In part three of the nutrition series, Director of Nutrition Mary Dye, MPH, RD, CEDRD, LD/N continues to share about the nutrition philosophy at Oliver-Pyatt Centers. Mary explains the use of only serving food, including “threatening foods”, and the philosophy behind it.
As part of the nutrition programming at Oliver-Pyatt Centers, we only serve food. We thoughtfully do not offer meal replacement shakes or supplements. Since our end goal is nourishment through solid food and inclusion of often threatening food, we have created a culture in our milieus of “food is fuel” and “all foods fit” and our clients have come to know this as the expectation. This has served to assist us in directly challenging our clients in the earliest phases of their treatment, which while distressing for some, helps to build their confidence early on and helps their GI tract to more quickly re-adjust to digesting solid foods. We acknowledge that consistently and appropriately feeding a malnourished body is uncomfortable initially. We validate this discomfort and help our clients to simultaneously re-adjust to food physically and psychologically.
We unapologetically serve threatening foods. I use that word because it’s the term used in research and study after study shows that inclusion of foods that threaten the eating disorders values are essential to sustained recovery. I proudly say that our foods are some of the most threatening (and delicious) in the industry. Our chef is tasked with preparing meals that are both nutrient dense, appealing, often challenging and complex. We aim to do more than feed our clients – we use the food served as a conversation starter and a way of building awareness and trust of self. Many centers choose to ease their clients into simple or safer food and more gradually introduce threatening foods. Not us. If you admit to us on a day with spaghetti and meatballs for dinner, we’ve very lovingly going to ask you to eat the meal. There will be a lot of support around helping you do so, but we want to send a strong to message to the eating disorder from day one: you are not welcome here and you have no-where to hide. All because we love the woman whose voice has been drowned out by the disorder. To empower her we set a high bar and help her climb to it. If the meal is overly distressing, we will give an option of an equally threatening initially, but more predictable meal. These can be used up to twice weekly. The cap on this option helps our women to be more thoughtful in using them and more prone to step up to the challenge presented in the chef’s meal. And of course we would offer varieties of the meal to accommodate allergies, religious restrictions and vegetarian diets for instance but the meals would look almost identical to one another to promote a family style dining experience.
Outside of several standing habitual exposures: pizza on Saturdays, breakfast sandwich Fridays, PB&J Sunday, our clients at Oliver-Pyatt Centers do not know the meals ahead of time. This allows us to serve threatening foods without raising our client’s anxiety for a long duration of time. We announce meals about 15 minutes prior to gathering at the table. We view the group rooms as safe, comfortable, non-threatening space. With this in mind, we’ve chosen to announce the meals in group rooms where clients can safely share their reactions in a time limited, supportive space. Then, they go with staff members to the table/exposure area where the food is served and they are given support throughout, as needed, with the goal of decreased support over time. They then return to the safe space of the group room to process the events of the meal and to receive more support before moving on to their next task. If spaghetti and meat balls were to be announced days or even hours prior to it being served, I truly think some client’s eating disorders would try to mutiny. But since it is presented in a thoughtful, supported and time limited manner their anxiety is contained and they’re able to take on the challenge. As for the habitual exposures, we see levels of anxiety notably decline from week to week as confidence builds. By the IOP (Intensive Outpatient Program) level of care, many of our clients consider pizza to be their safe food – the thing they order when they’re not sure what to have; a go to. Many of these same clients were tearful and avoidant of their initial pizza nights in residential and I remind them of this often as work to normalize and legalize more and more foods.