Guidelines for establishing “normal” eating if you suffer from Anorexia Nervosa
You might find these guidelines helpful if your eating pattern has been disrupted by an eating
disorder which is characterised by restricting your food intake. An important part of the
recovery process is to begin making changes to the way that you eat.
The following ideas may help you. Don’t try to do them all at once instead try to focus on two
or three to start with and then add in more as you go along. The first 3 are a good place to
start.
1.
Establish a regular eating pattern. A good way to start is to eat little and often,
working your way towards three meals and three snacks per day, in the sequence of:
breakfast; snack; lunch; snack; dinner; snack. This is made easier if you plan regular
eating times for your day. Plan your meals in detail so that you know exactly what
and when you will be eating. The idea is that you should try to keep one step ahead of
the problem.
2.
Use normal food wherever possible, instead of the dietary supplements or build up
drinks (such as Ensure or Build-Up) and try not to buy ‘diet’ or ‘low fat’ products.
3.
Try to eat in company and not alone.
4.
Aim for a balanced diet with adequate nutritional value. This includes food from
each of the five food groups (Protein, Carbohydrate, Fat, Vitamins and Minerals). Start
with controlling your blood sugar level by basing your food around starchy
carbohydrate foods such as bread, cereals, pasta, rice and potatoes then build in
other food groups.
5.
Meals are times of important social contact. Try not to do anything else while you eat,
except socializing. For instance, do not watch television, do not read books or
magazines. It is usually OK to listen to music or the radio, but you should try to focus
upon enjoying the meal you are eating.
6.
Plan your days ahead. Avoid both long periods of unstructured time and over-booking.
7.
Try to cut-out or cut-back on any behaviours which are associated with slimming (e.g.
calorie counting, over-heating food).
8.
It is appropriate for your diet to take into account concerns about general health and
good nutrition. However, extremes such as “cutting out all fat/sugar/” or “the more
fibre the better” are not acceptable.
9.
Your diet should consist of at least 4 starch based meals/snacks each day, and if
possible 5 or 6. It is better to have 5 or 6 small starch based meals. Starch is better
than glucose at normalizing hunger/satiety. In general, high sugar foods are bad at
doing this. The intervals should be breakfast, mid-morning snack, lunch, mid
afternoon snack, dinner and supper. The diet should be able to maintain a healthy
weight or approach it at an appropriate rate of weight gain.
©Eating Disorders Network, South East Scotland. Version: June 2009 www.ednses.org
This material can be copied and distributed for clinical use.
Please contact [email protected] if you wish to make any alterations to this material or to use it in any other way than originally intended.
1
10.
Try different or new foods on a regular basis. If this doesn’t seem possible while
weight is being gained, these certainly should be introduced when weight gain has
been established.
11.
Your diet needs to be flexible enough to allow for special events outside of your
routine, such as major social events: Birthdays, Christmas, outings with friends and
colleagues.
12.
Set aside some time regularly, to reflect on how you are coping, and to review your
strategies: some may be working, others may not. What do you need to focus on or
change? What do you need to keep doing?
13.
Use diaries or exercise books to record your eating. You may wish to do this using the
diaries your therapist or dietitian has provided, or you may prefer to write down
everything you eat and drink, with details of times, and how you were feeling at meal
times.
14.
Don’t weigh yourself more than once a week. If necessary, stop weighing yourself
altogether. Fluctuations in weight of plus or minus half a kilogram (a few pounds) are
entirely normal. If you weigh yourself too often, you may mistake these normal
variations, and believe that you have lost or gained weight.
15.
If you are thinking a lot about your shape and weight, this may be because you
are feeling stressed, anxious or depressed about something. Can you identify any
current problems, and do something productive to try to solve them, or at least
minimize them?
16.
Try not to eat all or most of your calories all at one time. There is a tendency for
calories taken over a short period of time, with long periods of fasting in between, to
lead to proportionately more weight gain than calories spread evenly throughout the
day.
17.
Remember that short periods of strict dieting tend to lead to temporary weight loss
of fluids. It may look as if you have lost weight with your diet, but most of this weight
loss is fluid, including the food that was passing through your stomach and intestines.
18.
Remember it is normal to feel full after a meal. You will need to learn to get used to
the feeling. It will pass.
19.
Weight often increases before a period. This is temporary and is due to fluid
retention. Bloated feelings will disappear after a few days.
20.
21.
Set yourself small realistic goals, work from hour to hour rather than day to day.
Expect setbacks; this is part of the recovery process. If you have a set-back, try to
start afresh as quickly as possible. Try not to use it as a reason to give up. Get back
on track, identify what caused the setback and decide what you can do to avoid it
happening again.
Note your successes, however modest, in your diaries. Every time you eat normally
you are reinforcing your new healthy eating habits.
We do STRONGLY RECOMMEND that you establish a regular eating pattern based on these
guidelines. It cannot be stressed too much that these principles are recommendations to aim
for; you are highly unlikely to achieve them quickly or without taking risks and experimenting.
The important thing is that you become aware of a different, healthier way of fitting food into
your life.
©Eating Disorders Network, South East Scotland. Version: June 2009 www.ednses.org
This material can be copied and distributed for clinical use.
Please contact [email protected] if you wish to make any alterations to this material or to use it in any other way than originally intended.
2
Helpful tactics
There are various ways in which you can help yourself as you set out on your journey towards
change. The task ahead of you is a hard one, so do take every opportunity to make it a little
easier.
•
Try to think of an activity you may enjoy doing that does not involve food (avoid
cooking) or intense calorie-burning (avoid aerobic exercises or sport.) examples could
include drawing, painting, reading, learning a new language, pottery, visiting the
cinema. It could be some activity you used to enjoy but have not participated in for
years. Make time to do this.
•
Identify triggers which are most likely to cause you to restrict food intake, using your
recent experience and the evidence provided by your diary. Examples could include
comments about your weight or eating habits, or a friend or relative starting a diet
and eating habits, or a friend or relative starting a diet and eating less. Think through
these situations and write them down, along with reasons why you think they should
not affect you. Then you can refer to these later should any of the situations arise and
tempt you to cut back on your eating.
•
In whatever ways possible, avoid obsessing about food and weight. If you have spent
time poring over recipes and cook books, or have been cooking for the family, try to
wean yourself off these activities and fill your time differently (this will be easier if
you have identified other activities, as suggested in the first point of this list).
•
If you suffer from the anxiety and depression that commonly accompany AN,
remember that they will become less severe as you gain weight. However, if you can
identify particular problems which are clearly getting you down, focus on them and
try to do something positive toward solving or at least minimizing them.
•
If you are exercising, ask yourself what you get from it: if it is merely to burn
calories, try to think of a sport or activity that is more fulfilling and will give you more
genuine satisfaction for its own sake.
•
For women, do not worry if you have not had a period for some time, or indeed ever.
When your body returns to a healthier weight your periods will also return,
symbolizing the return of your whole body to normal functioning.
©Eating Disorders Network, South East Scotland. Version: June 2009 www.ednses.org
This material can be copied and distributed for clinical use.
Please contact [email protected] if you wish to make any alterations to this material or to use it in any other way than originally intended.
3