Anorexia nervosa is a serious mental health condition affecting food intake, relationship with eating, body image, and nutrition beliefs. Recovering from it takes time, and using different tools can make healing easier. A nutrition meal plan may be a helpful tool for recovery.
How Meal Plans Help with Eating Disorder Recovery
A nutrition meal plan can be a helpful tool for recovery by:
- Providing structured eating times.
- Preventing meal skipping.
- Limiting surprises, which can be stressful, by outlining what meals and snacks will be served.
- Being personalized to meet your energy and nutrition requirements.
These meal plans won’t broadcast calories or other metrics that could trigger eating disorder thoughts (e.g., the grams of fat or carbohydrates in a meal). Instead, more focus will be spent reviewing the qualitative benefits of your meal plan, like how the different foods will nourish your body and help you heal.
The Role of a Registered Dietitian
It’s much easier to heal from an eating disorder when you can work with fantastic healthcare providers, including a registered dietitian. They’re expertly trained to:
- Identify any food rituals that might be linked to an eating disorder.
- Explain why food nourishes your body and is essential for daily function.
- Help you understand that no food is good or bad.
- Review your intake and address gaps in your nutrition.
Dietitians are compassionate providers who undergo extensive training to serve you. At every nutrition counseling appointment, you’ll receive unconditional support and guidance, which can help you develop a meal plan to help you regain healthy eating habits.
Read also: The Hoxsey Diet
Types of Eating Disorders and Meal Plan Customization
The severity of your symptoms will influence your eating disorder recovery plan.
- Anorexia Nervosa: Restoring your nutritional intake by eating several meals and snacks daily, and correcting mineral or vitamin deficiencies, is essential to helping your body heal. Your healthcare team will help you increase your meal and snack intake and challenge food fears and eating disorder thoughts so that you can heal your relationship with food.
- Binge Eating Disorder: A nutrition meal plan for binge eating disorder will be filled with foods that help you feel satisfied and energized. Through counseling, you’ll learn how to challenge eating disorder thoughts that might prompt you to binge and how to end the binge-restrict cycle confidently.
- Bulimia Nervosa: The nutrition meal plan for bulimia nervosa should be customized to meet your nutritional requirements and address deficiencies (if any are found). It will have nutrient-dense options to ensure you feel satisfied throughout the day. Through counseling, you can learn how to address binge eating and cope with other eating disorder triggers without purging.
- Avoidant and Restrictive Food Intake Disorder (ARFID): A meal plan will be customized to fit your ARFID preferences (textures, tastes, etc. will be considered). Learning how to expand your food intake is vital to getting enough nutrition to stay healthy. Through counseling, you can broaden your food choices and better understand your relationship with food.
- Pica: A PICA meal plan will address nutritional deficiencies (if any are found). In addition to dietary changes, you may need a supplement, which can be incorporated into your structured eating plan. Through counseling, you’ll learn how to build balanced meals and decrease the risk of dietary deficiencies in the future.
- Rumination: If you have rumination eating disorder, a meal plan will help you stay nourished and comfortable after eating. Through counseling, you’ll learn how to cope with triggers that could cause you to regurgitate food or purge.
- Other Specified Feeding and Eating Disorders (OSFED): A meal plan can help you stay nourished as you heal from OSFED. You’ll address eating behaviors and nutrition beliefs through counseling to help heal your relationship with food.
Sample Meal Plans
According to the USDA nutrition guidelines for adults, each meal should include one lean protein, plenty of vegetables (and fruits), and a high-quality carbohydrate. We haven’t included serving sizes or calorie amounts, as this can trigger eating disorder thoughts. Instead, we designed nutritionally balanced meals rich in vitamins, minerals, and nutrients your body needs to thrive. A globally recognized eating disorder expert, Dr. Marcia Herrin, recommends that people in recovery follow the “rules of 3”, which states that they eat every three hours and have three meals and three snacks daily. Your dietitian may have other recommendations to help you develop a fully customized plan.
Sample 1 (Omnivores)
Day 1
- Breakfast: Oatmeal with milk, Greek yogurt, ground cinnamon, and fresh berries.
