Meal Support: Friend or Foe in Eating Disorder Treatment?
Meal Support can help sustained recovery in Eating Disorder Treatment Programs for Teenagers and Young Adults.
Our families are often particularly interested in Meal Support and observations when researching Eating Disorder Treatment Programs. This is understandable, as they have often experienced mealtimes at home as being fraught with difficulty.
Food and eating may have become a battlefield. Exhaustion, anger and sadness, together with feelings of guilt and shame, are often evident.
The way in which we eat together as a family can provide an important structure and a cornerstone for personal development. Mealtimes have varying importance in families, communities and cultures. Every family has its own patterns, which are ‘usual’ for them.
Our relationship with food can be influenced by the ‘norms’ that we experience in our family, at school or in the extended community.
The thoughts, feelings and expectations around both food content and how, when and what is expected, can all be influenced by the unwritten rules of family mealtimes.
Are Families to Blame for Eating Disorders?
There are many factors that can be seen to have some influence on the development of eating disorders in young people. It is important to remember that no one factor is to ‘blame’.
Attitudes to food, body, perfectionism, study and control can all play a significant part in the development of eating disorders.
In addition, genetics, environment, social factors, early experiences with dieting and other mental health concerns can all have an impact on the development of eating disorders. Research indicates that having a close family member, who has struggled with challenges related to an eating disorder, substantially increases the risk for young people.
Rather than being ‘to blame’, families can actually be incredibly helpful in the young person’s recovery journey.
Family-based treatment is recognized as one of the most effective means of treating eating disorders in teenagers.
‘I am a bad parent. My child has an eating disorder.’
Quite simply, you are ‘a’ parent, who has a child with additional needs. As parents, we sometimes want to blame ourselves for (or, for some, deny the existence of) the problem. It is important for your teen’s recovery that you are able to commit to moving out of blame and into solutions.
Conflict Around Mealtimes
Conflict around mealtimes is a subject that is regularly discussed with us prior to admission. The families of our young people have often experienced periods when their teens or young adults:
- refuse to eat
- avoid family mealtimes
- excuse themselves from celebrations
- eat alone
- hide to eat in the bedroom.
It is also common for young people to engage in extreme picky eating, reducing and restricting food groups, and avoiding energy intake. Food and dining together can move from a time of shared, nourishing family experience, to an event filled with anger and feelings of inadequacy.
Parents often blame themselves. ‘I should be able to fix this,’ or ‘What have I done wrong?’.
Parenting a teen or young adult with signs and symptoms of an eating disorder is challenging. Parents need support too. Understanding more about eating disorders is often the first step. Psycho-education and understanding the medical effects of eating disorders are important tools for parents. Knowledge leads to greater awareness, and awareness plays a key role as families move into a journey of recovery. The fundamentals of eating disorders are explained during Family Therapy. Sharing information and education about your teen’s experiences of their eating disorder empowers the family to make great choices and decisions in recovery.
Family Therapy is a great place to discuss the difficulties and challenges happening at home. We aim to ensure that each family leaves us with the tools, skills and confidence needed to approach mealtimes with positivity and without fear.
Support At Mealtimes: A Confidence Boost for Teens
Teenagers and young adults who join the residential Eating Disorder Programs at The Wave, all start at the beginning. We believe that structure provides safety. Our approach is gently supportive as young people enter a period of orientation and stabilization.
During the early stages of treatment, we begin to look at stabilizing the energy intake whilst our young people begin to understand more about how their eating disorder affects them, together with addressing any denial in either the significance or severity of their issues.
The Wave’s Eating Disorder Programs are support by 3:3:3 meal plans during primary treatment. This means that our young adults, having been assessed by a dietician, are encouraged to enjoy:
- three meals (breakfast, lunch and dinner)
- three snacks (mid-morning, mid-afternoon and at bedtime)
- no more than three hours apart (no closer than two hours and no longer than four).
This 3:3:3 structure is an evidenced-based protocol to restore eating patterns through structured connection in the community.
Why Do We Offer Structured Support When Eating?
Many young people feel that Meal Support Services are anything but normal. It is our intention to offer discrete support whilst they challenge the thinking that is driven by their eating disorder.
Some have difficulty eating in the company of others and have become used to eating in isolation, hiding food or purging after every meal. Meal Support Services help to normalize eating styles and patterns, facilitate weight restoration, promote healthy connection and reintroduce the social and fun elements of sharing mealtimes with others.
We practice managing personal anxieties around the table and increasing confidence in their ability to make great decisions – whilst decreasing rituals or practices that have developed involving food or water intake. Most importantly, we prepare and practice for going home and feeling confident in managing challenges and celebrating success.
Food is Medicine
We also adopt the three ‘C’s when providing mealtime support. We teach these skills to families to help them restore peaceful mealtimes at home:
- Calm – we listen, we hear. However tough it is, we stay calm. An angry adult discussing eating is not likely to have a great outcome.
- Caring – we listen, we hear. Validating concerns whilst refraining from agreeing or colluding. We care that our young people receive nourishment in every sense of the word.
