The Center for Eating Disorders Blog

FOOD LOGS: How they can help with eating disorder recovery (& why you might still be avoiding them)

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coffee-writing-stuart-milesFood logs are one of a variety of therapeutic tools used during treatment for an eating disorderFood logs – also referred to as food records or food journals – can take many forms.  Some people prefer to jot things down free form in a personal notebook while others do best filling out the prepared charts provided by their dietitian.  Many others have gone tech-friendly and use an app on their phone to track info and share it with providers. Regardless of the form it takes, a food log does much more than track your food.  A helpful format for food logs will include the time of day, a description of the meal or snack, actual food and beverage intake, location/setting of the meal and, most importantly, an individual’s thoughts and feelings before, during and after eating. Completing food logs and subsequently reviewing them with a registered dietitian can be a pretty powerful part of the recovery process. Not surprisingly, and perhaps because they can be so powerful, many individuals also experience some resistance to using them.  If you’ve ever been encouraged to complete food logs as part of your treatment for an eating disorder but had trouble starting or committing to the process, we thought it might help to know why a dietitian would recommend doing them and the specific ways in which they can aid in the recovery process.

Completing food logs throughout the week maximizes time spent in session with your providers. Weekly nutrition counseling sessions are often 30 minutes long.  It could potentially take up the most of that half hour to do a 24 or 48-hour verbal recall of your meals during the session. It’s easier to get down to business if the logs are already done. Plain and simple.

Food logs are like x-rays. If you hurt your arm and asked your doctor to put a cast on it, she would require you to get an x-ray first to see if, how and where it was broken. If you refused, she broken-armwould only be able to give you broad advice, like “take a Tylenol and get some rest.”  (If you’ve broken a bone before you probably know that wouldn’t help a whole lot). On the other hand, if your doctor could look at the x-ray of your arm she could fit you for the exact type of splint or cast needed, assign the proper amount of physical therapy, and provide individualized prescriptions for your pain.  In much the same way, food logs allow the dietitian to give you tailored advice and individualized strategies, rather than simply relying on a general, one-size-fits-all nutrition goal.

Food logs provide insight into your bigger picture. Sure, your food logs communicate specific details from each meal, but they also show trends and patterns over the course of the week related to meal times, location, hunger/satiety  cues, situational triggers and thoughts. Dietitians can often see connections on the food logs that patients don’t always see themselves. Seeing “the forest for the trees”  allows the dietitian to offer the most useful and beneficial feedback to the patient. Let’s say you arrived home from work late and ate an entire large pizza. Looking back on the food log we may see that you had an 8-hour gap without a meal that caused you to feel extremely hungry. Perhaps a goal would be set to have an afternoon snack available for those situations to help you get to dinner hungry, but not ravenous. On the other hand, maybe you had a stable breakfast, lunch, and afternoon snack, but your dietitian notices you hadn’t allowed yourself pizza in six months despite the fact that it’s one of your favorite foods. A more appropriate goal in that situation would be to practice food habituation with pizza (exposure to a food over time makes the food less compelling) and having a support person around when you’re eating it for a while. The bottom line: It’s harder to learn from the incident when we only see it from one angle. Food logs help us both have more perspective on why things happen, to know whether the set-up was physical or emotional and how to address the physical and emotional needs going forward.

Food logs provide a way to monitor progress. Nutrition therapy is about making changes that improve your relationship with food and your health. We tend to set small weekly goals that create momentum towards overarching goals and bigger changes over time. How will either of us know if the goals are met if we don’t keep track of them? Keeping a food log provides an objective look at progress from week to week and month to month.  It also takes the pressure off of you and your dietitian to recall from memory all of the details of your food and symptom use from the past month.  Rest assured, as you heal from your eating disorder you will have many more important things to use your brain for!

Returning to a normal and healthy relationship with food means appropriately responding to hunger and fullness signals. It’s impossible to do that if your signals are broken from chaotic or disordered eating. The best thing to get your digestive system and metabolism back on track is structured eating – meaning adequate amounts of food with adequate frequency.  Food logs aid in structured eating accountability, and structured eating over time sharpens your signals. Food logs and structured eating can provide the training wheels to help you get to a place of intuitive eating.

Food logs help connect your mind with your body.  Putting your pen to paper before, during or after a meal increases mindfulness with eating which can decrease mindless eating. Logging intake with your thoughts improves your ability to tell the difference between emotional hunger and physical hunger.  This practice also increases awareness to how certain foods make your body feel – energy, mood, mental clarity, digestive happiness, etc. Being aware of how foods make your body feel is important in working towards more sustainable and fulfilling eating practices.

