Nutrition Series Part Two: Nutrition Exposures

Our nutrition series continues with Director of Nutrition Mary Dye, MPH, RD, CEDRD, LD/N diving into the nutrition exposures used at Oliver-Pyatt Centers. Mary explains the philosophy and thought behind exposing clients to multiple new experiences as soon as they enter treatment.

In planning our nutrition exposures, we think in terms of a classic exposure curve: anxiety and fear will rise, peak and then decline until a client is no longer activated. And then, we’ve reached our goal: the food, ritual or behavior has lost its power or maladaptive purpose. We know that in working toward recovery, multiple experiences related to eating require a trip on the exposure curve. We also respect that time in treatment is often limited, and we’d prefer to help our clients ride out the curves up front in order to spend our time with them working on the tools and tactics learned on the curve to sustain their recovery. So, for this reason, we may be asking our clients to ride 3 or 4 exposure curves at once when many centers would stagger such exposures. Here, it’s typical for us on day one to introduce threatening foods, eating in a group, being served unique portions of the same meal based on individual caloric needs and break a food rule such as eating the same food twice in a day.

Unlike most treatment centers, we do not offer clients meal plan options (such as: choose option A, B or C for lunch each day). In our philosophy this can fuel the eating disorders desire for options and leave the client exhausted from the decision making process before sitting at the table. I need our client’s to present at the table with a full tank of energy so they can give the exposure everything they’ve got. Multiple food options can also promote the continued use of “safe foods” while meeting caloric needs. For example, we had a client admit to our care following a ten-month treatment stay at a reputable ED treatment center and she had navigated the meal option system so much that she had not eaten a hot meal in her entire ten month stay. She had restored weight and “checked the boxes” so to speak, in nutrition but had not challenged basic rules driving her eating disorder.   She was fearful of eating hot foods with us initially, but with our support, our “food only” model and limited options she was able to normalize hot foods at Oliver-Pyatt Centers.

To read Part One of the Nutrition Series, visit here.

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