Meal plans are often an essential part of eating disorder treatment and recovery. Developed by registered dietitians as part of a comprehensive treatment plan, they are valuable in providing structure and ensuring that the individual gets the variety and amount of food they need. In this blog, we will cover the basics of meal plans, as well as some different types of meal plans used in eating disorder recovery.
What Is A Meal Plan?
While meal plans are often used in fad diets, a meal plan for eating disorder recovery is a very different thing. 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 in 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. Meal plans in recovery 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 patients 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.
To reiterate the difference between fad diets and meal plans, it is important to emphasize that the goals of recovery meal plans are NOT:
- Weight loss or controlling someone’s weight
- To promote one food, nutrient, or type of food over another
- To create a “perfect healthy eater”
- To follow a meal plan forever
Now that we truly understand why meal plans in recovery are different than non-medical diets, let’s move on to some different types of meal plans.
Types of Meal Plans
The (Eating Disorder) Exchange System
The exchange-based meal plan is the most common meal plan style utilized within the eating disorder field, though the exchange categories and portions differ from organization to organization. The focus of this plan is mainly on the regularity of eating, as well as portions and balance.
This meal plan system is organized using a system of exchange lists. These lists contain foods grouped together because of their nutritional similarities. The seven exchange lists include the following: grains, protein, fruits, vegetables, calcium/milk, fats, and desserts. The eighth category is listed as “other” and is most often used for supplements to the meal plan. This exchange system has proven to be essential in helping to re-regulate the eating process and support weight restoration and/or stabilization. When using the system, dietitians may omit nutrient information related to the exchange list, as that could be triggering for someone recovering from an eating disorder.
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
Also developed by a Registered Dietitian, The Rule of 3’s method focuses on regularity of eating with consideration of balance. It 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
- Eat at least three food groups per meal (and two per snack)
- Allow no more than three hours between eating
Intuitive eating is a meal plan system that is based on following one’s hunger and fullness cues, and it is less structured than the other meal plans we have discussed. It is often something that individuals can adopt beyond eating disorder recovery. Intuitive eating is about reconnecting with the body’s physical hunger and fullness signals in order to determine when and how much to eat. This method takes a lot of work because often those who are experiencing eating disorders often lose their ability to read their own hunger cues. Those suffering with or recovering from an eating disorder need to work closely with an eating disorder specialist to explore the best way to transition to this style while being careful not to inadvertently slip back into disordered patterns.
Choosing the correct meal plan for an individual’s recovery is essential for correcting malnutrition, providing structure, and challenging disordered behaviors. We hope we have provided more insight into some of the different types of meal plans used in recovery, as well as their importance.
If you would like to learn more about meal plans and other nutrition topics, check out the RD 101 presentation hosted by Shena Washburn, RDN, CD, CEDRD. Please also join us for our upcoming nutrition-related continuing education event, “The Cultural Culinary Challenge: Managing Varying Nutritional Needs in Eating Disorders Care,” happening this Thursday, March 10th.