- Lunch: Quinoa with black beans, baby spinach, diced onion, and bell peppers. Top with salsa and olive oil.
- Dinner: Baked salmon with broccoli and cauliflower. Serve with herbed quinoa.
- Snacks: Greek yogurt with nuts and seeds, crackers with cheese, apple slices with nut butter.
Day 2
- Breakfast: Whole grain toast with nut butter, berries, and lemon zest.
- Lunch: Whole wheat pita pizza with tomato sauce, onions, peppers, spinach, goat cheese, and grilled chicken.
- Dinner: Grilled chicken with mashed potatoes and Caesar salad.
- Snacks: Greek yogurt with berries and nuts, popcorn with parmesan cheese and garlic powder, banana with nut butter and chocolate chips.
Day 3
- Breakfast: Smoothie with Greek yogurt, spinach, banana, and instant oats.
- Lunch: Whole grain bread with tuna salad and fresh fruits on the side.
- Dinner: Stir-fried shrimp with cashews, onions, bell peppers, and pineapple. Serve over brown rice.
- Snacks: Greek yogurt with diced pear and cinnamon, crackers with cottage cheese and tomato, roasted chickpeas.
Sample 2 (Pescatarian)
Day 1
- Breakfast: Whole grain toast with avocado, tomato, onion, and sliced egg.
- Lunch: Chickpea curry served over brown rice.
- Dinner: Baked trout with Greek salad and roasted squash.
- Snacks: Popcorn with olive oil and nutritional yeast, apple slices with Greek yogurt dip, roasted fava beans.
Day 2
- Breakfast: Scrambled eggs on whole wheat toast with fresh tomato slices.
- Lunch: An open-faced sandwich with whole grain bread, tuna salad, and lettuce. Fresh fruits on the side.
- Dinner: Baked tofu with broiled bok choy and mushrooms. Serve with quinoa.
- Snacks: Crackers with cheese, Greek yogurt with mango and cinnamon, roasted BBQ lentils.
Day 3
- Breakfast: Baked whole wheat muffin with shredded carrot, cranberries, and walnuts. Serve with a Greek yogurt cup.
- Lunch: Minestrone with kidney beans, vegetables, and shell pasta noodles.
- Dinner: Grilled shrimp with shredded lettuce, cheese, salsa, bell peppers, and onions. Serve with black beans or rice.
- Snacks: Popcorn with parmesan and dried rosemary; pineapple and Greek yogurt dip, whole grain crackers with hard-boiled egg and cheese.
Sample 3 (Vegetarian)
Day 1
- Breakfast: Overnight oats with chia seeds, nut butter, berries, and coconut shavings.
- Lunch: Whole grain sandwich with smashed chickpeas, spinach, tomato, cucumber, and cream cheese.
- Dinner: Spaghetti with pesto, asparagus, lentil meatballs. Serve with a leafy green side salad.
- Snacks: Apple slices with nut butter, whole grain crackers with cheese, vegetable sticks with hummus.
Day 2
- Breakfast: Scrambled tofu with broccoli, red onion, and marinated red peppers. Serve with whole grain toast.
- Lunch: Whole grain English muffin with cream cheese, cooked tempeh, green onion, fresh cilantro, and basil.
- Dinner: Grilled black bean patties served on a whole wheat bun with tomato, pickle, tomato, cheese and mayonnaise.
- Snacks: vegetable sticks with savory Greek dip, banana with nut butter and chocolate chips, roasted chickpeas.
Day 3
- Breakfast: Smoothie with half an avocado, soft tofu, nut butter, and frozen fruits.
- Lunch: Five bean chili with a whole grain dinner roll on the side.
- Dinner: Broiled tofu with eggplant, red bell peppers, and bok choy. Serve with brown rice.
- Snacks: Popcorn with olive oil and black pepper, baked peach with nuts and spices, crackers with cottage cheese and tomatoes.
Meal Plan Approaches for Eating Disorder Recovery
While meal plans are often used in fad diets, a meal plan for eating disorder recovery is very different. First of all, meal plans for fad diets are often not created by a Registered Dietitian and are not individualized. Meal plans in recovery are created for an individual’s specific needs by a Registered Dietitian.
