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By Dr Marianne Trent, Clinical Psychologist, edited by Dr Gill Rapley
Today whilst considering our important work for clients with eating disorder diagnoses my brain switched on in what felt like a different way.
It's common place that for at least part of treatment, depending on client presentation that a Fortisip only diet will be offered, sometimes for as long as is needed.
What I know from my experience of supporting physically unwell patients in the past and from my own experiences with caring about my own Father who was prescribed them before he died in 2017, is that no-one really likes meal replacement drinks.
The idea that anyone has to exist solely on Meal Replacement Drinks for any extended period of time does automatically seem to elicit a disgust reaction within me.
Compassion Focused Therapy (CFT) runs through all of my work with clients and so discussion about disgust and its protective importance to us as humans is commonplace in sessions.
Of course, Fortisips and similar products have their medical place to support the nutritional needs of people who are not able, for whatever reason to meet their usual calorific need through a normal balanced diet. I’m definitely not disputing that within this article. However, as a Mother of 2 who has used baby-led weaning and attachment / gentle parenting it did make me wonder what we as a caring profession could learn from baby-led weaning to help clients with eating disorder diagnoses to have different outcomes.
Baby-led weaning (BLW) was brought to the mainstream public attention by Gill Rapley in 2003 and in her seminal 2008 book with Tracey Murkett. In a nutshell, the main principles of BLW are that:
The period from 6 months to 1 year is mainly about exploring and discovering food, not so much about eating it. No pressure, no counting, no fuss. The main source of nourishment continues to be breastmilk or formula milk. Solid foods are offered at normal family mealtimes with no expectations or pressure that they be eaten and with no ‘aeroplane spoons’ etc.
Food is shared, with everyone being offered the same (healthy) food and deciding how much or how little they want. There’s no chivvying to eat or try foods.
Food waste is accepted as part of the journey to learning to enjoy food and no shame or criticism is levied for food not eaten.
New foods / Not yet accepted foods are offered alongside presently accepted foods.
Allowing people to feed themselves is less likely to lead to choking and gagging because of the way that our tongues will naturally position the food in the mouth.
It occurred to me how unlike real strawberries a 'strawberry' Fortisip is.
Are we offering real strawberries alongside? No seems to be the answer. Are we discussing with clients what their previous favourite foods were? Alongside a desire to switch off intrusive thoughts and difficult feelings, the reasons behind restrictive eating disorders can be complex. Surprisingly it's often not about people hating food but can be a complex mix of people believing they're not worthy of the food and / or as a punishment to themselves to deny themselves the food they love.
It made me think of the empowerment of helping humans to enjoy good food with baby-led weaning. Watching children learn to experiment, explore and enjoy real food is such a delight and children really do just spontaneously pick up and try the different foods within their grasp. This personal experience and theory knowledge was making me realise that there is no spontaneous way for clients on Fortisip-only diets to spontaneously try not yet accepted foods. The digestion of our food starts as soon as we see it, as soon as we smell it, as soon as we hold it in our hands. A Fortisip served in a plastic cup holds very little appeal in terms of anticipatory digestion.
Children will often lick foods without trying to eat them and yet we often don’t allow our clients with eating disorder diagnoses the same grace.
I wondered what we could learn from the BLW processes of helping young children learn to love good food for the very first time that we could apply to the theory and practice of helping young people and adults with restrictive eating disorder diagnoses. I wondered whether we could enable them to go through the same processes of learning to welcome foods back into their lives.
I am of course aware that catering for specialist services such as eating disorder units is all part of a hospital process and that there are constraints and limits upon this. However, I do think there is ‘food for thought’ here and that we need to start thinking about how we would want to eat and how we would choose to eat, rather than thinking about our clients meals as being variables to be controlled. Speaking of variables though, even sitting at a table and being around eating paraphernalia like cutlery and crockery can be triggering but that’s an aside.
With the BLW theory in mind it made me wonder if the prescriptions for Fortisips or equivalent could be seen as the ‘main meal,’ the equivalent of the breastmilk or formula for the first year? The benefits of offering real foods alongside the currently accepted Fortisips but with no hustle and no stress could potentially be life changing.
I’d like to open the conversation on this and I’m happy to be guided by your professional, or lived experience opinions……… Are there any eating disorders community or specialist inpatient units who already integrate baby-led weaning theory into their work with clients with diagnosed eating disorders? If you have currently got or previously had struggles with restrictive eating presentation how would this feel to you?
Dr Marianne Trent is a Clinical Psychologist and author of The Grief Collective: Stories of Life, Loss & Learning to Heal.
Dr Gill Rapley is an author of many wonderful books on Baby-Led weaning and breastfeeding. For more information on her books please click here.