Graded Support in Eating Disorder Recovery
Graded Support describes identifying who is responsible for which decisions at meals. Rather than allocating all responsibilities to the person in recovery or their support person, Graded Support considers which aspects of the meal the person in recovery feels confident with, and where they could benefit from support. This can change throughout treatment to suit the person’s needs.
Some examples of responsibilities at meals can include:
Choosing the meal or snack
Cooking
Eating the meal
Choosing how much to eat
Choose plates, cutlery or cups
Choosing when to eat
Choosing where to eat
Choosing who to eat with
Choosing entertainment or distractions used while eating
Supporting the person at the meal
Logging in Recovery Record
Monitoring growth or weight change
This should be the treating GP, psychologist or dietitian
Graded Support and Eating Disorders
During eating disorder recovery, mealtimes can become significantly distressing. Planning Graded Support at a meal ahead of time can help by clearly outlining which parts of the meal the person in recovery is responsible for, and which their support person is responsible for. For many people, this can decrease anxiety by minimising ‘grey area’.
Applying Graded Support can also foster autonomy by supporting the person in recovery to make food decisions. Although the amount of responsibility the person has may change throughout treatment, Graded Support seeks opportunities for the person to make recovery-oriented decisions at each meal.
For example, a young person in recovery is eating dinner with their Dad. They have decided ahead of time that they apply the following Graded Support:
Dad will
Choose the meal
Choose when to eat
Choose where to eat
Cook
Portion the meal
Support the young person during the meal
Log in Recovery Record
The young person will
Eat the meal
Choose which plate they use
Choose the distraction strategy used
Later in treatment, the young person makes progress and is given more responsibility. The Graded Support at dinner is now:
Dad will
Give the young person two choices for dinner
Choose when to eat
Cook
Support the young person during the meal
The young person will
Choose the meal from options provided
Portion the own meal
Eat the meal
Choose where to eat
Choose which plate they use
Choose the distraction strategy used
Log in Recovery Record
Applying Graded Support in Eating Disorder Recovery
To apply Graded Support to meals during recovery, we recommend the following:
When planning meals, write the plan down and add space to allocate Graded Support for each meal and snack. Write down who will decide what, when, how much, and any additional decisions for this meal. If any of these don’t have a person allocated, decide on this.
This can also be used when creating a meal plan with your dietitian
Ensure all people involved in the meal are aware how Graded Support will be applied. For example, writing this on a whiteboard in the kitchen.
If Graded Support differs at specific meals, such as during school hours, ensure that this change is planned and clear.
If Graded Support at a mealtime changes, inform the person in recovery as soon as possible. The goal of using Graded Support is to maintain the person's autonomy.
For example, deciding to go out to dinner or to a social meal instead of eating at home
Try to prevent changing Graded Support during a meal. If the Graded Support at a meal does not appear helpful for the person in recovery, discuss this with them after the meal and suggest trying a different approach at the next meal.
Resources
We hope that you have found this information helpful. If you would like more information about supporting people in recovery at meals, please feel welcome to view the following: