How to Provide Meal Support in an Inpatient Setting

Throughout the meal support process, the meal supporter's role includes:

• Providing intensive support and coaching to the patient to help them get through the meal when it becomes clear that they are struggling - this could be displayed as wavering, procrastinating, or obvious distress or upset.

• Monitoring and addressing any attempts to minimise food intake or engage in any abnormal eating behaviours.

• Distracting the patient from the distress of eating the meal by engaging in light conversation or a distracting activity.

• Distracting the patient whilst having a constant awareness of where they are up to in their meal, whether they are engaging in any behaviours, what the time is, how long they have left, and whether they need to get involved and give more intensive support.

Summary of the Meal Support process

1. Maintain an empathic and non-judgemental approach.

Ensure your tone of voice is calm, firm, and warm.

• Lower the tone of your voice

• Be patient, kind, gentle, and firm

• Be positive, focus on positive reinforcements rather than punishment

• Remember how excruciatingly difficult this is forthe patient

• Keep your focus on finishing the meal

2. Validate distress

If the patient is distressed, scared, upset, or angry, validate their experience.

• “I can see that this is really difficult for you right now.”

• “I know it is hard. But look how brave you are standing up to the eating disorder.”

• “I know you can do it, and I am here to support you.”

• “I can see you are hesitant to eat any more. Take a deep breath in with me and a deep breath out.”

• “This is so tough, but you are ok, you’re getting through it.”

3. Support the patient to eat more

Explain to the patient that you are going to help them get through their meal or snack.

• “I’m going to stay right here and help you get through this. Can you pick up your fork and have another bite?”

• “Pick up your fork... now take a bite.”

• “You need to eat some more; can you try take another bite. Let’s try now.”

4. Validate progress and provide encouragement

Encourage the patient with positive reinforcement to keep going.

• “You’re working really hard. Now, can you have another bite?”

• “You are so brave. Keep going.”

• “You are doing a great job so far, let’s keep it up."

5. Avoid negotiating with the eating disorder

Deflect any negotiations for discussion with the team at a later date and refocus on finishing the meal. Be familiar with the hospital’s meal guidelines and abide by these.

• “I understand that you think this is too much food, but this is what has been specifically prescribed for you. Let’s focus on finishing this meal, and when the team comes in later you can speak to them about it.”

• “The Dietitian has individually tailored this meal plan for your specific health requirements. It is important that you finish it.”

• “This food is medicine for your body.”

• “I can’t make any changes to your meal plan, so let’s focus on eating what is here.”

6. Refocus on their goals of treatment

If the patient is unable to eat more, help them to refocus on their goals of treatment.

• “Can we take a step back from this meal right here and think about your goals. Is completing this meal going to help you to achieve your goals

• “Is completing this meal going to get you one step closer to being discharged?”

• “Can I help you to get through this meal? Let’s start by taking another bite – you can do it.”

7. Encourage normal eating behaviours

Provide gentle reminders or instructions to prevent the patient from engaging in eating disorder behaviours.

• “It’s going to be really difficult to finish the meal by taking small bites. Can you please start to take bigger bites?”

• “It’s more normal to use your hands to eat your muesli bar, can you please put down the knife and fork?”

• “I know it’s difficult, but please don’t break up that piece of toast into more than 4 pieces.”

• Maintain a supportive tone of voice.

8. Address eating disorder behaviours aimed to minimise food intake

Deal with eating disorder behaviours in the moment as they occur.

• “Please don’t smear food in your napkin, here I’ll take the napkin until you are finished.”

• “Please pick that up from your lap and put it back on your plate.”

• “Please take off your jumper so that the eating disorder isn't tempted to use your pockets to hide food.”

• Maintain a supportive tone of voice

9. Provide distraction

Distract the patient away from the distress of the meal when they are eating.

• Engage in light conversation, topics may be around TV shows, their hobbies and interests, stories on the news, pets. Steer away from talking about food or weight.

• Trivia questions, a puzzle, or card game

• Music

• Radio, audio books, or television if necessary

• Find the balance between providing distraction but always remaining focused on the task of completing the meal.

10. Stay focused on completing the meal

Whilst providing support, distraction, and monitoring eating behaviours, remember that the goal is to complete the meal.

• Keep an eye out for delayed breaks between mouthfuls, playing with food, or procrastinating eating

• Remember every mouthful counts

• Stay calm, confident, consistent, and compassionate.