Community‐based mealtime management for adolescents with anorexia nervosa: A qualitative study of clinicians’ perspectives and experiences

Abstract

Findings highlight the perceived need for more formal training for clinicians undertaking mealtime management, and the positive impact this could potentially have on their practice. Clinicians' emotion regulation during intervention delivery was perceived to be important. There was a perceived need for greater adherence to protocols but an acceptance that flexibility was also required.

Meal support intervention for eating disorders: a mixed-methods systematic review

“…Two studies did not include one or more of the following details: sample size justification, validity of outcome measures, description of the intervention, contamination and cointervention avoided, and drop-out reporting [ 35 , 36 ]. Qualitative studies ( n = 4) [ 37 – 40 ] mostly met the quality appraisal criteria except for two studies [ 39 , 40 ] which did not report, or provided inadequate detail, for one or more of the following aspects: theoretical perspective, obtaining informed consent, identifying assumptions and biases of the researcher and reporting on the decision trail. Kells (2013) reported better outcomes in patients who received meal support compared to patients who did not receive meal support; however, it is unclear whether patient characteristics, severity of illness, length of diagnosis, and physical compromise were comparable to the intervention group.…”

“…The length of time of mealtimes varied from 30 min [ 34 , 37 , 38 ], to 60 min [ 10 ]. Supervised rest period immediately after the meal ranged from 15 to 60 min [ 10 , 15 , 38 , 39 ]. While it is common practice in eatig disorder treatments (e.g., CBT) to use graduated exposure to ‘fear-foods’ in ARFID and AN, none of the articles described implementing a graduated approach to meal supervision.…”

“…Aesthetics of the dining room (e.g., size, shape, and setting of the dining table), timing of the meals to avoid delays, and consistency in approach were important aspects identified to alleviate distress in patients [ 10 , 40 ]. Familiarity with the clinicians and having a standardised training approach were facilitators of meal support effectiveness [ 39 ]. Furthermore, clinicians providing empathic emotional support during mealtimes, such as encouraging patients to continue eating and reducing feelings of anxiety [ 10 , 15 ], whilst also being assertive and firm around food consumption [ 10 , 15 , 37 ] was reported being effective.…”

“…The importance of training parents and carers in providing meal support post-discharge was acknowledged in three studies [ 34 , 39 , 41 ]. Rigorous training of parents and carers of patients with ARFID in the provision of meal support at home was shown to be a successful alternative to long-term eating disorder outpatient treatment.…”

‘It stopped you thinking about food’ – The experiences of mealtimes and attending a post‐meal support group for young people with anorexia nervosa

“…Clinicians often find managing mealtimes with young people experiencing an eating disorder challenging. It may provoke anxiety among staff, particularly if a young person becomes distressed (Watt & Dickens 2018). Furthermore, some mental health nurses, particularly those with less experience, may feel uncomfortable acting authoritatively when working with young people with an eating disorder and have less confidence in doing so (Ryu et al 2022;Zugai et al 2019).…”