imagesAs a registered dietician, I often see a lot of anxiety from my clients the first time I meet with them, especially when we’re talking about nutrition plans and what they will look like.

While eating disorders like anorexia aren’t all about food, changes to food choices and routines can often be a lightning rod for bringing up tensions, anxieties and increased eating disorder thoughts and/or behaviors. For this reason, we usually start clients on a nutrition plan with plenty of structure and support.

Much of the time, this means an exchange-based meal plan, tailored to meet the unique dietary needs of each client.  Regardless of whether a patient needs to gain or maintain weight, this type of plan is essential to help with treatment goals.

Patient benefits of exchange-based plans include:

  • Practice learning what adequacy looks like and feels like throughout the day
  • External support in challenging eating disorder thoughts
  • Reduced anxiety around food choices 
  • Consistency: everyone is on the same page, so if we need to alter the nutrition plan, there’s less guesswork or ambiguity
  • Trust in recovery and treatment teams

While meal plans are incredibly valuable, it is also a goal of mine for our clients to assume more flexibility in their daily choices down the road. While it doesn’t happen overnight, it’s incredibly important to help build trust in their ability to meet the body’s needs without feeling they have to conform to a meal plan.

When it is appropriate for the client to eat in a less structured manner, below are some things the client and their dietitian can discuss:

  • Think big-picture first: Decide what they should eat first, then work backwards to ensure the meal is both adequate and balanced (includes starches, fats and proteins)
  • “Eyeballportions: Practice with exchanges to help them learn and feel confident in their ability to estimate portion sizes
  • Be flexible: Increase variety, especially with snacks. The goal should be a minimum of two different food groups at each snack.
  • Practice: Encourage them to dine out or attend dinner parties, where others are preparing meals and setting portions. Yes, this can sometimes feel challenging and overwhelming, but it will get easier over time.

Changes in nutrition intake can yield different outcomes for everyone. Communication is key in closely examining how changes are tolerated, anxiety levels impacted and eating disorder behaviors potentially exhibited. Working together and meeting the client where they are at is essential to building trust and creating a nutritionally effective routine that will be lasting. 



Meg Salvia, MS, RDN, CDE is the dietitian at Walden Behavioral Care’s Peabody clinic. She sees adolescents and adults in the partial hospitalization program as well as in the binge-eating intensive outpatient program. She is also a board-certified diabetes educator (CDE). She began her career working in research at Joslin Diabetes Center and joined Walden Behavioral Care’s team in 2013. Meg earned a Master’s degree in nutrition from Boston University and a BA in English from Boston College.

*This blog post does not necessarily represent the views of Walden and its management. The Walden Blog is meant to represent a broad variety of opinions relating to eating disorders and their treatment.