Imagine this: you have to face the most terrifying challenge your brain can imagine, and the people around you—the people you love and who ostensibly love you—are the ones forcing you to do so. You have to do this every day, several times a day, with no end in sight.
For someone in eating disorder recovery, that’s what meals can feel like. It might be hard for those on the outside to understand, but when you’re in the grip of an eating disorder, meals and snacks can be the most mentally, emotionally, and physically demanding part of the day. This makes the kitchen table a scary and stressful place not only for the person struggling, but for those supporting them. And for family members who are concerned about a loved one, it can make the prospect of intervening and providing eating disorder meal support feel completely overwhelming.
The good news is that there are tangible things you can do to make eating easier for someone in recovery, and help bring some peace back to mealtimes.
Why are meals so hard in eating disorder recovery?
There’s no doubt that meals evoke negative emotions for those with eating disorders. Research indicates that those in recovery associate mealtimes with guilt, confusion, fear, and stress, and. that those with anorexia experience an increase in pre-meal anxiety.
“For people with eating disorders, meals are the apex of their anxiety, and they likely feel like all eyes are on them,” says Lauren Chaffin, a registered dietitian specializing in eating disorders. She explains that this anxiety can manifest in a number of ways, including fidgeting, becoming agitated, not engaging in conversation, and avoiding eye contact. It might also cause a person to turn to eating disorder behaviors, like food rituals or hiding food. In other cases, she says, someone may struggle to ignore the ever louder voice of their eating disorder, leading to them bottling up and pushing down their feelings.
Mealtimes can cause physical discomfort, too. “After a period of restriction, people may feel full even with inadequate nourishment. This is because their bodies are habituated to eating less food,” says registered dietitian Elyssa Toomey. She adds that if someone has been restricting their intake for a long time, they may no longer be receiving hunger cues, which can make it even harder to eat.
With all of this happening inside your loved one, it can be extremely difficult for family members to know how to help. “When you or someone you love is struggling with an eating disorder, mealtimes can feel like a war zone,” says registered dietitian Bryn Miller. She encourages friends and family to have as much compassion as they can, and remember that their loved one is not their illness. “We can all behave in ways that aren’t totally ‘rational’ or in alignment with our values when we’re under extreme duress, even if that duress doesn't make sense to someone else.”
Now for the good news: First, meals typically get easier over time with support, consistency, adequate caloric intake, and (when needed) weight gain. “A hungry brain is operating as a more primal brain, with the amygdala—or fear center—taking prominence,” says Toomey. “As nutrition rehabilitation progresses, one is more able to access the prefrontal cortex of the brain, which is responsible for executive functioning and reasoning.” This, she says, helps make mealtimes calmer.
And second, there are concrete things you can do to make meals easier for your loved one—and, in turn, for your entire family.
8 tips to provide eating disorder meal support
1. Choose regulating pre-meal practices.
As an eating disorder dietitian, I find one of the most helpful skills is soothing the nervous system before sitting down to meals. This means that everyone begins meals in their window of tolerance, or the most emotionally regulated place possible, instead of a state of fight-or-flight (anxious) or numbness (checked out).
Here are a few examples of regulating practices:
- Connecting with nature (like taking a walk outside)
- Taking several rounds of extended exhale breaths
- Using cold water or an ice pack on your face or hands
- Listening to soothing music. In fact, research shows music therapy may help with pre-meal anxiety in recovery.
2. Try pre-meal processing.
Give your loved one space to share how they’re feeling before eating. “Discuss and name any food-based anxiety. Perhaps a particular food is a challenge, or they’re feeling anxiety because of what else they’ve consumed today,” Toomey suggests. “Reassure your loved one that the foods are safe, and remind them to try and separate meal events: what we ate previously or plan to eat later should have no impact on what we’re having now.” She also suggests taking a few collective slow breaths and setting intentions for the meal, like “Stay engaged” or “Taste the food.”
3. Use healthy distraction.
Though it might feel counterintuitive (shouldn’t we face this head-on?) sometimes distraction is your best friend at the table, especially early in recovery. “Try using table topic cards to help keep the conversations going,” suggests dietitian Nicole Wavra, adding that music, podcasts, telling jokes or riddles, and games like 20 questions can all be helpful. “These forms of distraction can help the person struggling by keeping their mind off of the eating disorder thoughts.” She also points to screens as a helpful tool, suggesting turning on a favorite TV show or calming videos.
