Sunday, December 15, 2013

Will I Be on a Meal Plan Forever?

Drawing of foods for breakfast, lunch, dinner, a morning snack, an afternoon snack, and an evening snack, arranged in a circle around a clock. Breakfast, morning snack, lunch, afternoon snack, dinner, and evening snack are labeled.

"Will I be on a meal plan forever?" It is probably one of the most common questions my clients ask me.

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.

The first step to eating normally again is to understand the benefit of being on a meal plan. It is important to recognize that being on a meal plan is NOT a bad thing. Following a meal plan assures that you are meeting your nutritional requirements; it teaches you what a normal plate of food should look like; it wards off extreme hunger (which can be a trigger to using eating disorder behaviors); and it accurately retrains your hunger and fullness cues.

So, how exactly do you work on getting off of a meal plan? Below are the steps that I have found most useful with my clients who desire to return to accurate reliance on their hunger and fullness cues. Remember to do this under the direction of a Registered Dietitian who specializes in the treatment of eating disorders.

  • 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!

If you are considering working off of a meal plan, I would not recommend making drastic changes in the midst of a transition from one level of care to another level of care. Fear, uncertainty, and anxiety are all common when stepping down to a lower level of care and they can affect hunger and fullness levels. My advice is to step down to a lower level of care, demonstrate your ability to maintain recovery at that lower level of care, and then finally work on learning to rely on your hunger and fullness cues.
 
Know that the process of coming off of a meal plan can take time. DO NOT rush it. Remember, that there is NOTHING wrong with being on a meal plan if it keeps you from using eating disorder behaviors and helps keep you healthy, engaged, and functioning in life!

Sunday, November 17, 2013

A Little Help with Thanksgiving Meal Plan Exchanges

-Turkey 2-4 ounces = 2-4 ounces protein, 0-1 fats

-Mashed potatoes 1/2 cup = 1 grain (also 1 fat if made with butter, etc)

-Turkey gravy as desired = condiment

-Candied yams or candied sweet potatoes 1/2 cup = 1 grain, 1 fat

-Stuffing 1/2 cup = 1 grain, 1 fat

-Dinner roll = 1 grain

-Crescent roll/biscuit = 1 grain, 1 fat

-Green bean casserole 1/2 cup = 1 grain, 1 fat

-Steamed vegetables 1/2 cup = 1 vegetable

-Sauteed vegetables 1/2 cup = 1 vegetable, 1 fat

-Salad with 1 T regular fat dressing or 2 T light salad dressing = 1 vegetable, 1 fat

-Canned cranberries or cranberry relish 1/4 cup = 1 fruit

-Pie 1 slice or 1/8 pie = 4-5 snack exchanges (or half of a piece for half of the exchanges)


*Remember, all serving sizes look like the palm of your hand!


Tips for Meal Plan Flexibility During the Holidays:


  • If your meal plan only includes something like 2 grains at a meal, but you would like to have 4 different grains (for instance, you would like mashed potatoes, candied sweet potatoes, stuffing, and a dinner roll), eat half of a serving size of each item instead of a whole serving size. This will allow you the flexibility to sample a little bit of everything on Thanksgiving, but still stay accountable to your meal plan.

  • Sometimes, the food served at holiday functions may not fit perfectly into your meal plan. For example, a combination of the food served may put you over on your fat exchanges. Or, a food required on your meal plan may not be available (for example, there might not be a milk or fruit served). In these circumstances, it would be appropriate to be flexible and swap some meal plan exchanges around. For instance, go up on an exchange of something else in place of the missing exchange (for example, leave off your milk and have an extra grain in its place). Or, when over by 2 fat exchanges, leave off another exchange (as 2 fat exchanges are close enough in calories to that of another exchange). *Be mindful of balance when swapping around meal plan exchanges. It is important not to leave yourself with an unbalanced and as a result, an inadequate meal that may trigger eating disorder behaviors.

  • Since many eating disorder meal plans contain 2-3 snacks (in addition to the 3 meals), snacks can be an excellent place to fit appetizers and desserts into your intake. Snack exchanges can allow you the flexibility of fitting holiday treats into your meal plan while still being able to eat a balanced and well rounded meal.

Comment below if you need assistance figuring out other Thanksgiving food exchanges. I'd be happy to do my best to help you estimate them. Happy Thanksgiving!

