In honor of National Nutrition Awareness Month in 2021, we want to take a deeper look at how nutrition plays a central role in eating disorder recovery. We’re not going to bore you with breakdowns of statistics that a nutritionist might provide in a non-eating disorder setting – i.e. “you need XXmg of iron and calcium daily.” That’s counterproductive; people without eating disorders all have different nutritional needs, and people with eating disorders often have even more specialized and unique needs for an ideal nutritional plan.
Instead, we’ll focus on some of the core nutritional philosophies we employ here at Clementine Programs. Over decades of combined experience, we’ve found that these approaches to food, eating, and nutrition give our clients a solid footing in nutrition on which to base their recoveries.
Medical Treatment At the Start
People with eating disorders often enter residential or outpatient treatment suffering from a nutritional imbalance. In some cases, they may be malnourished. As mentioned, every situation is different, but it’s more likely than not that an individual beginning eating disorder treatment will need some form of nutritional stabilization – replacing missing nutrients and sometimes emergency weight restoration.
Certainly, this need varies depending on the client’s type of eating disorder and how long it has been happening. A person with binge eating disorder, for example, is likely to have an excess of the type of nutrients found in their preferred binge eating snacks – they’ll need a nutrition plan to increase what’s missing and reduce the excess. Or as another example, an individual entering eating disorder treatment with an advanced case of anorexia nervosa will likely need a full spectrum of nutrients to stabilize their physical safety. There might be a need for medical intervention, such as an NG tube.
Normalizing Nourishment and Nutrition
Most laypeople think eating disorders are about weight and foods – but most of them are not. Disordered eating behaviors are more often found to be a way to cope with a distorted body image, negative or distorted emotions, and/or stresses from past trauma. They are a way to assert control over a person’s life when they feel they are out of control. Binge eating episodes, restriction, purging, excessive exercise – all these behaviors provide a temporary sense of control.
For this reason, nutritional awareness in an eating disorder context is less about “eating more vegetables” or “reducing sodium” than it is normalizing regular eating patterns and continual nourishment. It’s so important to our clients to recover their “healthy selves” from the grips of their “eating disorder selves,” and this sense of nourishment and plain old enjoyment of food is at the heart of that.
Four Core Principles of Nutrition at Clementine
- Recognition that healthy, recovered people come in all shapes and sizes
In recent years, the concept of “Healthy At Every Size” (HAES) has become central to the eating disorder treatment and recovery circles. HAES principles inform almost every aspect of modern recovery. They center around the idea that a person’s health is not defined by their weight, or their body size or shape. This is a revolutionary attitude for many people with eating disorders. Distorted body image and the presentation of ostensibly “healthy” bodies in the media and advertising can force an unattainable goal into the minds of people at risk for eating disorders. This goal, of course, is a thin, toned, or sometimes muscular body. Unfortunately, these unrealistic “goal bodies,” even when they’re not Photoshopped, require extensive exercise and food restriction –two of the main things eating disorder treatment tries to avoid.
When employing a HAES-informed nutritional philosophy, people are encouraged to eat when they are hungry, eat what they like and what makes them feel nourished, and to eat for health, no matter if they gain weight or not. Body acceptance is a must with HAES-informed recovery. On the way to finding their recovered selves, individuals in treatment often use cognitive retaining methods like Cognitive Behavioral Therapy to identify and dispel disordered thoughts about their body (specifically those that cause a feeling of “fatness” or being too big). By objectively identifying these kinds of thoughts, they can start to accept their body’s natural size and shape, even if that’s not thin or “straight-sized.”
- Recognition that all bodies deserve to be nourished and experience satiety
When they first step foot into an eating disorder treatment center, people usually have been unable to feel a sense of nourishment or satiety for some time. Some eating disorders, such as anorexia nervosa, include symptoms such as food restrictions that mean they rarely if ever eat enough in a sitting to feel full or satiated. Others such as binge eating disorder include periods of dieting in public offset by private binge eating episodes, which often go past the point of satiety, even to the point where it causes pain. A large part of avoiding these kinds of disordered behaviors is to promote intuitive eating.
Intuitive eating is the state of being able to eat in a way that makes a person feel nourished and satiated. This, again, is the idea that it’s ok to eat when you want, what you want, and how much you want to get the nutrition your body needs as well as feeling nourished by your meal. Eating and drinking are things that can bring joy. Part of an eating disorder treatment program is always to instill that sense of joy and contentment when it comes to mealtimes and snacks. Very often, it’s helpful for people in treatment to journal about their favorites snacks or meals that made them feel happy and full – these can be stepping stones for a full recovery.
- Behavior-focused, rather than weight-focused, philosophies
As must be clear by now, the overriding theme of nutritional philosophies at a comprehensive eating disorder treatment center like one of Clementine’s is that aside from medical stabilization and weight restoration, the focus of treatment isn’t about weight. It’s about behavior. Although some clients might be put on a weight restoration plan at first, or stay on a weight maintenance plan recommended by our dieticians, we find it essential to stick to HAES principles when it comes to the overall treatment plan. That means we focus on behavior rather than weight once everything is stable.
The primary therapeutic goal is to identify and eliminate disordered eating behaviors and repair the individual’s relationship with food and eating. For a person with bulimia nervosa, for example, who is medically deemed overweight, there may be a deep-seated desire to lose weight. But in the recovery context, it’s far healthier for them to gain weight and cease bingeing and purging than to lose a few pounds here or there. This focus and philosophy works to continue promoting clients’ healthy selves long after treatment is completed; by focusing on behaviors rather than something as variable as weight, the template is set for regular and nourishing eating patterns.
- Kitchens that are open and accessible as in a homelike setting; at any time throughout the day, individuals can request and be provided with more food for satiety
Sneaking down to the kitchen for a quick snack doesn’t seem like a big deal for most people – for someone with an eating disorder, it can be everything. Just as important is the act of planning and cooking a nutritious meal that provides a sense of nourishment and pleasure. In order to normalize a nutritional, HAES-inspired relationship with food, our Clementine locations all feature an accessible, homey kitchen with a well-stocked fridge and pantry. At any time, upon request, our clients can ask for more food.
Feeling comfortable in the kitchen bodes well for an individual’s long-term recovery prospects as well. After treatment ends, individuals have to do their own meal planning, their own shopping, cooking, etc. Being able to feel at home in a kitchen and making food goes a long way towards normalizing healthy eating behaviors and healthy attitudes about eating and food. With time spent in the kitchen and learning to ask for food when they feel like it, our clients are much better prepared to integrate their healthy selves back into daily life.
Keep Nutrition in Mind When Choosing an Eating Disorder Treatment Center
Nutrition is important to everyone, but it’s even more important to people in eating disorder recovery. From treating initial imbalances to setting the foundation for an intuitive, satisfying relationship with food and eating, a good treatment program will foreground nutrition at every step. If you or your adolescent is struggling with an eating disorder, remember the core nutritional principles Clementine has to offer. They can make the difference between a disordered life and a nourished one.