4. Increase external cues of safety.
Having a physical object that provides comfort can make a big difference during mealtime, reminding the person struggling that they’re safe and helping them regulate their nervous system. I suggest clients bring items to meals that evoke a sense of peace—seashells from a beach trip, a song that evokes a happy memory, a calming essential oil, an affirmation from our session, a cherished photo a piece of jewelry from a loved one—and to look at, listen to, smell or touch it when necessary. Having pets nearby can also create an internal sense of safety for the whole family.
Toomey says homemade placemats can also go a long way here. “They can be full of drawings, clippings from magazines, quotes, motivations, goals, whatever will help keep one focused on a peaceful state of being during the meal,” she says.
5. Use mindfulness.
Another way to help manage the nervous system throughout meals is by using mindfulness tools—like breathing techniques, sense engagement, and grounding practices—which can help move us out of our heads and into our bodies.
For example, when my clients are struggling in meal sessions, I ask them to pause and name five things they can see, four things they can touch, three things they can hear, two things they can smell, and one thing they can taste. I ask them to feel their feet’s connection to the floor and their body’s connection to their chair. After doing this, they’re typically able to re-center and continue the meal with less distress.
6. Keep the conversation light.
As a young eating disorder dietitian, the best advice I received was not to talk about the eating disorder or food while eating. “The support person should always avoid comments around the type of food, the meal itself, the quantity, or anything related to the eating disorder,” Chaffin says. “Basically, no attention should be drawn to the food itself, whether seemingly positive or negative.”
By shifting the conversational spotlight from food and eating disorder to other parts of the lives of everyone at the table, the meal becomes more endurable for the person struggling. That said, it’s important to keep conversations light even if they’re not about food. Meals aren’t for discussing hard family issues or emotionally charged topics—try talking about movies, books, travel. Conversation cards can be helpful when it’s hard to know what to discuss.
7. Communicate clearly.
Before meals, it can be helpful for everyone to clearly communicate their needs. “Both the person supporting and the person struggling should be open to conversations around what is needed and what to do when those needs are unable to be met, such as getting more support or seeking help from the treatment team,” Chaffin says.
Communication can also come in handy during the meal if things become too overwhelming. “Often when someone is struggling to eat their meal, a loved one focuses on the specifics of the food, like how many more almonds they need to eat,” Toomey says. “This isn’t helpful. Instead, pause and say to your loved one, ‘it seems like you’re having a really hard time, do you want to talk about it?’ This can diffuse the tension and hopefully get to the root of the problem.”
8. Be intentional after and outside of meals.
One of the hardest parts of a meal is actually the period afterwards, since this is when the relentless eating disorder voice loves to berate the sufferer about what they ate, evoking shame and guilt.
Research shows that staying occupied and supported after meals can help soften these hard thoughts and emotions, and prevent compensatory behaviors. “After a meal or snack, it’s important to stay present with the person struggling,” Chaffin says. “Keep the conversation going, play a game, watch TV, or go outside for some fresh air together.”
Finally, Toomey suggests viewing meals as the main event, and preparing for them by prioritizing self-care outside of mealtimes. “If you’re an elite athlete and want to perform at your peak, then off the field you need to support your ability to do that,” she says. Find out what self-care looks like for everyone who participates in mealtimes in your home—is it napping, reading, spending time in nature, watching a movie, snuggling with a pet?—and commit to prioritizing these activities outside of mealtimes.
“Supporting a loved one through meals can be challenging, so do your best to get rest, food, and your own support,” Toomey encourages. “You can't pour from an empty cup, so be sure to prioritize your own self-care.”
- Lloyd, E Caitlin et al. “Associations between mealtime anxiety and food intake in anorexia nervosa.” The International journal of eating disorders vol. 54,9 (2021): 1711-1716. doi:10.1002/eat.23589
- Monaghan, Margaret, and Louise Doyle. “'It stopped you thinking about food' - The experiences of mealtimes and attending a post-meal support group for young people with anorexia nervosa.” International journal of mental health nursing vol. 32,1 (2023): 128-138. doi:10.1111/inm.13068
- Ceccato, Enrico, and Cristina Roveran. “Effects of Music Therapy in the Reduction of Pre-Meal Anxiety in Patients Suffering from Anorexia Nervosa.” Brain sciences vol. 12,6 801. 19 Jun. 2022, doi:10.3390/brainsci12060801