jade was baking (from the many recipes she would save for herself but felt too fearful of), and used these baked goods for some of her snacks that week. Some weeks she was going to get drinks and snacks at coffee shops. Some weeks she was asking her family to cook dinners that she used to like but has avoided for a long time.
And as her eating disorder was one of restriction, the work here was always to be able to show up to her regular meals and snacks AND the foods she was working on normalizing.
There was no space for restriction or compensation in this process and as such, what Jade was able to learn was that “nothing crazy happened”. She ate the scariest foods that her eating disorder would never have allowed her to eat, and all the crazy and terrible things her eating disorder said would happen, didn’t!
That is the power of fear food normalization, as once someone has that affirming experience enough times over, those foods no longer holds power over them. In wellness they can choose what to eat, without the eating disorder having a say.