While fad diets establish diet culture rules, often exclude essential nutrients, and reinforce shame, meal plans for eating disorder recovery provide a framework to meet individual needs while allowing flexibility and a variety of food types. Instead of being restrictive in nature, they are additive and focus on ensuring that nutritional needs are met. Eating disorder recovery meal plans also set the stage for future eating practices in addition to providing resources to use as a backup as needed.
The level of structure can vary depending on what is best for each individual. Some clients require a highly detailed exchange-based meal plan, while others may need to simply follow an intuitive eating-based approach. None of the meal plan types are better or worse than the other. What is important is providing the appropriate level of support and structure. Often, meal plans are modified over time to adjust to wherever the person is at in their recovery from an eating disorder.
Read also: Walnut Keto Guide
Types of Meal Plans
The level of structure provided by a meal plan can vary from a highly detailed exchange-based plan to a more general entrée-sides plan to more of an intuitive eating-based approach. No meal plan style is necessarily better than another; what is important is that it provides the right level of support for that person at that time. As a person’s ability to manage food intake changes, their meal plan is often adjusted as well.
The (Eating Disorder) Exchange System
In this style of meal planning, a person works with their dietitian to create a “meal pattern,” which outlines the timing, type, and amount of each food category over the course of the day.
The meal plan is organized using a system of exchange lists. These lists contain foods grouped together because they are nutritionally similar. The seven exchange lists include grains, protein, fruits, vegetables, calcium/milk, fats, and desserts. The eighth category is called other, and it is generally used for supplements to the meal plan.
The Plate-by-Plate Approach
The Plate-by-Plate Approach was developed by Registered Dietitians for children and young adolescents as a supplemental meal planning tool for parents, but it can be used for adults as well. This method incorporates five food groups, including grain/starch, vegetable/fruit, protein, fats, and dairy. There are two visual plate model variations, one for weight restoration and one for weight stabilization. There are three key aspects to this meal plan type:
- Put parents in charge of all aspects of food
- Utilize a 10-inch plate
- Emphasize variety and exposure to all foods from the start (dependent on parent knowledge/nutrition counseling)
The Rule of 3’s Meal Plan
Also developed by a Registered Dietitian, the Rule of 3’s method focuses on regularity of eating and eating a balanced diet, in order to help in recovering from an eating disorder.
Read also: Weight Loss with Low-FODMAP
The Rule of 3’s meal plan is categorized by six different food groups, including calcium, grains/starch/complex, carbohydrates, proteins, fruits or vegetables, and fats. This plan is more appropriate for someone who has a moderate or high risk of refeeding syndrome or someone who is experiencing moderate or severe malnutrition. The Rule of 3’s is made up specifically of these guidelines:
- Eat at least three meals and up to three snacks a day (you might think of this as a breakfast, lunch, and dinner meal plan)
- Eat at least three food groups per meal (and two per snack)
- Allow no more than three hours between eating
Entrée-Sides Meal Plans
Another approach, the entrée-sides meal plan, has features of the exchange-based meal plan but with more general categories for food and less exact portion sizes.
In this style of meal plan, there is still an emphasis on eating regularly spaced meals and snacks. However, instead of breaking meals down by various exchanges, there are just two categories, entrées and sides.
The advantage of this approach is that simplifies food choices and uses everyday language we typically hear when thinking about meals. Snacks are similar; the lists of snack options include commonly consumed snacks but in differing quantities and combinations in order to provide the needed nutritional level. This plan is our front-line approach for adolescent clients as it is family-friendly and easy to adapt to family meals. However, it lacks the level of precision many individuals need when the eating disorder is more in control, which is why it is frequently a step-down method for adult clients once an exchange-based meal plan is no longer required.
Intuitive Eating Meal Plan
Intuitive eating focuses less on creating an external framework by which to make eating decisions and more on reconnecting with the body’s physical hunger and fullness signals to guide the timing and amount of food chosen. Getting in touch with internal cues for hunger and fullness is then paired with developing, or reclaiming, a sense of what the person is truly hungry for and/or what they know their body needs to balance out their intake for the day.
