What ‘Safeguarding Nutrition’ Means in Eating Disorder Recovery

I first heard the term of “safeguarding my nutrition” from an experienced eating disorder dietician when I was in treatment, doing an intensive outpatient program (IOP). It’s been two years since then, and the term is commonly thrown around by my case manager and GP now. Other people who support me will also mention the same concept, but generally they word it in a different way.

When I asked the dietician what she meant by “safeguarding nutrition,” she explained that as someone living with an eating disorder, I needed to put more effort in than most people to make sure my body was adequately nourished and to overcome the malnutrition and starvation my body was experiencing.

This can take many different shapes and forms, and looks different in different stages of recovery. For example, for someone who is medically unstable, safeguarding nutrition would most likely look like providing the body with nutrition using 24-hour enteral feeding of a nutritionally complete formula. (Been there, done that!) For someone on the other end of the “recovery spectrum,” safeguarding nutrition might look like consistently reminding yourself and being proactive at making sure you not only have three main meals a day, but you also have your three snacks (morning tea, afternoon tea, and supper) which can be hard to do when the people around you don’t see the value of regular snacking. It can be very daunting to explain to someone that it’s 3 p.m. and that means you need to stop and eat, even if you are in a lecture where you’re not supposed to have food.

For me, safeguarding my nutrition is an uphill battle, because there are so many different aspects to it. Not only do I have to take the responsibility to eat, but this can actually be made harder by the expectations, assumptions and opinions of those around me. This is something my eating disorder is more than happy to join in on: “See, I’m right! You really shouldn’t have another piece of toast because everyone else has only had two pieces and they all agree with me that you’ve had enough!” I don’t listen to the eating disorder though; I know I haven’t eaten enough today, and that having four pieces of toast is OK if that’s all that’s available or is all I find “safe” to eat at the moment.

The biggest and hardest things I have to do in my eating disorder recovery is manage other people’s expectations of how much I should eat, and what I should eat. I have to distance myself from the way society and some individuals view diet and healthy eating because there is so much contradicting information out there and everyone has their own ideas of what’s right. For me, I try to stick to the basics I have been told by dietitians who specifically work with eating disorders.

One of these is the rule of threes. That is: three meals, three snacks, no more than three hours apart. Despite being in my third year of treatment, even I still slip up with this. I know the reason for regularity and eating every three hours is to maintain blood glucose levels, help nourish the body, maintain energy levels throughout the day and fight starvation syndrome but my eating disorder is always pushing me to skip a snack here or there, or to restrict, and this means that I, like many people struggling with an eating disorder, am constantly fighting borderline or mild hypos, which can leave me feeling anxious, irritable or having mood swings.

Another “fact” I try to hold onto, based on what dietitians have told me, is that my body actually needs a surprising amount of calories or kilojoules each day to just maintain my weight, and even more if I’m working toward weight restoration. While specific calorie amounts differ according to age, gender, diagnosis, different dietitians, treatment methods and according to weight restoration goals, I know I can safely say the absolute minimum number of calories my body needs a day, and many treatment guidelines including the “Minnie Maud method” would propose even more calories.

I’m not going to lie: even on my most “normal” days of eating, days when I’m trying to eat unrestricted or even days I’m actively trying to meet these requirements, I definitely fall short. However, the point is I’m trying and I don’t need people pointing out that I’m eating a lot of food. I know! Trust me!

The last “rule” I keep in mind is what I refer to as the “meal wheel.” This is another guide I received doing the IOP with Queensland Eating Disorder Service (QuEDS). This is probably the biggest point of contention amongst society and differs so much between people, countries and even different time periods, so I try not to engage in conversations about it with people. But basically, the “meal wheel” includes a serve of protein, a serve of carbs, a serve of fats, fruits or vegetables and a side for every main meal. Lots of people can get super fixated on the different macronutrients — and which ones they should be eating more of and which ones they should be eating less of — but for me, I know a healthy diet consists of all macronutrients.

Safeguarding nutrition goes even further than what I’ve spoken about and in living my life day to day, I need be consciously aware of it. This may look like:

• Taking snacks with me whenever I leave the house.
• Making sure I carry Jelly Beans around to treat a hypo.
• Taking a meal supplement with me to places — restaurants included — if I know there’s a chance that a main meal might be jeopardized by my eating disorder.
• Spending money that might not necessarily be a part of my budget on food if I’m out during the day and have been caught without a snack.
• Dipping into my savings account to do my weekly grocery shop.
• Spending money on groceries that might be on the more expensive side but make up an important part of my diet — for example, avocados, which is one of my main sources of fats.
• Being aware of incidental activity levels when out and about.
• Making sure, if I am being active, that I eat more.