Wednesday, February 6, 2013

Meal Plans for Eating Disorder Recovery



The importance of following a meal plan is something that I mention throughout this blog. There are different types of meal plans, all with the same general goals: 1) to stabilize your eating patterns and 2) provide you with adequate nutrition. The most common type of meal plan for someone with an eating disorder is one that deals with exchanges of food. This type of meal plan is based off of the diabetic exchange system and focuses on X number of servings within each of the food groups (servings of grains, proteins, fruit, vegetables, fats, and dairy). Meal plans usually include breakfast, lunch, dinner and between two to three snacks per day.


Below is a general list of serving sizes within each food group for an exchange based meal plan. *There are often slight variations with this type of exchange system. The list below is to provide you with a general understanding of what this type of meal plan entails.

MEAL PLAN EXCHANGES

GRAINS (1 EXCHANGE)
-1 slice bread
-1 small dinner roll
-1 6” tortilla
-½ bagel
-½ English muffin
-½ hamburger bun
-½ - ¾ cup cold cereal
-½ cup hot cereal
-½ cup cooked rice
-½ cup cooked pasta
-1 small baked potato
-6 crackers
-1 pancake
-½ 6” pita

FRUITS (1 EXCHANGE)
-1 piece fresh fruit
-½ cup canned fruit

-3/4-1 cup fruit chunks
-¼ cup dried fruit
-½ cup fruit juice

VEGETABLES (1 EXCHANGE)
-½ cup cooked vegetables
-1 cup raw vegetables
-½ cup vegetable juice

MILK (1 EXCHANGE)
-1 cup skim milk
-1 cup 2% milk (1 milk, 1 fat)
-1 cup chocolate milk (1 milk, 1 grain)
-6 oz. Dannon Fruit on the Bottom yogurt (1 milk, 1 fruit)
-6 oz. Yoplait Original yogurt (1 milk, 1 fruit)

PROTEIN SERVINGS
-Beef, chicken, turkey, fish, cheese, tofu, eggs, peanut butter (I count the fat within protein sources towards fat exchanges in the meal plan).
-1 cup beans, peas, and lentils (I count the carbohydrate content in legumes towards grain exchanges in the meal plan).

FATS (1 EXCHANGE)
-1 teaspoon butter or margarine
-1 Tablespoon butter substitute (ex: I Can’t Believe It’s Not Butter; Country Crock)
-1 teaspoon regular mayonnaise
-1 Tablespoon light mayonnaise
-1 Tablespoon regular salad dressing
-2 Tablespoon light salad dressing
-2 Tablespoon regular sour cream
-1 teaspoon oil
-about 1 Tablespoon nuts and seeds


Below is an example of an exchange based meal plan for someone with an eating disorder. It is important to remember that everyone's nutritional needs are different and are based on gender, age, height, weight, and activity level. *I am providing the below meal plan as an example only. To determine a meal plan for your own individualized nutritional needs, please visit a registered dietitian that specializes in eating disorder treatment.

EXAMPLE OF A MEAL PLAN

-Breakfast: 2 grains, 1 ounce protein, 1 fruit, 2 fats, 1 milk.
(Meal example: 1 cup oatmeal, 1/2 cup raspberries, 1 cup skim milk, 1 hard-boiled egg, 1 Tablespoon almonds).

-Morning snack: 2 snack exchanges.
(Snack example: Kashi granola bar).

*Some dietitians prefer to require X number of servings within specified food groups at snacks (the above snack would be classified as 1 grain, 1 fat). I, however, prefer to allow more flexibility at snacks. I require a certain number of exchanges at snacks, each exchange being about 65 calories. This way, my clients can have anything they want for snack (as it is just a matter of portion size).

-Lunch: 2 grains, 2-4 oz protein, 1 fruit, 1 vegetable, 3-4 fats, 1 milk.
(Meal example: turkey sandwich on 2 pieces whole wheat bread with 1 piece of cheese and 1 Tablespoon light mayo, 1 cup raw veggies with 1 Tablespoon dill dip, apple, 1 cup skim milk).

-Afternoon snack: 2 snack exchanges.
(Snack example: 1 chocolate chip cookie).

-Dinner: 3 grains, 2-4 oz protein, 1 vegetable, 3-4 fats, 1 milk.
(Meal example: 1 piece lasagna, 1 piece garlic bread, 1/2 cup steamed vegetables, 1 cup skim milk).

-Evening snack: 2 snack exchanges.
(Snack example: 1/2 cup juice, 1 piece string cheese).

32 comments:

  1. Dear Sarah,

    what would be the approximate Meal times when the first meal is at 6am and I have to be in Bed at 10pm?
    And what would be the exchanges if breakfast and lunch are my main meals and dinner the smallest?

    Thank you very much.

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    1. Thanks for the comment! Good question. Your meal and snack times could look something like this:

      Breakfast: between 7 and 8 am.
      Morning snack: around 10 or 10:30 am.
      Lunch: around 12 or 12:30 pm.
      Afternoon snack: around 2:30 or 3 pm.
      Dinner: around 5 or 6 pm.
      Evening snack: around 8 or 8:30 pm.

      You could adjust the times a little if that still doesn't work for you, but the above is a good example so that you are eating every 2-3 hours.

      As far as your question about dinner being the smallest meal...if I were using the example meal plan I provided in the blog post, I would still make sure to have at least have 1-2 grains, 2-4 ounces of protein, 1-2 fats, and a vegetable at dinner (meaning that you could move 1-2 grains, 2-3 fats, and 1 milk to breakfast or lunch...or a mix of both). If you wouldn't want these exchanges at breakfast or lunch, my suggestion would be to add those exchanges onto snacks (maybe making sure to add at least some of the exchanges to the evening snack since I would expect someone would be hungry at that time with a smaller dinner). *Remember that the meal plan I gave in the blog post is just an example...everyone's needs are a little different :) Let me know if you have any other questions.

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  2. Dear Sarah,

    I am so glad that you answered.
    Well my time schedule is a bit given through work.
    6am is my fist meal and lunch I can shift quite freely.
    The last meal that I can take is about at 7pm where as this shouldn't be dinner...(my digestion is really sensitive in the evening and in the early morning)
    I am a bit more used to calories, so I only know that I need about 2200 cal at least to gain weight. How would that look like in exchanges?

    Thanks allot for your feedback.

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  3. To get to 2200 calories, add about 3 exchanges onto the example meal plan. For example, add 1 exchange to each snack.

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  4. Hi Sarah,

    How do I know how many of each exchanges I should be eating a day?

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  5. Hi Sarah,

    I also had another question... What if my work day starts at 4:00am? How many snack should I have? Thank you! Your awesome!

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    1. Hi Taylor. Thanks for the comments. You need to visit a registered dietitian (preferably one who specializes in eating disorder treatment) to obtain the specific number of exchanges you should be eating each day. I would be doing you a disservice by giving that to you without doing a full nutrition assessment first and and allowing for follow up care to tweak things. The exchange based meal plan I provided in the example is really general and it can be quite common for someone's needs to be higher than the meal plan I provided (it's pretty typical for a meal plan to start low and increase over time based on nutritional needs).

      Some places to find a registered dietitian in your area are www.eatright.org --> click "find a registered dietitian" and specify "eating disorders" as the specialty when searching in your area. Another place you can go to is www.edreferral.com or www.psychologytoday.com (I believe that some dietitians may be listed under the "find a therapist" tab).

      As far as your question about starting your day at 4 AM, I would still eat three meals and three snacks. Use whatever time you want to eat breakfast as a starting point and then work off of that, spreading your intake for meals and snacks roughly two to three-ish hours apart from each other. I hope that helped a little bit. Let me know if you need more guidance on the eating time.

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    2. Omgosh thank you so much! I really appreciate it! You've been such a huge help!!!

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  6. Hi, I was set on a 1600 calorie to begin by my nutritionist but I seem to only get up to 1300 on good days. I want to increase to 1400 and so on. Would that be a good idea? In other words, I need help with a 1400 calorie meal plan :/ thank you

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    1. Thanks for the comment. You should work with your current nutritionist to set up an appropriate meal plan for you. If your nutritionist wants you to to be eating 1600 calories right now and you are struggling with that, you should be working together and tweaking your current meal plan to help you get your intake to where it needs to be. 1400 calories sounds quite low to me, but you need your nutritionist to assess that for you. I would love to be able to help you (and others) more with specific meal plan questions like this, but since I won't be following up with you, I unfortunately can't (or at least I don't think I should be providing that kind of individual advice over the internet). I'm sorry, I wish I could be of more help. Talk to your current nutritionist though...I'm sure you can work on a good plan together to get your intake in a better spot.

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  7. hi, could you please give me some examples of sncacks (morning and afternoon)? im really confused, thanks :)

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    1. Sorry for the untimely response. If you still need help, it would probably be easier for me to answer this if you gave me a list of snacks you would like to have and I told you the exchanges of them (and how I figured it out).

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  8. Hi Sarah,

    I have reached my goal weight and I'm trying to maintain now but I'm also a type 1 diabetic. I was wondering if this meal plan is suitable for me? If you have any snack ideas for diabetics that would be great!

