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Dr. Shaun Riebl, PhD, RDN, Within’s Chief Nutrition Officer, answers some questions that many have had about what meal support entails at Within. Learn about the support patients receive during their time in treatment when it comes to mealtimes, including how we help them cope with anxiety and triggers.
Meal support at Within includes individualized approaches to help you use meals and snacks as opportunities to get one step closer to recovery. Our team provides you with individualized coaching depending on your current emotional state and overall goals.
Meal support is both communal and individual. Meal support groups are offered for breakfast, lunch, dinner, and snacks two times a day. Sometimes, individual meal support can be a part of your personal treatment plan and might occur one-on-one with a dietitian, therapist, or care partner.
Within coaches you to ultimately become independent with food decisions. Our treatment philosophy is to help you—our patient—become autonomous so you can use internal resources to fuel yourself with delicious, nourishing food. Through meal coaching and support, you’ll work through the most challenging aspect of treatment and eventually take back the responsibility of nourishing yourself adequately and consistently.
In addition to meal support, Within provides meal delivery when needed to support your recovery.
During treatment, meal support gives you a safe place to eat, struggle, and recover.
It helps you to center yourself around your values versus the values of the eating disorder. Sometimes, patients aren’t aware—or maybe were never told—how the eating disorder uses specific eating strategies to temper anxiety. They don’t realize how the eating disorder uses eating strategies to cope with discomfort or uncomfortable body sensations and feelings. Meal support provides you with the opportunity to learn, grow, and ultimately heal.
When providing meal support, your Within care team members will say something versus nothing because if we don’t say something, it sends the message that things aren’t that bad when, in reality, the eating disorder is running the show.
During meal support, your Within care team will help you overcome eating disorder beliefs, rules, and thoughts.
Absolutely.
As you receive meal support during treatment, you lean on others, which helps you feel safe and capable of doing things that are intimidating or different. Once you are back on your own, the transition can be difficult for some because you don’t have the same support you had before.
As you progress through treatment, you will gradually use more of your own resources (i.e., skills and tools) at meals and snacks and eventually have opportunities to practice independently. You may start with just one snack a day on your own, then one snack and one meal a day, then two snacks and one meal, then two snacks and two meals, and so on.
You’ll build up your resilience to a point where you can intuitively support yourself while at the table outside of treatment. You’ll find you no longer have to rely on eating strategies that keep you stuck, oppressed, or bending the knee to society’s unrealistic ideals.
While not every eating occasion will be with someone else after treatment, the hope is that many meals will be with others.
The causes of anxiety around mealtimes can be multifaceted. The environment, company, health, food itself, and more can contribute to this. Coping with this anxiety partly depends on the cause. Sometimes, we need to identify where the discomfort is coming from to get relief. Knowing the source can guide us on what tools or resources to use.
Go-to skills we recommend are grounding, deep breathing, defusion (a skill taught in acceptance and commitment therapy), and STOPP (Stop, Take a breath, Observe, Pull back from perspective, and Practice what works).
If anxiety is very high and skills aren’t accessible, we may need to distract ourselves to get relief. We use distraction cautiously since it doesn’t help us ultimately heal but postpones the discomfort that comes with healing.
Some people worry about being triggered during meal support and don’t want to do it. Meal support offers help with portioning, encouragement from staff, connection with peers, and even distraction from unhelpful thoughts, leading to a healing experience with food.
It’s important to remember that being triggered isn’t bad—it can help us cope and function better. We need to be aware of triggers to work through them. When we are able to face our anger, frustration, and/or fear from a nonjudgmental stance and look at them with wonder, we open the door for healing.
Meal support benefits everyone at the table—you might be struggling in a similar way to someone else, and it can help you talk about it and know that you’re not alone in your feelings. Furthermore, it can help put the focus on taste, satiety, and the overall eating experience versus macronutrients.
At Within, we intend meals to be an opportunity for community and connection. An eating disorder robs individuals of this experience. Regular, predictable intake and steady, unwavering support, free from distraction, are powerful in returning people to a place where intake is not so overwhelming.
The support table provides a smaller ratio of patients to care team members, keeping the primary goal on meal completion. It gives strength to individuals during a time when an eating disorder can be very loud and overwhelming.
The community table extends healing for patients who are ready for this step. This experience is for patients who are completing meals regularly and are ready to move into learning to reconnect their food experience with ease, joy, and social connection.
The goal behind the support table is to help clients get back to the basics and work on their ability to successfully complete and engage during the meal; therefore, the space reflects those intentions.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
