It's critical to reintroduce fear foods during treatment, according to Kelly Davidson, RDN, CEDS, Nutrition Therapist at Princeton Center for Eating Disorders.
“Continuing to avoid fear foods can reinforce the eating disorder and fear-based beliefs,” she explains. “Plus, through avoidance, patients may be missing out on certain micro- and macro-nutrients they need for balanced nutrition.”
A step-based approach can ease reintroduction. Davidson asks adult patients to rank foods from preferred to very challenging and create a hierarchy of their top ten fear foods. The timing for introducing foods depends on medical acuity and whether patients can complete a meal plan – at which point she typically gives them the option to select a few fear foods to incorporate or have her choose on their behalf.
Team members at Princeton Center for Eating Disorders help patients mentally prepare for meals through grounding exercises, distress tolerance skills, and cope-ahead plans. Coached meals are available, providing validation, support, and prompting while eating. Plus, patients have access to creative ways to broaden exposure when ready, such as in-person or virtual family meals, takeout meals, and the opportunity to visit the Princeton Medical Center cafeteria.
“Sometimes it’s baby steps, but achieving mastery on one level can build a foundation that helps patients take on the next,” says Davidson. “Once an adequate calorie intake is established, we can expand variety. The process is a key part of helping patients begin to feel normal around food again.”
A Scoop of Accomplishment
In July, Princeton Center for Eating Disorders team members and patients participated in their first unit-wide fear food challenge with the availability of an ice cream truck on site at Princeton Medical Center. Patients incorporated the ice cream, a cone, and a topping into their meal plan for that day. Despite feeling nervous or fearful, many patients reported that they ultimately enjoyed the experience of trying something new outside on a beautiful day.