Understanding the Process of Meal Process Groups

Written by Gabby Guzman, AB and Melissa Riegel, BA.

Research assistants at the Columbia Center for Eating Disorders have many different responsibilities ranging from completion of administrative tasks, management of patient and healthy control phone contact, to accompaniment of study participants through research procedures.

During our first year on the job, the primary focus is on learning about the range of feeding and eating disorders, and training in organizational and administrative tasks as well as clinical interviews used for research purposes. By the start of year two on the job, we have an opportunity to participate as junior clinicians, co-leading a weekly meal process group through our inpatient program for people with anorexia and bulimia nervosa.

Meal process involves eating lunch with individuals hospitalized on our unit and facilitating a group discussion, a ‘meal process,’ in which patients reflect on their experience of the preceding meal and support others. Participants in the program ‘process’ after every meal — that’s 3 meals a day, 7 days a week – tracking challenges, appreciating progress, and offering encouragement to others. Though we get only a glimpse into this aspect of the work patients are doing in our program, our weekly participation in the process of meal process has been more than just another RA responsibility. It’s been an eye-opening experience that has allowed us to better understand the complexity of eating disorders and how symptoms can manifest.

For many of us, eating lunch with a group of people be they colleagues, classmates, friends or family is an every day (multiple times a day) occurrence. Food itself is central not just to our living, but to our socializing — celebrating birthdays, holidays, or casually getting together with a friend.

We approached our initial meal process groups aware that the mealtime experience was often different for people for eating disorders, but not exactly sure of how.

During the meals, conversation was usually flowing—without fail, Taylor Swift, Justin Bieber, and The Bachelor were topics that came up for months (Melissa blames Gabby for Justin Bieber, Gabby blames Melissa for The Bachelor). We enjoyed getting to better know the people receiving treatment with us, and learning about their interests, talents, and lives outside of the illness.

Over time, we observed patients with a variety of potentially problematic mealtime behaviors including:

• Dissecting food
• Using utensils for common finger-foods
• Staring at food/waiting a while before beginning to eat
• Picking at food
• Eating food in a specific order

In fact, one of the valuable research contributions some patients at the Center have made in the past few years includes taking part in an eating behavior study (published in 2015) which confirmed that patients’ behaviors were notably different from mealtime behaviors for people without eating disorders.

During the discussion (i.e., the ‘meal process’) portion of the group, participants would share the feelings and thoughts they experienced while and after eating. We learned that people with these conditions are commonly distressed by:

• Portion sizes
• Uncertainty regarding food preparation
• Feelings of fullness
• Fear of weight gain
• Urges to vomit after the meal
• Urges to exercise following the meal

It was not always easy for patients to talk about how the meal went for them, but they bravely did so time and time again. Learning about the eating experience from people with eating disorders has provided us with an education unparalleled by reading about these illnesses. The depiction of eating disorder symptoms we had read about in papers and learned about in class, and the illustration of what each meal means for recovery, was brought to life by the patients with whom we interacted. Witnessing the moments of distress and victorious milestones reached underscored how hard people work to achieve recovery, and how resilient individuals with eating disorders can be. Our ability to empathize with the challenges of recovery has grown stronger.

Each one of us is unique in the ways that we think (e.g. whether food is good or not) and in what drives our behaviors (e.g. to eat or not). Something so easy to one person could be another person’s most difficult struggle. And this, of course, is one of the challenges that concerned friends and family members face when they sit down for a meal with a loved one with an eating disorder.

We have gained insight into why this program and others like it do what they do – asking important questions and using research to answer them in the hopes of better understanding these illnesses, and developing more treatment options to help affected patients and their families.

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