The Issues with Exchanges as an Consuming Dysfunction Meal Plan — Registered Dietitian Columbia SC


In the event you’ve been to remedy for an consuming dysfunction, you recognize what I’m speaking about once I say exchanges.

If not, enable me to introduce you to the idea. Exchanges are a sort of consuming dysfunction meal plan. With exchanges, every meals group is damaged down into models or portion sizes which are related in vitamin worth. Exchanges had been initially developed by the American Dietetic Affiliation together with the American Diabetes Affiliation within the Nineteen Fifties as a software for serving to individuals with diabetes follow “portion management” and eat constant quantities of carbohydrate from meal to meal (notice: most individuals with diabetes don’t want to make use of exchanges, though it may be useful in restricted circumstances). These exchanges had been tailored to be used in consuming dysfunction remedy, the place they’re used as a software to offer construction an adequacy to consuming.

For instance, a plan would possibly prescribe a meal that appears like this: 3 starch exchanges, 2 protein exchanges, 1 fats exchanges, 1 fruit alternate, 1 dairy alternate. Whereas the shopper may select no matter meals they like inside these particular teams, they might know the serving measurement of meals that rely as an alternate, and both measure or estimate their servings to fulfill their prescribed exchanges.

Now, earlier than I dive into the issues with exchanges as an consuming dysfunction meal plan, let me be clear that the purpose of this submit is to not say that exchanges ought to by no means be used. In the event you’re on an alternate based mostly plan and it’s useful for you – nice! Whereas I personally hardly ever prescribe exchanges for a shopper, I work with lots of purchasers who had been positioned on them in remedy, and it really works rather well for them or is useful in the interim. Whereas the objective is at all times to progressively transfer away from exchanges on no matter timeline is suitable for the person shopper (as a result of nobody needs to be 80 and nonetheless utilizing exchanges), it will possibly serve a goal. Exchanges is usually a useful gizmo as an consuming dysfunction meal plan, however for my part, it’s an over and sometimes inappropriately used software.

What’s the Objective of an Consuming Dysfunction Meal Plan?

Earlier than speaking concerning the issues with exchanges as an consuming dysfunction meal plan, I believe it’s vital to floor the dialog within the goal of a meal plan:

  1. Refuel the physique with an applicable quantity of meals, and to deal with underlying malnutrition.

  2. Assist unfold consumption comparatively evenly all through the day.

  3. Guarantee a steadiness of vitamins by offering all of the completely different macronutrients and meals teams.

Ideally, an consuming dysfunction meal plan will assist a shopper relearn expertise for creating ample, balanced meals that they will use past remedy. When somebody has an consuming dysfunction, they usually limit energy, meals teams, or put collectively odd mixtures of meals in an try to eat much less. They’ve discovered the way to craft meals based mostly on the consuming issues guidelines relatively than their meals preferences and physique’s wants. The meal plan replaces the consuming issues guidelines and helps a shopper relearn the way to feed themself.

Once I work with a shopper in restoration, one among my targets in creating an consuming dysfunction meal plan is to discover a useful steadiness of flexibility and construction. The construction is vital, as a result of we have to guarantee a shopper has a really clear concept of how a lot meals to eat, and stop that sneaky ED from discovering loopholes for restriction. However the flexibility is equally vital, and that’s usually ignored in remedy. Inflexible considering, particularly round meals, is a facet impact of an consuming dysfunction. Training flexibility helps problem that inflexible considering, and provides purchasers instruments to flexibly adapt to completely different consuming conditions.

Versatile construction appears completely different for every shopper, and determining essentially the most useful steadiness is a person and ongoing course of.

Issues with Exchanges as an Consuming Dysfunction Meal Plan

Right here’s among the issues I see with utilizing exchanges for an consuming dysfunction meal plan.

Exchanges are comparatively rigid, and replicate among the rigidity of counting energy.

When somebody is in a better degree of care, like residential or acute hospitalization, it’s usually vital to have a tighter management over caloric consumption. The dietitian is making an attempt to refeed their shopper rapidly, with out triggering among the signs that may come up from feeding a shopper an excessive amount of, too quick. In these instances, exchanges and even calorie counting is usually a great tool.

Nonetheless, as soon as somebody is healthier nourished and medically secure, and particularly when they’re in an outpatient atmosphere the place they is likely to be going out to eat, the rigidity of exchanges can turn into a bit suffocating. From a medical standpoint, whereas a shopper will nonetheless want extra meals and/or consistency all through the day, there’s hardly ever a scientific cause for vitamin consumption to be so tightly managed. Most individuals don’t have to have a really certain quantity of fats, protein, carbs or produce at every meal. Whereas their physique nonetheless wants all of the macronutrients after they eat, it’s additionally OK if they’ve meals which are increased or decrease in numerous macros.

