Thirty Minutes and 80 Percent

I needed to relearn HOW to eat, not WHAT to eat.

Three nights per week the IOP program were required to eat dinner together.

I’ll start out by talking about what Monday nights were like. I’ll dedicate a post to each of the three nights of eating at treatment because each night presented different challenges.

On Mondays, as a group, we were required to prepare the entire meal in our “Culinary” group. Going into the kitchen and cafeteria understandably caused anxiety. We were only required to prepare the meal up to the point where it was actually on the stove cooking. The staff chef would take it from there until it was completed. Some days, nothing would seem “off” during that time while things were cooking and we were waiting. But, most days, it was nearly tangible. One patient would pace the floor from window to window. One patient would sit in the window sill near their chosen seat. Some people distracted by talking. The meal-prepping process, seeing, and touching the ingredients, was extremely anxiety provoking for some. A few patients wouldn’t even sit at the table, when it was time to eat, until they were instructed to do so.

Once the meal was finished cooking we stood in line with our plates. A “sample” plate with the meal laid out on it was set up on the counter with a sign behind it telling us how much of each item we were to plate. Some people, like myself, were more visual and just matched what we saw. Others would read the sign, see the “exchanges” (what counted as what: fats, protein, dairy, etc.) and try to be as precise as possible, and necessary, in plating. Precision was incredibly important to those who wanted to get the absolute minimally required amount of food. That small amount of food could mean the difference between having a successful meal or not.

Once our plates were ready, we would check in with a therapeutic assistant (TA) to go over our plate. Each patient had an individual meal plan specifically detailing our requirements. For me, I was required to have 3 proteins (3 oz. of protein), 2 fats (2 TBs of fat), at least 2 cups of veggies, and 1 cup or equivalent of starch. These requirements were written out on a card. We would point to our food and tell the TA which requirements we were meeting as they followed along with our meal card. If we had too much of something, we had to take it off and throw it away. If we had too little, we had to go back and add more.

Once our plates met the requirements, we grabbed utensils, a glass with at least 16 oz. of water in it, and had a seat. After we all took our seats at the table, a timer was started for us to start eating. We were required to stay seated at the table for 30 minutes. If you ate fast, you would still have to sit there until that 30 minutes was up. Some patients powered through their meals to get it over with and would be left with sometimes nearly 20 minutes to sit there.

My first night there, I started to notice that most of the binge eaters would take small bites, put down their utensils, and chew for quite a while before moving on the next bite. In preparation for my weight loss surgery I was to do this exact thing such that the food is chewed to the consistency of applesauce before swallowing. One patient would shovel the food in as fast as she could to seemingly make it go away. In the PHP program, they were taught to make the food more palatable by adding condiments. A few of the PHP graduates smothered their food in hot sauce no matter what that food was. Some people talked excessively while others were completely silent. If the TAs noticed that we were not eating something, they would quietly talk to us and remind us of the time remaining. Although the conversations were at a whisper, we all knew what was being said and what the end result may be.

When the 30-minutes were over, people wasted no time in getting away from the table. If we did not finish 80% of our food, we were required to stay at the table and continue eating or to supplement with a meal replacement drink.

After each meal, we were not allowed to use the restroom for at least 30-minutes. We would also participate in “meal process”. During meal process, we filled out individual questionnaires regarding the meal. The questions required us to rate our level of anxiety prior to the meal as well as after the meal. It asked us to discuss what specifically was causing our feelings- what we were concerned about. Once our questionnaires were completed, we would talk about and share our experience with the meal and how we felt at that moment.

What was the Monday meal experience like for me? The very first Monday that I went, I had no idea how the meal “worked”. I was partnered up with someone in the kitchen to prepare the food with, which was awkward for me. I don’t like making small talk and I don’t generally get too close to strangers. When I plated my food, I didn’t understand their thinking in making us all have similar plates. That first night we prepared a Mexican inspired meal of tacos, Mexi-corn, guacamole, salsa, cheese, and sour cream. I was not in the mood for it. I didn’t want the corn, tortillas, or sour cream, but was told that I had to put them all on my plate. I became furious and didn’t understand why. Why make me eat food that I didn’t want if I was deliberately trying to lose weight? By the time we were ready to eat, my anxiety and anger were off the charts. Then to have to eat around strangers, in this unfamiliar situation, and to eat a meal that I wasn’t interested in? I’ve never felt that much anger in regards to food. I thought about that night for two days. I finally understood that my anger was coming from being told that I HAD to eat something versus being restricted (on a diet and limited), which was a new thing for me. I was used to people and programs/ diets outlining what I could NOT have. If someone had told me not to eat this or that, I wouldn't have thought twice about it. I had actually EXPECTED that upon signing up for treatment. I was used to changing my eating by dieting and restricting. Being told that I couldn’t limit myself was unfamiliar and scary. My fear came out as anger. It often does. Fear is hard to admit and seems weak. Anger seems more “acceptable” and powerful. I didn’t like being told what to do. Making my own decisions, even harmful ones, gives me some control and they were taking that away from me just like diets do. Being told and given permission to nourish my body did not provide the restrictions that I am accustomed to. Dieting and restriction, I understand. I’ve formed a negative association with certain foods- whether they are "good" or "bad" for me. No matter the eating disorder, there is a negative association with some food or behavior related to it. No starch. No fat. No calories. No carbs. No sugar. More protein. More fiber. All restrictions. Eating a healthy amount and variety of foods, to some, is a trigger to count calories and calculate how much physical activity will be required to burn those calories off. Some will eat what they truly want and then purge to get rid of the calories. Some of us eat until we are sick in hopes of filling a void unrelated to food. For sufferers, this behavior and these considerations can happen every single time we eat anything.

Mondays were also challenging for me because it meant participating in the preparation of a meal designed to feed nearly 20 patients and staff, in an unfamiliar kitchen, with unfamiliar recipes, and noisy people moving around me. I was totally out of my comfort zone. Some of the other patients expressed not liking to touch certain ingredients (like meat) or were not accustomed to fixing their own meals or following a recipe. One of the reasons that we were tasked with preparing the meal is called “exposure therapy”. It “forces” those of us with eating disorders to interact with “fear foods” and hopefully lessen that fear by working with it. But, seeing those ingredients going into the meal was anxiety triggering for many. Knowing WHAT they were actually eating was terrifying. At home, many didn't prepare meals because of the same fear and anxiety that they felt every Monday. It was better to avoid food altogether than to deal with these emotions.

Eating in public or around lots of people is extremely stressful for me. I never truly realized the depths of it until that first meal in treatment. I feel like I'm being judged by the types and amounts of food that I truly want to eat. I also found that being around people that I knew were having difficulty eating made me NOT want to eat as well. During many meals in treatment, I uncharacteristically didn’t enjoy the meal and on two occasions actually refused to eat some portion or all of the food. As soon as I left the treatment facility, I would stop by a grocery store on the way home, buy cake, and binge on for the rest of the night.