When someone you love is battling an eating disorder, one of the most challenging things for that person to do is to engage in regular eating for recovery. Your loved one may feel their prescribed eating plan is too much food. They may feel overwhelmed or anxious just talking about food, let alone trying to sit down and eat a meal. For you, as the caregiver, mealtimes may leave you feeling helpless, like nothing you are doing is making a difference, or maybe you feel like you’re just making things worse.
Helping your loved one to eat normally again will be challenging, but it is incredibly important for his or her health and well-being. In the recovery process, your loved one will learn to eat adequate amounts of food, enjoy a variety of foods from all of the food groups, eat regularly throughout the day, and establish a positive relationship with food1.
An important part of your loved one’s recovery will include your involvement during mealtimes, which is often called “meal support”. In this blog post, we will summarize a video from the Kelty Mental Health Resource Centre in British Columbia2. The video is aimed at parents of youth who are battling an eating disorder, however, much of the information can be transposed to other contexts, such as someone who is caring for their partner, sibling, friend, etc.
The video outlines four parts of meal support which are meal planning, meal preparation, supported eating, and post-meal support. Throughout all four phases, it is important to keep in mind the four C’s of meal support2:
- Remain calm. When you are calm, this helps to ease the anxiety of your loved one.
- Be confident. Your confidence will help to reassure your loved one.
- Be consistent. Consistency means not negotiating on decisions that have already been made.
- Be compassionate. Recognize that your loved one is doing something that is very difficult for them.
Without further ado, let’s dive into the four phases of meal support.
The first phase is meal planning. Planning helps to reduce anxiety – for someone with an eating disorder, lack of structure and predictability can be very stressful. Planning also helps to ensure that your loved one is getting adequate nutrition to facilitate their recovery. Meal planning will involve sitting down with your loved one and planning the week’s meals together. It can sometimes be helpful to plan several days in advance so that there is enough time for your loved one to accept to the meals that are planned for them to eat. When planning, it’s best to provide minimal choice so that your loved one doesn’t become overwhelmed. For example, when choosing the protein for a meal, you might ask, “Would you like chicken or beef?” instead of “What protein do you want with this meal?”. The details you will want to include in your meal plan are the names of who will be involved in the meal, what the meal will be, what time it will happen, and the location of the meal. It can be comforting for someone with an eating disorder to know these details in advance. Then, once everything has been decided, no more negotiation can take place. This will help provide consistency (one of the 4 C’s!) and discourage conflict at meal times.
The next phase is meal preparation. When a meal is being prepared, it can be stressful for an individual with an eating disorder. They may be angry if you are putting something into the recipe that they feel they cannot eat, or that has too much fat or too many calories. Many individuals with eating disorders want to be involved in meal preparation to control what is going into the food and how much, but this can be counterproductive to their recovery. It’s best to set some ground rules. Here are a few examples of guidelines you may consider instigating in your home:
- No negotiations—once a meal is decided, it can’t be changed
- Your loved one is not involved in meal preparation and is removed from the kitchen until they have recovered to a point where they can participate
- Avoid measuring when cooking or serving
- Avoid using diet or low-fat food products
- You, as the caregiver, have the final word on portion sizes (i.e. if you feel your loved one has not served themselves enough)
You may want to create some of your own guidelines, too, that are catered to your family’s unique needs.
The third phase is supported eating during the meal. For someone with an eating disorder, the process of eating can be very painful. Your loved one may experience a barrage of eating disorder thoughts that are hard to ignore. As they are looking at their food, they may be thinking about the calorie content, or how much exercise they’ll need to do to burn the meal off. These thoughts can be especially loud when someone is eating alone. With your support, however, meals can be a positive experience. Here a few practical ways to help reduce stress during mealtimes:
- Create a positive atmosphere
- Eat together
- Avoid discussing topics that may be stressful or triggering, such as food, weight, calories, appearance, or other topics that are upsetting to your loved one
- Draw attention away from the meal using distractions such as telling stories, watching a TV show, doing a crossword puzzle, or listening to music
- Make use of short, supportive phrases (i.e. “You are so brave. I know you can do this”) that feel natural to you
- Stay focused on finishing the meal
Finally, your loved one will greatly benefit from your support after the meal is finished. Eating disorder thoughts can be equally as loud and distracting after eating, and someone with an eating disorder may feel guilty, remorseful, or physically sick. It may be tempting for your loved one to deal with these overwhelming feelings in unhealthy ways. You can help by providing distraction during the time immediately following a meal. Again, you can discover unique ways of doing this with your own family, but here are some ideas to get you started:
- Play a board game
- Watch a movie
- Engage your loved one in positive conversation
- Colour in a colouring book
- Learn to knit
A key part of the post-meal phase is supervision. Make sure you or another caregiver is present with your loved one during these activities. Also, ensure the amount of time you spend doing an activity is long enough for any negative thoughts and feelings to subside to a manageable level.
It’s clear that this is not an easy process. But even amidst setbacks and challenges, we can’t lose sight of the truth. Recovery is possible. Though it may take months or even years, this is a battle that can be won. Know that you are not alone –there are people all over the world who are on a similar journey, and there are many who have gone before you who have seen their loved ones recover from eating disorders. The most important thing you can do is to never give up supporting your loved one.
- Cairns, J. (2011). Eating disorder nutrition (full video). In Retrieved from https://www.youtube.com/watch?v=XK3xWN3O2V8
- Kelty Eating Disorders. (2018). Meal Support. Retrieved from https://keltyeatingdisorders.ca/recovery/meal-support/