Most people who begin treatment for an eating disorder have adopted an irregular pattern of eating that is usually characterized by dietary restraint (food rules, calorie limits, etc.) and/or dietary restriction (actual under-eating). This may take the form of delaying eating for as long as possible over the course of a day, allowing for only one meal, drinking water or liquids to stay “full,” or counting calories and consuming only foods that are considered to be “safe,” non-fattening, etc.
Increased Risk of Binging
Dietary restraint and restriction can be accompanied by binge eating and/or purging via vomiting, laxatives, or exercise. This type of unstructured eating can make you more vulnerable to binge eating in three ways:
Physical hunger: Going multiple hours between meals and restricting certain foods and the amount of food you eat can result in physical hunger. When physical hunger is prolonged and strict rules are adhered to for some time, you may experience serious physical effects on weight, cardiac function, anemia, and metabolic changes, to name a few.Preoccupation with food and eating: Restricting food often results in hyper-focus on what and when you will eat, what you should and shouldn’t eat, recipes, cooking, and food preparation. Psychological sense of deprivation: Regularly avoiding food, being preoccupied with food, and being physically hungry usually, at some point, results in breaking a diet rule or limit. Perpetually feeling like you cannot have something can also result in a feeling of failure when that food is consumed. When this occurs, you may decide to “go all out,” since you’ve already broken a rule. For example, if you’ve eaten a cookie that you “shouldn’t have,” the eating disorder mindset might rationalize eating the rest of the box and starting back on your diet tomorrow.
What Regular Eating Looks Like
The pattern of regular eating recommended as part of CBT includes three meals and two or three snacks and looks something like this:
Breakfast(Optional mid-morning snack)LunchAfternoon snackEvening mealEvening snack
Experts encourage eating discrete meals and snacks, rather than grazing on food throughout the day, and avoiding eating between meals and snacks. Along with regular eating are instructions to avoid binging and purging, which may require implementing additional skills such as engaging in activities that are incompatible with binge-eating/purging, or “urge surfing.” Importantly, you should avoid going more than four hours between episodes of eating. This type of eating takes effort, especially at the beginning of treatment. It may require forethought, planning, or even setting alarms as reminders to eat, especially in the context of busywork, school, and home schedules. When practicing regular eating, extensive meal planning over the course of a week may not be necessary, but you should always know roughly when and what your next meal or snack will be. At the beginning of treatment, it is more important to focus on the structure and timing of eating, rather than what you are eating. Later in treatment, issues such as avoided foods are addressed through exposure and experimentation. Some greatly benefit from meal delivery services, which can take some of the work out of planning and encourage variety and adequate nutrition.
Common Fears
It’s commonly feared that eating regularly will result in weight gain. However, this is usually not the case (with the exception of those with anorexia nervosa for whom the initial goal of therapy is weight restoration). Clients are not being asked to change what they eat or the amount of food they eat. Furthermore, regular eating results in decreased binge eating, which is associated with a large amount of energy intake. People with eating disorders commonly either avoid knowing their weight at all or they weigh themselves very frequently (daily or multiple times per day). Frequent weighing is problematic because the natural fluctuations in body weight that are observed on the scale result in the desire to further restrict food intake no matter what the number says. If your weight goes down, you might say to yourself, “I should keep dieting to stay on track.” If your weight goes up, you might say to yourself, “I better diet more to see some results.” Avoiding knowing your weight is also problematic in that you might assume your weight is fluctuating drastically based on how you feel, when, in reality, your weight is staying relatively stable. For this reason, regular weighing, usually once weekly, is appropriate. Another common fear for those who binge eat is that eating earlier in the day starting with breakfast will result in an unstoppable pattern of binge eating over the course of the day. Again, while implementing additional strategies and skills learned in therapy, this fear is usually not realized. For some, it may take many weeks to reach the goal of eating in this way. Although it can be challenging, regular eating is helpful in the process of overcoming eating disorders. Once regular eating is adopted, treatment can move on to other facets that are maintaining the eating disorder, such as placing a high value on weight and shape, the effect of negative mood states on eating behavior, and body image concerns.
Meal Support
Some people in recovery may benefit from additional meal support. Meal support is the provision of emotional support during meal times, focused specifically on helping complete regular meals.