Monday, November 4, 2013

A Healthy Holiday Season During Eating Disorder Recovery

It’s that time of the year again! The holiday season is almost here. Unfortunately, for those who are overcoming years of disordered eating, the holidays can be a real struggle. Food is often at the forefront of almost every holiday celebration and the bounty of calorie rich foods often trigger a fear of weight gain. As a result, some make a hasty retreat back to their familiar disordered eating behaviors in an attempt to compensate for the food they ate. However, the holiday season does not have to equate to diets and deprivation. In fact, your holiday season can be a healthy holiday season. Here are some how-to’s for a healthy holiday season:
-Give yourself permission to eat as well as permission to enjoy what you eat. You are a human being and because of this, you have the right to eat and you have the need to eat.
-Take the judgment out of the food and take yourself off the hook. You are not good or based on what you eat. Your values and the person you are are not affected by the food you just ate.
-Do not starve yourself before hand in an attempt to save up the day’s allotment of food for the holiday celebration. Doing so may trigger you to overindulge, which may in turn produce feelings of guilt and shame and start a cycle of disordered eating behaviors. Instead, avoid the triggering highs and lows with your hunger level by nourishing yourself with a balance of food throughout the day.
-Remember that the holiday is usually more of a holiday season versus a one day ordeal. You do not need to overindulge in one sitting because there will be special food around throughout the holiday season.
-Give yourself permission to eat (as stated above), but don’t rush to eat. Slow down, settle in, and socialize first. Stand more than an arm’s length away from the munchies so that you can focus on the good company and festivities versus the consistent mindless hand to mouth motion.
-Anticipate some of the possible triggers in advance so that you can have a game plan for how to positively cope when you encounter them. This may mean having a support person available (in person or on the phone) who can help you work through momentary struggles and difficult situations.
-Before stepping in line to get your food, plan ahead, assess your hunger and fullness level (and/or your meal plan) and evaluate your options. Consider portion size and moderation. Mindfully consider the foods you enjoy. Decide which foods you’ll definitely eat, which ones you will sample, and which ones you will skip.
-Make a decision and stick with it. Do not play a back and forth game of this is good/bad for me, but this is better for me. The back and forth choices can cause confusion, frustration, anxiety and can trigger the cycle of disordered eating behaviors.
-Slow down and become mindful while you eat. Enjoy the taste, texture, and smell. Breathe and assess your fullness (and/or your meal plan) while you are eating. It takes at least 20 minutes for fullness cues to arrive and signal us to stop eating. Therefore, instead of heaping your plate full right from the start, moderately fill your plate and remember that you can go back for seconds if you are still hungry.
-Legalize the holiday yumminess! Deprivation, chronic dieting, cutting back, or labeling food as good or bad can lead to cravings, overeating (or binges), and poor nutrition. When foods are forbidden, they take on a magical quality that is difficult to resist. Research shows that the more you legalize a food, the more in control you will be when eating that particular food. If you try to restrict yourself from all holiday treats, you may be more likely to overindulge at some point. Focus on moderation versus deprivation.
-If you consume alcohol, be mindful of your intake and the effect that it has on your food inhibitions and mindful eating.
-Cope with holiday pressure/triggers and stay accountable to your recovery by staying in touch with your personal support system and your treatment providers.
-Avoid some of the stress and anxiety that can foster a lapse into unhealthy eating behaviors by keeping control of your calendar.

Thursday, October 17, 2013

50 Snack Combo Ideas for Eating Disorder Recovery

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  1. Peanut Butter and Jelly Sandwich
  2. Cheese and Crackers
  3. Smoothie
  4. Parait with Yogurt, Fruit, and Cereal or Granola
  5. Leftovers
  6. Pretzels and Hummus
  7. Veggies and Hummus
  8. Pita Bread and Hummus
  9. Peanut Butter and Granola or Cereal Balls
  10. Trail Mix (Nuts, Chocolate, Cereal, Granola, Dried Fruit)
  11. Wrap (Mini or Regular Size)
  12. Sandwich (Mini or Regular Size)
  13. Celery and Peanut Butter Topped with Raisins
  14. Granola Bar or Cereal Bar with a Side of Juice or Milk
  15. Graham Crackers, Teddy Grahams or Animal Crackers and Pudding
  16. Cereal and Milk
  17. Popcorn Topped with Parmesan Cheese
  18. Sliced Tomato with Feta or Mozzarella Cheese and Olive Oil
  19. Power Bar, Cliff Bar, or Luna Bar with a Side of Juice or Milk
  20. Muffin with a Side of Fruit, Juice or Milk
  21. Graham Crackers, Animal Crackers or Teddy Grahams Topped with Nutella or Peanut Butter
  22. Oatmeal with Dried Fruit and/or Nuts
  23. Turkey Jerky or Beef Jerky and Pretzels
  24. Cheese and a Side of V8 Vegetable Juice
  25. Fruit Leather and Mixed Nuts
  26. String Cheese and Pretzels
  27. Veggies and Dip or Dressing
  28. Rice Cakes Topped with Peanut Butter or Nutella
  29. Mini Pizza (Made with a Small Tortilla, Bagel or English Muffin)
  30. Pita Pocket Stuffed with Feta/Ricotta/Cheddar Cheese and Apple Slices
  31. Waffle Topped with Peanut Butter, Applesauce and Cinnamon, or Yogurt and Fruit
  32. Cottage Cheese and Fruit
  33. Apple Slices and/or Banana with Nutella or Peanut Butter
  34. Snack Kabobs Made with Pretzel Sticks, Grapes and Cheese Cubes
  35. Bagel, Toast, or English Muffin Topped with Nutella or Peanut Butter
  36. Scrambled Egg or Egg White on Toast
  37. Fruit with Fruit Dip
  38. Tortilla or Pita Chips with Bean Dip, Guacamole, Hummus or Salsa
  39. Rice Cakes and Yogurt
  40. Chocolate Banana Pops
  41. Tuna or Tuna Salad on Crackers
  42. Banana Bread, Zucchini Bread or Pumpkin Bread with a Side of Juice or Milk
  43. Roasted Pumpkin Seeds with a Side of Juice
  44. Small Baked Potato with Cheese and Salsa
  45. Apple Slices and Cheese Slices
  46. Jell-O and Fruit
  47. Puppy Chow or Cookies with a Side of Milk
  48. Fruit Pizza
  49. Veggie Pizza
  50. Cup of Tomato Soup and Crackers

