By: Jacy Pitts, RD, CSP, LD
As eating disorder practitioners, we are all familiar with the concept of adding variety to a client’s often-limited food repertoire. As a non-diet dietitian who works with clients of all ages and all eating disorder diagnoses, I find that safe or preferred foods, or ways of eating them, are common amongst all groups. Eating is already scary… so eating a new food, texture, color, or combination, in a new place or with new people can really push clients out of their already-uncomfortable comfort zone. How do we tackle the complicated task of moving clients toward adding more variety on their plates (and in their lives)?
One of the top questions I get from clients when providing guidance around eating or meal planning is: “Is it okay to eat the same thing every day for lunch?” This is tricky, because although something is better than nothing, it’s really not okay in terms of their long-term recovery. So my response is usually something like, “Well, do you want to get better? Then let’s work on that.”
In fact, a small exploratory study (n=41) by Schebendach et al., found that eating patterns which were lower in both energy density and variety were associated with poorer treatment outcomes in weight-restored women with anorexia. The study also observed “food monotony” in this subset, and that less palatable foods tended to amplify this effect. Let’s look at a real-life example: that client who mixes a concoction of high-volume, low-calorie foods that don’t go together and calls it a meal? Food monotony, less palatable. Guess what helps combat the monotony effect? Adding highly palatable foods, or, as we often call them, “fear foods”. Think combination dishes, fats, desserts, and sauces. Normalizing these foods as part of balanced eating can help prevent relapse.
Here are a few thoughts and tips on steering clients toward more variety:
Invite clients to eat with you during a session. Eating is a fundamental way we connect with other people. This form of connection is often impaired in our clients due to the isolating nature of eating disorders. Allowing a client to explore the process of connecting with another person over a meal or snack, in a safe and trusted space, can give them the stepping stones to eat in other environments later on. This vulnerability that comes with a shared eating experience can lead to new insights about how the eating disorder functions and the ways in which it keeps them stuck. The example of a client staying stuck in food monotony is just one of many. Do you have to then eat together every session? No. Even one shared experience of eating a meal or snack can provide valuable information for both the practitioner and client and open a dialogue of specific areas that need improvement…with the goal, of course, to increase variety over time.
Food is fuel, and fuel helps us function. This is a favorite saying of mine, and its purpose is to neutralize the belief that there are “good” and “bad” foods, and that the body is fully capable of utilizing a variety of foods for fuel. Fuel and balance are words that I use often with clients. Sometimes, this means exploring with a client the rigid belief that they simply must load up on vegetables at every opportunity, every day, or they have not achieved the pinnacle of healthy eating. Such a vegetable-heavy style of eating actually is not balanced. Heavy vegetable consumption may displace other critical nutrients, such as calcium from dairy or dairy alternatives, iron from protein-rich foods, and a slew of other vitamins and minerals from major groups such as grains or fats. Recently, I had a client switch from eating a large salad at lunch every day to a smaller yet more nutritionally balanced panini, and the following week, she reported how much less bloated and gassy she felt. This felt very rewarding in that she had a reduction in unpleasant body sensations and she had been able to add variety with her eating. Other times, this means explaining the trajectory of carbohydrate breakdown in the body and how it is used by the muscles and brain. Understanding how carbohydrates are used has helped many of my clients shift from carbohydrate avoidance to carbohydrate inclusion…and more variety.
Take a trip down memory lane. What was a favorite childhood food memory? Did the client stop eating that food during their eating disorder? A teen client once shared that she used to eat a donut for breakfast every Friday, and since her eating disorder hit, it had been two years since she had done so. She actually knew the exact date. One day, I received a picture of her eating a donut and giving a big “thumbs up”. She discovered that in reality, her anxiety was wrapped up in the thoughts of eating the donut (anticipatory anxiety) and that once she made the leap to eating it, her anxiety lessened significantly. Help a client imagine a present-day exposure that stems from a favorite food in childhood…. imagined exposures often lead to real life ones.
Create a bucket list with them: I will know I am fully recovered (or well on my way) when I can do/eat ________. For some clients, one item might be cooking with oil or butter again, or eating a hamburger patty with the bottom and top bun at the same time. It might be having a pan of brownies in the house and not eating them all in one sitting. It might be driving by a favorite fast food restaurant without feeling that they must order something in the drive-thru. Over time, help the client to work their way up the list, from the least to most anxiety-inducing.
Jacy Pitts, RD, CSP, LD is a Registered Dietitian with offices in Smyrna and Buckhead. She sees eating disordered clients of all ages and genders. Board Certified in Pediatric Nutrition since 2007, Jacy specializes in working with children, teens, and families. Her office has a fully equipped kitchen and meeting space for meal/group support to help clients build skills in recovery.