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Chapter 4


Box 4.3 How Your Meal Plan Is Unlike a Diet Your meal plan is devised to promote physical and mental health for your patient, not to destroy health in search of weight loss at any cost.


Your meal plan is (ultimately) intended to provide adequate cal- ories, rather than calorie deprivation, which is the goal of all weight-loss diets. Adequate caloric intake, even if it is fewer total calories than the patient’s current intake, as in the case of binge eating disorder, will not trigger the starvation mechanisms and eating-disordered responses that weight-loss diets cause.


Your meal plan is individualized to each patient. Even though you may use your facility’s general protocol as a starting point, unlike weight-loss diets that are standard for everyone, your meal plan will ultimately be unique for each and every patient.


Your meal plan is modifiable, with input from the patient. Unlike rigid weight-loss diets that require the dieter to meet the same calorie goals with the same allowed foods and the same disal- lowed foods week after week after week, your meal plan will be adapted by you and your patient on a daily, weekly, or other basis, based on the patient’s changing (and hopefully improving) sense of taste, satiety, activity level, and other needs and desires.


Someday your meal plan will be obsolete. It is simply a tool to teach patients to nourish themselves without the need of a meal plan at all. This is the polar opposite of weight-loss diets that tout themselves as “a lifestyle” that requires constant participation and purchases.


required to do so.1 Long-held habits and food rules are


difficult to break, even when you give a patient good infor- mation. It is difficult to connect with internal cues after months or years of ignoring hunger by restricting or push- ing past fullness when binge eating. Anxiety about food and the stress hormones it triggers interfere with the ability to sense hunger and fullness. Early satiety, delayed gas- tric emptying, bloating or nausea may be misinterpreted as “fullness” and therefore a reason to stop eating too early or to purge.3 The occasional exception is the highly functioning individual who comes to you in the outpatient setting


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