As appealing as intuitive eating may seem, a fair amount to work needs to go into being able to follow body cues to lead food and eating decisions. Those active in their eating disorders often find physical signals of hunger and fullness either unavailable to them or that these signals have been hijacked by disordered thoughts, judgments, or associations. Eating disorders are masters at using approaches such as intuitive eating to justify over/undereating or to avoid certain foods out of “preference,” when in reality it just serves as a way to legitimize disordered eating behaviors. Those dealing with, or who have a history of, an eating disorder need to work closely with an eating disorder specialist to explore how to transition to this style while not inadvertently slipping back into disordered patterns.
Strategies for Meal Planning During Recovery
Even if you’ve never planned meals before, it’s never too late to learn. Here are some tips to help you get started with meal planning and meal prep:
- Set a schedule for when you will go grocery shopping-typically, once a week is adequate for the majority of your planned meals.
- Make a grocery list ahead of time so that you can focus on what you need to get and avoid becoming overwhelmed
- Ensure your shopping list includes all of the ingredients you need for each meal or all of the pre-made foods you can assemble for your meal.
- Plan two or three options for meals you can rotate but still have variety and don’t get sick of the same thing.
- Make sure to include snacks in your meal plan.
- If you are pressed for time or know that you’ll be too tired or busy to cook, plan for premade meals from the grocery store.
- If you plan to go out to eat with friends or family, you can try to take a look at the menu ahead of time
- Remember to be flexible and give yourself permission to change your mind or plan a spontaneous outing.
- Choose foods you associate with positive food memories.
If you are recovering from anorexia, you may find choosing nutrient-dense foods helpful if you are struggling with reaching meal plan goals.Having some go-to foods that are nutritious and nutrient-dense can be a great starting point for you. This is especially true if you are struggling to return to eating normal portions.
Nutrient-Dense Foods
- Oily fish
- Baked beans
- Avocados
- Nuts and seeds
- Eggs
- Greek whole milk yogurt
- Smoothies or shakes
- Potatoes
Strategies for Meal Planning for Caregivers
Caregivers and families may find cooking and meal planning for their loved one in recovery stressful or overwhelming, but supporting your loved one doesn’t have to be anxiety-inducing. Here are some tips for caregivers who are preparing or helping prepare meals for someone in eating disorder recovery:
- Have several options for planning breakfasts so you can offer variety.
- Think about how your loved one can achieve nutrition goals for the week. Writing ideas down may be helpful for you or them, but don’t spend too much time thinking about things says in advance
- Set aside time each week to plan the coming week’s meals.
- Plan family dinners on a weekly basis, choosing meals that can be adjusted based on people’s preferences (such as salads, pasta dishes, and tacos).
- Make sure to factor in snacks to your meal planning and grocery shopping for the week.
- Keep your child or loved one’s recovery goals in mind (if they need to gain weight, plan some energy-dense or nutrient-dense meals).
- Make sure to communicate with your child’s eating disorder treatment team, especially if you have questions or need guidance.
- Include your child in the meal planning, if advised by their provider.
You may also want to talk to a registered dietitian nutritionist about your meal plans to make sure that your child is getting the balanced, nutritious meals they need.
Treatment and Recovery
How is anorexia treated?
Treatment for anorexia nervosa is specific to the person being treated. The goals of treatment include:
- Restoring good nutrition
- Stabilizing weight loss
- Eliminating disordered eating behaviors
- Treating underlying psychological concerns
The biggest challenge in treating someone with anorexia is helping them recognize and accept that they have a serious illness. Many people with anorexia deny that they have an eating disorder and only seek help when it becomes life-threatening. This is why early recognition and treatment are so important.
Your healthcare provider will design a custom treatment plan, which may include:
- Hospitalization may be necessary to treat severe malnutrition or other serious health complications. You may also stay in the hospital for severe mental health issues.
- Medications sometimes play a role in treating these complications. But the long-term treatment for anorexia nervosa is psychotherapy.
- Psychotherapy, or talk therapy, helps change thinking and behavior patterns associated with eating disorders. It can help you develop healthier attitudes toward food, weight and body image. It can also help you learn better coping mechanisms and techniques for dealing with stress and negative thoughts.
