How a Dietitian Uses Meal Plans in Eating Disorder Treatment

Nutrition counseling with a dietitian who specializes in eating disorders is a vital part of any treatment team.

No matter the type of eating disorder a person struggles with, correcting nutritional deficiencies and creating a regular eating pattern is necessary for recovery.

Many people report that they have followed external food rules for so long, their brain feels inundated with contradictory, confusing nutrition information – and that eating without some type of structure feels overwhelming. This is where a meal plan / meal pattern developed by a Registered Eating Disorder Dietitian comes in!

An Eating Disorder Dietitian uses the meal plan as a framework for “normal” eating that also provides essential nutrients for recovery. A meal plan can be helpful to the person who has lost touch with the basic tenets of a balanced plate. Through years of chronic dieting, restricting, binging, or any behavior that disconnects the body from the brain, a meal plan can serve as a bridge or a safety net from disordered, rigid or chaotic eating.

The plan provides the foundation for internal food regulation and acts like “training wheels” for normalizing a daily eating pattern. Letting go of diets and food restriction can be both a liberating and scary feeling at the same time.

Today I want to share some information about the many types of meal plans or meal patterns that are used to give structure instead of strict rules.

Benefits of Meal Plans for Eating Disorder Recovery

Some of the many benefits of a meal plan when first starting recovery are:

• Provides vital macro- and micro- nutrients for nutritional rehabilitation.
• Gives “permission” to eat foods that may have been feared.
• Reduces guesswork around types of food needed, quantity, and timing.
• Ensures a consistent daily routine, with food being an anchor.
• Prevents meals and snacks from being missed.
• Decreases stress around food shopping, meal prep and eating.
• Promotes weight gain or weight stabilization.

Types of Meal Plans

The various meal plans differ by the amount of support a person needs at any particular time in recovery; none are superior. Some meal plans are very structured (the Food Exchange System), while others are a bit less structured (Rule of Threes). Intuitive Eating is more of a strategy than a meal plan. You can learn more about this by reading Meal Plan Ideas to Help You Start Intuitive Eating and remember this as a standard practice.

Food Exchange System

The most structured, Food Exchanges, categorizes foods according to their nutritional profile and includes fruits, vegetables, dairy, meats and other proteins, starches (sometimes called breads and cereals), and dietary fats.

An eating disorder dietitian will create a meal pattern indicating how many servings of each food group is needed at a meal or snack. For example, a typical breakfast might include 2 servings of starch, 1 protein, 2 fats, 1 fruit and 1 dairy. This would translate into specific foods, such as a peanut butter sandwich with a banana and glass of milk. Please note that the amount of each of these food groups will vary greatly for each individual. For people needing to gain weight and/or recover from malnutrition, this can be a very effective tool.

Entrées and Sides

An entrée and sides model is less numbers-based, but still provides structure to meals and snacks. The goal of this plan is to have all meals consisting of an entrée, as well as two different side dishes. For example, lunch might include a sandwich (entrée), chips (side), and a fruit (side). Snacks include 2-3 food items (similar to sides) from a list given by the dietitian; a typical snack might include cheese and crackers, or cereal and milk with fruit.

Rule of Threes

The rule of three meal pattern¹ includes three meals, up to 3 snacks per day with no more than 3 hours between eating episodes. This structure provides a simple way to include all food groups including protein, fats, and carbohydrates, as well as a fruit and/or vegetable.

A day on this meal plan may start out like this: breakfast is scrambled eggs, toast with butter and orange juice. Snack three hours later is cottage cheese and fruit. Lunch is a turkey sandwich on bread with tomatoes/avocado, and a glass of milk. This meal and snack pattern creates consistency, prevents blood sugar from dropping, allows your body to anticipate food at regular intervals and provides all food groups.

Plate-by-Plate Approach

The Plate-by-Plate method² was designed by two dietitians (Wendy Sterling, MS, RD and Casey Crosbie, RD, CSSD) and focuses on the variety of foods on a plate at each meal. Designed for use with Family-based therapy (FBT), this treatment model puts parents/caregivers in charge of refeeding their child.

A 10-inch plate is used as a base and filled with various food groups in amounts that support weight gain and recovery. Typically, the plate is filled as follows: 1/2 grains/starches, 1/4 fruits/veggies, 1/4 protein, with added fats and dairy. Three meals and 2-3 snacks are provided at regular intervals. This method supports normalization of food at home using the visual of a filled plate that includes all food groups. One of the best features of this method is ease of use with less calculating!

Intuitive Eating

Intuitive Eating is a non-diet approach to food using internal regulation of hunger, fullness, and satisfaction. The goal is to help people move away from diets and diet culture mentality. This is often a final step in recovery from an eating disorder as it moves away from strict meal plans, and towards recognition of internal bodily cues. Intuitive Eating is a personal process of learning to trust your inner body wisdom to make choices around food that honor your physical well-being as well as your emotional health! You’ll discover which foods feel good in your body, without judgment and without influence from diet culture.

Intuitive Eating is not a diet or food plan, although this article explores sample meal ideas for anyone starting their journey to intuitive eating. There is no pass or fail; no “blowing it.” Rather, it’s a journey of self-discovery and connection to the needs of your mind and body. Many of these principles can be explored in early recovery while someone is on a meal plan or meal pattern. Further practice comes when a person is ready to let go of a strict meal plan and start listening to bodily sensations of hunger and fullness.

Here are the 10 Principles of Intuitive Eating:

• Reject the Diet Mentality
• Honor Your Hunger
• Make Peace with Food
• Challenge the Food Police
• Discover the Satisfaction Factor
• Feel Your Fullness
• Cope with Your Emotions with Kindness
• Respect Your Body
• Movement – Feel the Difference
• Honor Your Health with Gentle Nutrition

You can learn more about intuitive eating in the following article: What is Intuitive Eating?

There is no “best” meal plan. Your Registered Dietitian will work with you to create an individualized plan that helps to meet your nutritional goals.

References:

https://marciaherrin.com/about-the-the-parents-guide/
https://www.platebyplateapproach.com/

So if you have more questions and would like to know what you would need to do to work with one of our eating disorders dietitians, please reach out by booking a call with Erica, our practice owner. She’ll talk with you to determine the best dietitian on our team to work with you, for your specific nutrition needs.