When a person is living in the trenches of an eating disorder, decisions around how to safely and appropriately interact with food are dominated by unhealthy, dangerous and life-limiting thoughts, beliefs and behaviors. Over time, connections to bodily signals are weakened and awareness of hunger and fullness becomes distorted. At Monte Nido, we understand while most clients who walk through our doors describe a desire to eat “intuitively”, disconnection from, or repeated disregard of bodily cues makes it impossible for clients to thoughtfully and appropriately nourish themselves without support and guidance. Instead of using “intuitive eating” as an ideal, at Monte Nido treatment centers, we practice “conscious eating” with our clients. Conscious eating acknowledges that a client cannot safely rely on intuition immediately and balances nutrition science, body awareness practices, challenging of eating disorder beliefs and movement away from judgment to ensure an individual is properly nourished while following a medically indicated meal plan.
While all Monte Nido and Affiliate programs share the same underlying food philosophy, the manner in which we achieve the objectives that support our respective nutrition philosophies differ slightly.
A person who is newly admitted to treatment experiences a great amount of change upon admission. We acknowledge the very act of showing up to treatment is a challenge and while we ultimately aim to help our clients shift from their eating disorder self into their healthy self, we allow space to gently allow this process to occur. The concept of gentle nutrition is honored throughout treatment at Monte Nido. Programmatically, we understand we are treating the physical, emotional, and spiritual body of our clients and as such, allow our clients to ease their way into increasingly challenging food and eating experiences.
While we acknowledge some degree of distress must be experienced for healing from an eating disorder, we do what we can to make the process as relaxed and comfortable as possible. Upon admission, we reduce anticipatory anxiety by providing menus for the following week to our clients. While it is expected a client is able to eat all meals without substitution and that all exception foods are eliminated to advance through the levels of treatment, we honor and acknowledge that this will take more or less time depending on the client and do not hold energy around it.
While a client is able to move at his or her own pace through treatment, it is expected all meals be completed from the time of admission. If a client is unable to complete a meal, supplementary nutrition will be provided. Similar to the expectations around elimination of exception foods and substitute meals, a client must be completing 100% of meals provided, without supplementation, to advance through the level system.
As clients become more comfortable in the program and in their ability to complete meals and snacks without supplementation or exception is demonstrated, they are provided with limited autonomy around food. Clients begin interacting with food by using measuring tools and utensils under staff supervision to ensure adherence to the dietary plan developed by the dietitian. Next, clients advance to reverse portioning, a model that allows a client to eyeball what they believe they should serve themselves, based on their experience measuring, and then check their portions with measuring tools and utensils. Finally, clients move into eyeball portioning without specific certainty. All portioning is done with staff supervision and support until a client has demonstrated competence in this area.
We are often asked about the rationale for our dietary programming and philosophy; specifically, why our meals and snacks are not exchange based and why clients are not provided with meal plans in treatment. While we acknowledge meal plans can be helpful, we also acknowledge meal plans themselves can be the source of great distress to clients who are easily preoccupied by numbers and external reinforcement. Instead of utilizing a specific meal plan, we aim to normalize and neutralize interaction with food throughout treatment. Our program is developed to maximize client-staff interaction. All meals and snacks are shared between clients and clinicians, and staff is present at all times to model healthy interactions with food and to support clients in developing their own sense of “normal” eating.
After nutritional adequacy has been achieved, and movement away from eating disorder behaviors has been demonstrated, we encourage our clients to explore a variety of eating experiences, to practice with achieving balance, dietary variety and taste preferences.
We do not expect clients to enter treatment as conscious eaters and do not necessarily believe they will leave as fully conscious eaters. Nutritional treatment at Monte Nido is designed to provide clients with the experiences and skills they need to continue the process of developing freedom, flexibility and ease with food needed for a recovered life.
In the coming weeks, check back at the OPC Blog for more insight into their particular nutrition philosophy and strategy.