Some people with anorexia have coexisting mental health conditions that contribute to their eating disorder. It’s important to treat these conditions alongside anorexia. But even if you don’t have another disorder, anorexia itself is a mental health issue. Treatment must address the root cause in your mind.
Types of Psychotherapy
There are many types of psychotherapy, including:
- Acceptance and commitment therapy. This method focuses on developing the motivation to change your behaviors, regardless of your thoughts and feelings.
- Cognitive behavioral therapy (CBT). This method focuses on addressing distorted views and attitudes about weight, shape and appearance, and making behavioral changes.
- Cognitive remediation therapy. This method involves exercises and activities to help improve your cognitive and executive function and your ability to take charge of your life.
- Dialectical behavior therapy (DBT). Specific skills you’ll learn in DBT include building mindfulness, improving relationships, managing emotions and tolerating stress.
- Family therapy. Family support is very important to anorexia treatment success. Family-based therapy for anorexia (the Maudsley Method) puts your family in charge of your nutrition.
- Interpersonal psychotherapy (IPT). IPT involves improving your relationships and communication, which may reduce your eating disorder symptoms.
- Psychodynamic psychotherapy. This therapy involves looking at the root causes of anorexia as the key to your recovery.
Possible Complications of Anorexia Treatment
The most serious complication of treating anorexia is refeeding syndrome. This can happen when someone severely malnourished begins feeding again. Your body needs certain nutrients to be able to metabolize your food. When its stores are low, it draws those nutrients from your bloodstream.
This shift of nutrients from your blood into your cells can cause a wide range of complications and can even be fatal. This is why it’s important to begin refeeding under medical care. Healthcare providers take care to replace your lowest nutrients first and carefully monitor you during the refeeding process.
Recovery Time
Recovery from anorexia is a journey that’s different for everyone. Some parts of your treatment plan may take longer than others. What’s important to remember is that recovery is possible. No matter where you or your loved one is in your or their journey, it’s essential to continue working toward recovery.
Precision Nutrition in Anorexia Nervosa Treatment
The Need for Individualized Approaches
AN etiopathology is complicated and heterogeneous, encompassing environmental and societal risk factors alongside metabo-psychiatric risk factors including genetic variation and gut microbial taxa. The relative roles of these disparate risk factors likely change between patients and may interact to increase risk. Precision approaches may allow tailoring of treatment decisions to individual risk factors and disease characteristics.
Precision nutrition refers to the stratification of dietary recommendations based on individual factors from data sources such as genetics, microbiota profiles, environmental factors, and phenotypic data to optimize health outcomes.
Factors for Personalizing Dietary Interventions
Several factors can be used to personalize dietary interventions for optimizing weight restoration:
- Energy Expenditure: Traditional nutrition interventions to restore weight in AN typically followed a “start low and go slow” approach, beginning with meal plans under ~ 1,200 calories and gradually increasing intake to mitigate the risk of refeeding syndrome. Recent research shows that a conservative low-calorie method is associated with decreased weight gain and prolonged hospital stays in patients with AN. Emerging evidence supports higher initial caloric prescriptions combined with close medical monitoring and electrolyte replacement to prevent refeeding syndrome.
- Macronutrient and micronutrient targets: Overall, guidance for macronutrient composition aligns with those recommended for adults without an eating disorder (ED). The recommended composition includes 50-55% of total energy intake from carbohydrates, 25-30% from fats, and 15-20% from proteins. Some studies have indicated that macronutrient distribution, rather than calories alone, can influence the risk of refeeding syndrome.
- Gut Microbiota: Some patients may benefit from microbiota-directed dietary plans that focus on restoring microbial diversity, keystone taxa, or functions that promote energy absorption, which could enhance weight restoration-although stronger evidence is needed to support this approach.
- Genetic Factors: Accounting for genetic factors influencing metabolism may help refine nutrition prescriptions improving upon existing energy estimation equations, which were not developed for patients with AN.
- Psychiatric Comorbidities: Furthermore, accounting for psychiatric comorbidities such as depression and anxiety may help refine nutrition prescriptions improving upon existing energy estimation equations, which were not developed for patients with AN.