I usually hear from purchasers who’ve used exchanges that it felt quite a bit like counting energy to them. By breaking meals down into small models, it prompts the identical mind pathways that had been utilized in calorie counting. It additionally feeds into the concern of “going over,” which brings me to my subsequent level…

Exchanges could make it appear to be there’s a “proper” quantity of meals to eat.

An consuming dysfunction meal plan ought to be used to prescribe a baseline quantity of meals, not a restrict. Exchanges can unintentionally (or sadly, deliberately, relying on the supplier) ship a message that there’s a correct amount of meals, and going over the quantity prescribed is improper or unhealthy. In actuality, human beings are outfitted to eat variable quantities from meal to meal, and profit from that flexibility. When somebody is given the message that there’s a correct quantity of meals to eat, and that consuming ought to be meticulously managed to stop going over that quantity, the consuming dysfunction will flourish.

Exchanges could be troublesome to adapt to actual world consuming conditions.

Let’s use the instance of exchanges I used earlier on this submit. What occurs when you’re going out to eat and the menu merchandise you want doesn’t have a supply of dairy included? What when you’re undecided precisely how a lot starch and the way a lot protein will likely be on the plate? What when you’re consuming at a associates home they usually make an enormous bowl of pasta alfredo with garlic bread – loads of carbs and fat, however no protein or produce. Or maybe you’re attending a superbowl social gathering that’s serving a lot of appetizers and snacks, however no set meal.

For somebody who doesn’t have an consuming dysfunction, you would possibly see these situations and suppose “so what?” However for somebody with an consuming dysfunction who’s trapped in inflexible considering, these conditions can create intense anxiousness that makes it arduous for them to feed themselves. To be honest, I believe these situations would create anxiousness for lots of people with consuming issues, no matter what meal plan they’re on, however a extra inflexible alternate system plan would doubtless heighten it. The higher the anxiousness, the extra doubtless somebody will flip to restriction as a approach to cope. In creating an consuming dysfunction meal plan, I believe it’s vital to make sure it permits the pliability for going out to eat and social consuming, particularly since feeling much less harassed in these environments is usually an enormous a part of individuals’s motivation for restoration.

It’s arduous to recollect exchanges!

I simply pulled up an alternate booklet and it’s a chart that’s 6 pages lengthy! For sure, it may be arduous to maintain monitor of the alternate portion sizes. I initially discovered exchanges 17 years in the past (!!!) once I was in faculty, and have used them to some extent or one other ever since. Whereas I’m fairly good at a meal and estimating exchanges, I nonetheless usually neglect, particularly on the subject of snack meals. Once I work with purchasers who’ve been discharged on an alternate meal plan, I usually hold their alternate checklist open in session so I can Ctrl+F when questions come up. If after 17 years, it’s nonetheless not utterly intuitive to me, I can’t anticipate that for purchasers in restoration. When a shopper is just not 100% certain if a meal matches their exchanges, they usually underestimate as a result of they’re afraid of unintentionally going over.

Exchanges are designed for extra Eurocentric consuming patterns.

For these of you who’re acquainted with exchanges, I would like you to contemplate the way you would possibly decide the exchanges within the following meals:

  • A meal of dim sum (a Chinese language, sometimes Cantonese, fashion of meal the place a lot of small plates are shared) that features shrimp dumplings, rice noodle rolls, turnip muffins, barbecue pork buns, and stuffed eggplant.

  • An Ethiopian meal of injera bread topped with doro wat (hen stew), gomen (collards), and misir wat (spiced pink lentils) served with sambusa (like a samosa).

  • A Korean meal of banchan (very small plates of facet dishes, often veggies, served first in a meal) adopted by kimchi jjigae (kimchi stew).

  • An enormous bowl of posole (Mexican pork and hominy stew) served with tortillas and guacamole.

Any concept? Me neither! Exchanges are designed to suit a extra Eurocentric consuming sample, the place a foremost dish protein is often served with a starch and vegetable or two as sides. Blended dishes, it doesn’t matter what tradition they arrive from, are way more troublesome to calculate exchanges for. This usually leaves out many non-white/American individuals with consuming issues after they go to remedy.

Change-based meal plans are sometimes include a facet of fatphobia.

Sadly, I’ve seen fatphobia in consuming dysfunction remedy extra occasions than I can rely. One of many methods it’s introduced into remedy is thru exchanges, which are sometimes prescribed inadequately for purchasers in bigger our bodies. My pal and fellow consuming dysfunction supplier, Shira Rosenbluth, who identifies as fats and in consuming dysfunction restoration, has spoken extensively about how she was prescribed much less meals than the skinny purchasers in remedy, although as somebody in an even bigger physique, and somebody who extraordinarily extreme and long-lasting anorexia, her physique wanted extra meals. This could occur with any sort of meal plan, however I see this way more steadily with exchanges.


  1. You’re so awesome! I don’t believe I have read a single thing like that before. So great to find someone with some original thoughts on this topic.


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