Nutritional Rehabilitation for Eating Disorders: River Centre Clinic Program Description

Nutritional rehabilitation plays a central role in the treatment of eating disorders, and the varied plans recommended; however, it is noteworthy that the details of this aspect of treatment are rarely specified and little has been written on the theoretical principles behind the different approaches. This report describes our approach in sufficient detail to allow our outcomes to be replicated and compared with other programs. Our approach to meal planning has been referred to as “mechanical eating” and consists of a structured eating program in which quantity of food consumed, type of food consumed and spacing of meals, are all specified in advance. This approach is designed to temporarily remove decision-making associated with eating and relies on a set of rules for starting, maintaining, and stopping eating designed to override the complex physiological and psychological cues that typically disrupt normal eating among those with eating disorders. It diverges markedly from the Exchange System recommended in many nutritional rehabilitation programs. It relies heavily on using commercially available packaged meals and prescribing the exact number of Calories to be consumed throughout the day. Body weight is checked on each treatment day and Calories are adjusted to promote steady weight gain in anorexia nervosa and weight stabilization in other eating disorders when weight suppression is less prominent. We have anticipated potential criticisms of this approach and have provided the theoretical and practical basis for our model.