My answer is always a little complex. There are several things that need to be accomplished before someone is ready to come off of a meal plan and begin eating on hunger and fullness cues.
- If needed, restore your weight to a healthy weight range. Use your meal plan to do this in a safe and healthy way. Note that it can be common to feel uncomfortably full during the refeeding process. Be patient though as the fullness is only temporary.
- Once in a healthy weight range, your dietitian will tweak your meal plan to maintain your weight (this can take several weeks and several adjustments). When on a stable weight maintenance meal plan, work on becoming confident that you will be able to maintain your weight while eating regularly and being abstinent from using eating disorder behaviors. Use your meal plan to decrease rigidity. You must be able to eat a variety of foods, eat in a variety of settings, and be able to estimate your portion sizes while being abstinent from eating disorder behaviors before you are ready to come off of your meal plan.
- Be abstinent from eating disorder behaviors and follow your meal plan long enough so that you begin to experience hunger cues before your meals and snacks. This can take up to several months so do not get discouraged if you feel consistently full for a while. Typically, the first hunger cue to return is the one upon waking in the morning (before breakfast). Sometimes, before other appropriate hunger cues come back, there can be a period of time where you may experience hunger at very odd times (sometimes a short while after you may have just eaten). I'm not sure why this occurs. I do know, however, that this tends to be short lived and is followed by a return of hunger cues at much more appropriate times. Once your hunger cues return, take some time to get used to what normal hunger and fullness feel like.
- Work with your dietitian to slowly put some ranges into your meal plan. For example, instead of 3 fats, put in a range of 2-4 fats. Or, instead of 2 snack exchanges, try a range of 1-3 exchanges. Use your hunger cues to decide which end of your meal plan you will choose to eat on. If you can continue to maintain your weight (while still eating a variety of food, in a variety of settings, while estimating your portion sizes and abstaining from eating disorder behaviors), allow your dietitian to add more and more ranges to your meal plan. Eventually, you will have so many and such wide ranges in your meal plan that you will have worked your way off of your meal plan!