Monday, July 15, 2013

Using a Food Label for Eating Disorder Recovery

Earlier this year, I wrote a blog post titled Meal Plans for Eating Disorder Recovery. This post gave a brief overview of an exchange based meal plan for eating disorder recovery. For someone who is a newbie to the world of meal plans though, the information contained in that post may not be enough guidance. As a result, it can be easy to stick to eating familiar foods for fear that making a mistake with the portion size and exchanges will cause weight to spiral out of control.

If you are reading this and you can relate, don't get stuck in the rut of only allowing yourself safe foods! Break out of your comfort zone, challenge yourself, and incorporate some variety into your intake. After all, challenging yourself is the key to recovering from an eating disorder.

If you are too fearful and anxious to take a guess with the portion and exchange of an unfamiliar food, you can rely on a food label to help you. Click here for a breakdown of the exchange system based off of a food label (*please do not click, however, if a food label is going to be a trigger and will not be helpful for you). 


Food label


The trick to using food labels... 


1. Only rely on food labels when you need to! Although food labels can be helpful, it can also easily become an area of obsession. Look at a food label only when you don't have a clue what you would count a particular food as. Obsessing over food labels will leave you stuck in your eating disorder. However, using them to learn how to incorporate new foods into your intake will keep you on the road to recovery. 

2. Take a guess first! Before you look at a food label, try to estimate the portion size and exchange of that food first. Doing so will allow you to use the food label as a teaching tool versus an area of obsession. Use the information you learn about one food to help you estimate a similar food. After all, many foods you will come across will not have a food label (example: foods at a cook out, food at many restaurants, etc). 

3. Be flexible! It can be quite difficult to be exact with the calories and grams needed for a protein, grain, fat, and snack exchange. Therefore, do not focus on perfection. Instead, work on being flexible with each exchange. You will be on the high end of an exchange at times. Consequently, you will be on the low end of an exchange at other times. In the end, it will even out to what your dietitian is calculating your needs to be.

Monday, June 17, 2013

Step Away From the Scale!


Step away from the scale! Yes, you! Back away from the scale! And here's why...


1. The number on the scale does not tell you the whole story. The number on the scale is a blind number. It does not differentiate between bone, muscle, water, skin, fat, or how much you have eaten (or had to drink) that day. For example, muscle mass is lean mass, yet weighs more than body fat does...and this muscle mass certainly does not mean that you are fat! 

2. Your weight fluctuates from day to day. It is normal for weight to fluctuate within a couple of pounds from day to day (up one day, down the next, up the day after that, down the next, etc). This fluid fluctuation is not actual weight gain! Your weight fluctuates after you eat, after you drink, after you work out, during your menstrual cycle (obviously, only if you are a female), and can also fluctuate from certain medications. Don't let these day to day fluctuations work you into a tizzy! 

3. The number on the scale does not define you! You are so much more than a number. Seriously! Let's not forget about all of the things that you have to offer the world! Are you compassionate, generous, humorous, talented, strong, adventurous, or brave? Don't let the fixation with the number on the scale cloud all of the things that make you, you! Others like you for your personality...not your weight! 


Now, get off the scale, quite fixating on your weight, and live your life!



Thursday, May 30, 2013

NEED A BODY IMAGE PICK ME UP? FITCH, PLEASE!

Check out Fitch, Please for a body image pick me up! Could not have said Ellen's message any better myself!