Why do I need an anorexia recovery meal plan?
Anorexia nervosa is a serious and potentially deadly disorder. An anorexia recovery meal plan is a crucial tool to safely re-nourish the body and mind. If left untreated, anorexia can cause dangerous physical and mental effects including:
- Heart damage
- Bone loss
- Loss of menstrual cycle
- Tooth decay, hair loss
- Kidney damage
- Nerve damage
- Neurological dysfunction
The goal of an anorexia recovery meal plan is to restore a healthy body weight and establish consistency, adequacy, balance, and variety to your eating habits.
Is it safe to follow an anorexia recovery meal plan at home?
There are risks associated with following an anorexia recovery meal plan, especially without the guidance of a nutrition professional. Refeeding syndrome results from rapid re-nourishment when the body has been in a chronically starved state. Refeeding syndrome causes drastic shifts in fluids and electrolytes from the bloodstream into cells, which can result in heart failure, seizures, coma, or death.
Risk of refeeding syndrome increases if BMI is below 18, there has been low to no nutritional intake for 5 or more days, or the individual has lost 10% or more of their body weight in the last 3-6 months. Daily monitoring of blood tests and heart function tests by a doctor can help your dietitian determine an appropriate meal plan to avoid refeeding complications.
Choosing an appropriate level of care
Outpatient nutritional rehabilitation, like that offered by the dietitians at Rebecca Bitzer and Associates, is most appropriate for those individuals who are clinically stable and not at high risk of refeeding syndrome. Outpatient sessions are usually 30-60 minutes, 1-2 times per week or less. Your outpatient dietitian will monitor your weight restoration progress and help you make adjustments to your meal plan so you continue meeting your weight and intake goals.
Higher levels of care include (in order of increasing clinical support) intensive outpatient (IOP), partial hospitalization (PHP), residential, and inpatient hospitalization. Everyone’s journey is different. It is not uncommon for someone recovering from anorexia to need different levels of care at different times in their recovery. Recovery is not linear.
Your outpatient dietitian will closely monitor your progress and make recommendations for higher levels of care if they are concerned about your health and safety.
How much do I need to eat on my anorexia recovery meal plan?
Your anorexia recovery meal plan’s calorie amounts are tailored to your specific body and needs by your dietitian to achieve weight restoration. There is no one-size-fits-all recovery meal plan.
You may need to eat more food than you did prior to your eating disorder in order to restore a healthy body weight; This is normal. Your dietitian will help you determine a healthy goal weight range based on your growth charts (children and teens) and weight history (adults)
In general, an anorexia recovery meal plan will follow the “Rule of 3’s”: 3 meals, 3 snacks, no more than 3 hours apart. Meals will be structured around exchanges or fuel groups. In general, meals will include at least one portion of a carbohydrate or grain, a protein, and a fat. Snacks will include at least one portion of a carbohydrate and either a portion of a protein or a fat.
What about my fear foods/safe foods?
When you’re struggling with an eating disorder, the thought of eating some foods, or even whole food groups, can feel very challenging. We refer to these foods as “fear foods.” Fear foods can make it difficult to meet adequacy, balance, and variety goals.
Your dietitian will work with you to plan meals around foods that feel safer and less challenging to meet your energy needs. If you are unable to meet your energy needs with safe foods alone, your dietitian may recommend nutrition supplements like Ensure or Boost, to increase intake.
Your dietitian will also provide support in the planning and execution of food experientials to reintroduce fear foods into your diet to meet longer term goals of balance and variety. Challenging fear foods is an important and necessary part of anorexia recovery and establishing a healthy relationship with food.
Can my meal plan be vegetarian or vegan?
It is true that some individuals choose a vegetarian or vegan lifestyle for reasons pertaining to ethics or sustainability. It is also true that some individuals adopt a vegetarian or vegan lifestyle to further restrict their intake in accordance with their eating disorder.
Your dietitian will work with you to figure out how best to incorporate your values into your meal plan while still meeting your intake and weight restoration goals. If you are unable to meet your nutrition needs, your dietitian may recommend incorporating animal products at least until a healthy weight is restored.
What if I get too full too quickly to meet my meal plan?
Early fullness is to be expected after long periods of undereating. Your dietitian may work with you to plan smaller, more frequent meals and snacks. The sensation of fullness may feel very scary at first. Your dietitian and your therapist can work with you on how to manage difficult emotions at mealtimes.
The discomfort of early fullness may resolve on its own over time with consistency. In other cases, your dietitian may recommend a digestive enzyme or refer you to a GI specialist to address slow gastric emptying, or gastroparesis. This may be managed medically.
How can I be most successful in my anorexia recovery?
- Choose an appropriate level of care from a treatment provider/facility that aligns with your clinical, emotional, and spiritual needs
- Assemble a care team of providers who specialize in eating disorders, including a dietitian, a therapist, a psychiatrist, and a medical doctor
- Establish an eating plan with contingencies so you feel confident in what, when, where, and how you are nourishing yourself each day
- Identify your support system and include them in your treatment so they may offer support, encouragement, and accountability in your home environment
- Seek out resources that encourage, educate, and inspire you in your recovery including support groups, social media accounts, books, podcasts, and more
- Keep a list of your reasons why you want to recover; add your recovery wins and accomplishments to this list over time
- Identify when you are at risk of relapse, including times of transition, high stress, or the holidays, and recruit more support during these times
- Acknowledge that slips are not slides, and slides are not failures; relapsing does not mean you cannot fully recover from your eating disorder long term
Kristin Jenkins, MS, RD is a Registered Dietitian Nutritionist. Kristin specializes in eating disorders and intuitive eating, and is an advocate for weight-inclusive care for all her clients.