    Thanks :)

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    1. Sorry for the untimely response on my part. I somehow missed a bunch of comments. The exchange system and meal plan I described in the post is based off of the diabetic exchange system. Generally (key word is "generally" as everyone's needs are a bit different) it would be appropriate for a type 1 diabetic. Generally, a diabetic should eat 45-75 grams of carbohydrate per meal and 15-30 grams of carbohydrates per snack. The meal plan I gave follows this guideline.

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  9. hi sarah could Please write me about calories. I am 152 cm ,26 years old and only 27 kg ,i know it means i am underweight ,so please write me to overcome from this low weight and how can i overcome from this situation also how much calories should i eat everyday?please help me.

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    1. Hi Farjana. I'm sorry I am responding to your comment so late. I must have missed some notifications on comments that were left. By now, I hope you are doing much better. Unfortunately, I cannot give you personal advice like this through a blog as I just don't feel comfortable doing that. Refeeding someone takes a one on one assessment of history, current intake, labs, etc in addition to height and weight. Please seek out someone to see individually. If you need help finding someone to work with, let me know and I might be able to help you find someone in your area.

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  10. Hi Sarah I am waiting on authorization to go through my insurance so I cannot start treatment.. I am currently 5' 81pounds and 22 years of age. Do you have any starting pointers I could use till I start treatment?

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    1. I'm sorry I am responding to your comment so late. I hope you got insurance authorization by now for treatment. If not, please please please seek out someone to see individually for this question. Without seeing you personally, I can't give you that advice through a blog. If you need help finding someone to see in your area, I can point you in the right direction.

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  11. Hi Sarah,

    I was just wondering if the meal plan you gave above is most commonly used for weight recovery or weight maintenance? Thank you!

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    1. Sorry, I missed your comment and an just responding now. The meal plan I gave would be most appropriate for Weight maintenance. However, in many cases a maintenance meal plan may need to be higher than the one I described.

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  12. How many calories is the mealplan on? :-)

    Greets from Denmark

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    1. Hi Lisa. It is roughly 1950-2050, average 2000 calories.

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    1. Hi Perdita. Thank you! This breakfast is likely not too much. Generally speaking, it would not be a bad thing if you even added a little to it.

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  14. Greetings Sarah,

    I am struggling not exactly with my weight, but because of the loss of my periods. I was diagnosed with anorexia and have not recovered fully as I still get clumsy about consuming too much. I know I am eating less than 2000 calories and have not reached my goal weight yet. I am told to increase my fat intake in order to activate my LH and FSH hormones.
    Should eat more fatty fish and eggs? In order for my cholesterol level to rise?

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    1. I would focus on variety. Fatty fish and eggs would be great to incorporate into your intake. Don't be afraid to eat nuts, avacados, use oil/butter, etc. All foods are beneficial and ok. Variety is the best bet and moderation is the key :) I have found that periods return when food intake is adeqaute, varied, and balanced AND weight is restored to an appropriate level.

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  15. Hi Sarah,

    I have a history of disordered eating (restricting and bingeing) but I was never diagnosed with anorexia or bulimia. I am at a normal weight (135 pounds at 5ft 5") but I am struggling with binges, coming off of a restrictive diet. If I follow a meal plan like this, with a calorie intake of about 2000 calories, will the binges stop? Are binges a normal experience after eating at a calorie deficit for a while? Thank you!

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    1. Hunger can certainly trigger a binge. Generally speaking, 2000 calories may be enough to ward off binges which are triggered by hunger. However, a more thorough individual assessment can provide you with more detail (as I have no idea your age, your weight history, or your activity level). Binge eating can also contain an emotional component to it, which may need to be worked on with the help of a therapist. A more adequate intake will most certainly help. You probably should still follow up with a full treatment team, however (doctor, therapist, dietitian). Hope that helps :)

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  16. Hi Sarah!so on average could I use your plan for a 2000 calorie daily intake?
    how many calories do your plans usually have? thank you so much, its so helpful to have someone like you!

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    1. Good question. On average (key word being average), the 2000 calorie meal plan is a good middle ground. It might not be enough for some people though, so again...the key word is average. I will always recommend someone see a dietitian so they can prescribe an individualized meal plan though based upon their current food intake, activity level, age, gender, height, weight, need to maintain or restore weight, etc.

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  17. Hi Sarah, Just wondering is that 1 cup of cooked porridge or 1 cup of raw oats? I always get so confused over breakfast portion sizes! Thank you so much :) x

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  18. Also, sorry, do you know how many grams of oats it should be? x

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