- Consistent – we listen, we hear. Teenagers and young people can find any uncertainty around food difficult to manage. We are consistent in our approach. We are clear in our expectations of ourselves and of others. Our guidelines are explained and young people know that they can rely on stability from the adult decisions around them. It is a take-home skill that parents can utilize at home. Inconsistent supervision or messages around food and body can leave young adults feeling unsafe around food-related activities.
Criticizing, being angry, threatening or begging young people to eat, really does not work. It is unproductive to argue with the ‘eating disorder voice’. In many cases, the situation will just escalate, along with the need to control. The outcome is usually stalemate.
Taking the Anxiety Out of Food
By providing Meal Support, we are able to explore distress tolerance and learn new skills to manage anxiety. During our 30- or 60-minute support sessions, we use activities to increase the ability of our young people to stay present. We may use:
- art and crafts
- board games
- mindful activities
- card games
- friendly and comforting conversations.
You Deserve to Eat
We encourage the social element in dining. We also encourage our young people to enjoy their food in a reasonable timeframe, with a member of our clinical team at each table. The members of our team are all great listeners and great conversation starters.
What Happens if My Teen Will Not Eat?
We encourage and discuss. We are consistent in our messages and promote discussions that foster healthy and realistic views on food and body image. We encourage our young people to enjoy food and believe that there are no bad foods. No one food has any greater power than the next. We debunk myths around weight loss and weight gain and we encourage involvement in all aspects of treatment planning.
Young people who are not able to complete their meal plan are offered supplements. Supplements are not a punishment, they are an alternative to the meal plan. Nourishment is our goal whilst stabilization is under way.
Friend or Foe?
Whilst supporting your teenager or young adult at home may have been difficult in the past, and at times even created conflict, it is an essential part of our Eating Disorder Treatment Programs. The majority of our young people explain to us how grateful they feel to have the security of continual support whilst they are learning to make good choices. Meal Support is often described as a safety net when all else around has failed. In our experience, young people greatly benefit from the companionship and community that Meal Support offers.
To be free to from the patterns of destruction is a wonderful feeling. To witness young people having a second chance at really living life, without a fear of food, is simply magical.
Of course, the responsibility for recovery belongs to the young person. Our job is to encourage them, support them, and keep them safe, until they are ready to fly. Eating disorders are one of the most complex mental health diagnoses. Our young people and families need us to have hope. They need us to believe in them. We do.
Are You Concerned?
It is not possible to tell if someone is challenged by eating disorder symptoms simply by looking at them. Size and shape alone are not predictors of the absence or diagnosis of an eating disorder.
Eating disorders are not always visible but there are some common signs and symptoms to be aware of. For example, does your teen or young person:
- describe not feeling hungry, despite not eating regularly?
- seem preoccupied with loosing weight? Have they lost weight?
- appear to have drastically increased or decreased food consumption?
- seem excessively concerned about changes in their body shape?
- regularly check their body?
- believe certain foods will make them fat?
- count calories when planning to eat?
- exercise to burn calories?
- eat regularly in the night (often consuming large amounts of food)?
- avoid foods that have a higher calorie content?
- hide food / steal food / eat alone?
- use stimulants, cigarettes or other distractions to reduce their appetite?
- make themselves vomit after food or snacks?
- use laxatives regularly?
- wear baggy clothes to conceal weight changes?
- eat more food than usual in a very short time frame (binge)?
- feel guilt or shame around food and eating?
- find it difficult to eat with others or to share food?
- barter, trade or manipulate at meal times?
Approximately 10% of young adults will be affected by an eating disorder. Many more are affected but not diagnosed.
If you are concerned about your teenager or young adult, it is essential to seek the advice of a mental health professional, experienced in the care of eating disorders. Eating disorders do not simply go away of their own accord.
The team at The Wave is committed to Health at Every Size (HAES®) principals and works towards inclusion of all.
Our Clinical and Medical Teams can be contacted on firstname.lastname@example.org
The Wave is dedicated to the treatment of young people and families.
Dr. Rashid Sulaiman; Medical Director. Consultant Psychiatrist. Senior Lecturer International Medical University. The Wave Eating Disorder Programs for Teenagers and Young Adults. Specialist in the care of Teenagers and Young Adults diagnosed with Substance Use Disorder, Eating Disorders, Personality Disorders and co-occurring mental health concerns.
Fiona Yassin is an Accredited Clinical Supervisor (UNCG). Member of The International Association of Eating Disorder Professionals (Member Number 1533). A Fellow of The APCCH, FDAP & Australian and New Zealand Academy For Eating Disorders. EMDR. CBT-e. FBT. DBT Committed to upholding the principals and best practice in the treatment of Eating Disorders.
Fiona has a specialist interest in Borderline Personality Disorder, CPTSD and Eating Disorders. Fiona is currently studying PCOS – An Evidence-Based Approach with Monash University – in order to bring informed care for those diagnosed with both PCOS and a co-occurring Eating Disorder to The Wave Programs. Women’s Mental Health is an area of speciality and Fiona has enjoyed taking part in the Massachusetts General Hospital Psychiatry Academy Women’s series.