The Eating Disorder Treatment Glossary- Part 2: Nutrition


Protein and carbs and fat- oh my! The world of nutrition in eating disorder recovery can be really overwhelming. We hope the glossary helps break down common terms into more digestible (pun intended) pieces of wisdom. Bon appétit!


Meal Support:


Meal Support

This refers to any sort of boundaries, incentive, or consequence around eating. It can look like a parent sitting with their child until they complete a meal, requiring meal completion before phone time, or even preparing a meal for your loved one. Basically, it is anything that helps you or your loved complete their meal plan!


Our dietitians can also help with meal support in session, as well as our recovery coach! This can help keep the anxiety around meals contained and behaviors redirected. We can even do telehealth sessions where we prepare meals and eat in your own kitchen, without the RD actually having to be there physically.


Safe Foods

These are foods that cause no or very little anxiety to eat. Often they are foods that diet-culture tells us are good- typically low calorie or low carb foods.


Risky Foods (aka Fear Foods)

These foods cause a lot of anxiety to eat. Coping skills are used to reduce anxiety through a therapy called Exposure Response Prevention. This therapy focused on working through the anxiety without a response, such as purging or exercising. Once you learn to tolerate the anxiety, you find it’s not as high!


Table games

These are easy games to play that can distract you or your loved one while they’re eating. Keep an eye out for our upcoming video!


Validation

When you’re in an intense situation, it can be easy to say “I know you don’t want to eat, but just do it anyways!” This can actually be unhelpful. By acknowledging and accepting their anxiety, we allow them to feel and reduce the anxiety.


Incentives

These are rewards for completing a meal, snack, or the entire meal plan. It can be phone time, mindful movement, time with friends, or even things like stickers/squishies/slime.


Natural consequences

These are ‘consequences’ for not completing a meal or snack. The term ‘natural’ denotes that there needs to be a solid reason for the consequence. For example, if your loved one did not complete lunch, they do not have the energy to go for an evening walk. A forced consequence (ie punishment) would be grounding them or taking away hobbies without a logical reason, but out of fear.


Meal Plans:


Meal Plan

A set structure of foods to eat and their quantities. It is a ‘cast’ to out around the ‘broken bone’ of the eating disorder to keep the person stable until they can ‘walk’ again. It is a way to ensure they get enough nutrients while learning to cope with the ED voice. The ED voice is the part of them that scream to do behaviors, whereas the healthy voice is focused on long term goals and values.


Exchanges

This refers to serving sizes of food groups. Each portion of food can be ‘exchanged’ for another portion within its category. For example ½ cup of rice= 1 slice bread= 8 gummy bears. It denotes that each of these foods have similar calories and macronutrients. It is a very structured meal plan.


When someone has engaged in behaviors, they need to relearn what typical portion sizes are. Restricting and binge eating causes your brain to ‘forget’ what you needed to eat before the eating disorder.


Rule of 3’s

This is a more flexible meal plan that focuses on having a balanced plate, rather than exact portion sizes. It’s called rule of 3’s because it specifies 3 meals, 3 snack, every 3 hours. It can be as general as “1 main dish and 2 side dishes” or as structured as requiring each category of food at meals.


Plate Method

This is the least structured meal plan that we commonly use. It looks like a pie chart and denotes the amount of food categories to include at each meal. It can change as the person progresses.


Plate by Plate Method

This is a concept from Family Based Treatment. When transitioning onto or off of a meal plan, it is helpful to try one meal at a time to allow for the person to notice changes and cope slowly.


Magic Plate

This is another term from Family Based Treatment. The plate is created without the client’s input or knowledge, and served at a specific meal time- as if the plate magically was prepared. Often, the parents/loved ones are informed about the meal plan, while the client is asked to relinquish all control of food. This prevents the ED voice from influencing caregivers in what to provide the client with.


Medical terms:


Gastroparesis

This literally means “stomach paralysis”. When we’re underfed, the stomach loses muscle tone due to lack of adequate fuel. When you’re increasing your intake, it can take time before the stomach builds strength to digest the food you’re eating. It can lead to feelings of bloating, early satiety, no appetite, and prolonged fullness. There is a medication called Reglan (metoclopramide) that can help. Eating more frequently and using nutrient dense foods can also minimize symptoms, which is why a meal plan is so important. While it’s not a fun side effect of eating disorders, it does go away with time.


Refeeding syndrome

When the body goes from a state of being undernourished to nourished, it can have changes in electrolyte balances and blood glucose levels. This can lead to fainting, heart irregularities, coma, and even death. The risks of getting refeeding syndrome are reduced by medications, eating consistently, and frequent monitoring of medical status.


Growth Curve

Each child has their own unique genetic blueprint that determines their growth potential. They stay along the same ‘curve’ until they reach the age of 20, when growth and development slows. For example, if your child was at the 78th%ile at age 13 weighing 120 pounds, their growth would indicate they weigh 134 pounds by age 15. This can help us determine how much weight your child needs to restore, especially because EDs are often not diagnosed until several years after they begin, leading to disruption in usual growth patterns. Of course, weight goals are determined by MANY factors. When the body restores, so does the brain, heart, stomach, and other vital organs. Weight restoration is essential for recovery.

This is explained further here: https://youtu.be/akoXXuyXA2

https://www.youtube.com/watch?v=akoXXuyXA2g&feature=youtu.be


Growth Records

This refers to your child’s or young adults record of height and weights that have been taken by their doctor. You can obtain this from their current pediatrician, even if they have not been seen by one pediatrician their entire life. Records are stored and transferred to new pediatricians, even if you move or haven’t seen your pediatrician in several years. You can ask your pediatrician for the “complete growth records including height and weight”.


Setpoint Weight

This is a weight where the body naturally feels comfortable. Signs of malnutrition, excess anxiety, and behaviors cease or significantly subside at this weight. More about setpoint weight can be found here https://seven-health.com/2018/03/114-set-point-theory/


Malnutrition

Hearing that you or your loved one is malnourished can be really scary. It often brings up feelings of self-blame or failure. Malnutrition exists along a spectrum, and one can actually become malnourished after just 5 days of low food intake. As one low intake becomes more prolonged, they become more malnourished. One can be malnourished in either protein, calories, specific vitamins/minerals, or all of the above.


Myelin Sheaths

Thick layers of fat that surround every neuron in our body. During malnutrition, these myelin sheaths thin. We don’t just lose body fat when we lose weight- we also lose the fat in our brains and the fat that cushions and protects our vital organs. Our brain is 60% fat, so it literally shrinks during malnutrition. This leads to fatigue, anxiety, rigidity, fogginess, and depression. This can actually worsen and amplify eating disorder behaviors! The good news is, it will grow back as you weight restore- which means some anxiety and behaviors will naturally decrease.


I hope this helps you in your introduction to eating disorders. What other terms should I define? Is there anything you’d like separate blog post on? We’d love your feedback!

If you haven’t already, check out our part one! Looking for something more about anti-diet culture? We have a glossary for that, too!


Take Care,

Brenna Topham, RDN, LD


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