Expanded Treatment Options for Eating Disorders

Coaching and meal support are two relatively new and important signs of progress in eating disorder treatment. One theme throughout this blog describes the experience that eating disorder thoughts are ever present in a person’s life, and treatment needs to find ways to counter the thoughts and behaviors much more regularly during the day.

I have written about using daily food logs as a primary way to enable patients to face their thoughts and feelings. This treatment plan continues to work very well.

Coaching and meal support offer a different way to provide more help through the day. These modalities focus on extra time with a clinical provider either around daily activities or at meal and snack times.

The provider can interrupt entrenched eating disorder thoughts and behavior patterns and increase the time a patient can try to change these patterns rather than reinforce them. The result is that treatment plans extend into more parts of the day and give the eating disorder less leeway and freedom to dominate a person’s life.

For coaching and meal support to be effective, the patient needs to be far enough along in recovery to be willing to hear the messages around eating more consistently and why the eating disorder can be so destructive. If a patient is so fixed on staying sick, extra support still won’t make much of a dent.

These expanded options in treatment allow for providers to create a much more specific plan for each patient. Therapists, dietitians, groups and outpatient programs used to be the only available options. Now coaching, meal supports, online groups, mentors and a variety of mixed programs offer so many more ways to get well.

The Existential Nature of Eating Disorder Recovery

The last few posts circle a pressing issue in modern day life, especially post-pandemic life. It’s more common for us to be home now and feel comfortable in an increasingly virtual world. As much as we have the luxury and convenience of having everything at our finger tips, there’s something fundamental to the human experience that is slowly fading from our lives.

One element we are missing is social interaction. Virtual relationships certainly do matter and saved us all through the pandemic. However, we are biologically built to be social beings. Extensive research shows that our health and well-being benefit enormously from in person contact, something we are slowly agreeing isn’t as important anymore.

On a more profound level, engaging with the world enables us to find meaning and purpose in our lives in a way that virtual life cannot replace.

Eating disorders create purpose, meaning and structure to people’s lives. The day revolves around how to eat, how to move and how to plan each and every day. It’s clear every night if the day was a success or failure based on the philosophy and morals of an eating disorder. The eating disorder brings pain but also enables people to find a sense of purpose, safety and even calm.

If we retreat to the virtual world, the structure of an eating disorder becomes even more appealing. Diet culture, the exercise industry and the wellness cult draw us further into these depths and away from lives with meaning. The media easily confound any sense of direction in life through endless advertising and images that associate food and weight with personal value. Individual choices drown when faced with the overwhelming messages about health and thinness. And social media imprint a profound sense of inadequacy about who we are and how we live.

The cure to most of these ills is out in the world. Purpose and meaning come largely from relationships. We find our best selves learning from others and celebrating the complex, emotional and new experiences in our daily lives.

In order to decrease the incidence of eating disorders, our society needs to prioritize interaction and relationships enough for people to find identity and meaning outside themselves. It’s not a small task but a necessary one.

Our Intentions About Food Matter

People who come to see me for help with their eating disorders often ask me how I eat and how I think about food. Years ago when first asked this question, I was taken aback, but I have thought quite a bit over time as to why this question is so important. Now I try to answer honestly either about what I might have eaten in any given day or how I approach food in general. As a result, I try to look into all the ways I approach food and how my experience might help guide people in recovery.

This question gets to the heart of dealing with food in our world as it is. There is no clear way to think about and approach food. We aren’t equipped to handle the endless array of food at our disposal, as I mentioned in my last post. The media noise about dieting, “healthy” food, irresistible food and weight is extremely loud while the silent whispers of a more balanced way to think about food and body are barely audible.

For the first time ever as humans, the fortunate of us expect to be able to follow hunger and fullness cues and desires to figure out a way to eat without a care of a future without plentiful food at our disposal. Even for those of us who don’t have eating disorders, eating is complicated and laden with many contradictory impulses.

Many if not most people use the messages in the media to eat based on some ambiguous sense of doing the right thing balanced with their own desires. Some people use exercise as a way to justify eating (food as “fuel”) while others focus on the kinds of food they eat (or don’t eat) either as a way to eat ethically or to focus on perceived health benefits.

We all may look for the right way to eat, but more than anything I think we are searching for a structure to help us eat regularly and in a way that feels good physically and emotionally. And more often than not, the media have an enormous impact on how much time and effort we put to our food.

I often answer the question in a few parts. During the week, my food is fairly consistent without too much variation since this way of eating needs less attention so I have more energy to focus on the weekdays. The weekends tend to be a time of more food pleasure either around foods I enjoy, being with others or cooking. The balance between routine, ensuring there is time and attention to meals even on busy days and enjoyment is a pattern that has worked for me and is often a helpful guide for many people to begin to figure out the place of food in their lives.