Keeping up with food logs can help prevent relapse during transitions.  If you’ve ever received care for an eating disorder in an inpatient or partial hospital setting, you know the transition into outpatient or even intensive outpatient treatment can be difficult as you are once again responsible for completing more meals on your own. One way to help maintain the stability or progress you made in the higher level of care is to continue to self-monitor your intake and associated emotions during that transition and promptly discuss any specific challenges you encounter with your outpatient providers.  If you’re completing food logs, it’s easier to catch a slip-up before it becomes a full-blown relapse.

As mentioned earlier it’s not uncommon for individuals to question the benefit of food logs or to experience some resistance to the idea of completing them. A common reaction from patients is that, “writing down everything I eat makes things worse“ or “I don’t like doing food logs because it reminds hands with pen.africa and freedigitalphotosme of acting on my eating disorder.” As providers, we completely understand that rigidly tracking food and exercise can often be a symptom of the eating disorder.  That being said, there is a big difference between keeping a detailed, private food diary and collaborating with a dietitian to complete food logs during treatment. For one, the end goals are very different. If you tracked your food before it was probably to monitor strict adherence to dangerous eating disorder behaviors or dieting techniques. Those logs probably involved weighing, measuring, and counting calories and were done to benefit the distorted rules of the ED, not to honor or nourish your body. Conversely, the goal for food logs in treatment is to monitor weekly goals, help normalize eating behavior and to improve your relationship with food. When doing food logs with a dietitian, there is no good vs. bad, no shaming, no judgement. The role of the dietitian is not to be the food police waiting to condemn you. Rather, their role is that of a supportive detective. To examine the data, to see if there is something that is setting you up for problematic eating behaviors and then provide you with education and ideas to help make improvements going forward.

Still not sure? Here are a few additional tips for those of you who may have lingering fears about food logs…

For those that are embarrassed to show anyone… Does it make you nervous or uncomfortable to think about showing someone else a record of your daily eating behaviors? If you are worried that your dietitian will be shocked, grossed out, alarmed, or otherwise disturbed by your food log it can be helpful to think of the dietitian like any other specialist.  Take a dermatologist for example. You might feel nervous or uncomfortable during an annual skin check but to the dermatologist, that’s what they do everyday – they look at freckles and moles all day long.  Food logs and weights can be things that feel vulnerable to share, but remember, those are just pieces of data that the dietitian analyzes and they’ve seen and heard it all before. It’s their job to look at meal patterns and associated thoughts/behaviors. Vulnerability takes courage, but being courageous can lead to positive change. If you’re feeling shameful about sharing your food logs, remember this quote from AA – “secrets thrive in the dark and die in the light.” Being honest with your dietitian and allowing him or her to see your food logs is one of the first steps in moving away from the pain of the eating disorder.

For those who struggle with perfectionism… Food logs aid in improving nutrition behaviors just like practicing an instrument aids in learning the skill of playing an instrument. Writing down logs is intended to keep you in the mindset of practicing your nutrition goals for the week. The more often you practice a particular skill, the more it becomes a habit over time. That progression will not be perfect, and that’s a good thing. Even when you have a rough week and the goals aren’t met, food logs are still very helpful!  As providers, we actually learn more from the rough days than we do from the stable days. The logs allow us to see and discuss what some of the barriers might have been to meeting the goal, so we know what to try or be mindful of the following week. Portraying a “perfect” day of eating when it’s not what actually happened is not helpful.  Recording struggles or slip-ups in a food log allows us to work together to correct the focus and try again. Just like it takes practicing a song on the piano before you can play it without looking at the music – food logs keep you intentional in your practice of positive nutrition behaviors before you can naturally engage in the behaviors without the logs.

For those who don’t want to be stuck doing food logs for the rest of their lives (a.k.a. everyone)… Food logs are used to benefit an individual’s relationship with food and establish normal eating.  To that end, the goal is never for someone to be reliant on tracking their intake or completing food logs for the rest of time.  Rather, this is a temporary tool to help bridge the gap between eating disordered and eating intuitively. It might seem counter intuitive to spend your time tracking food in an effort to heal from a disorder that caused you to obsessively focus on food.  But if your goal is to one day be free from disordered eating, it can help to remember this: learning a new behavior often requires focusing on it more before you can focus on it less.

If a dietitian has recommended that you try doing food logs and you were never quite ready to give it a try but you continue to struggle with your ED, it might be worth taking some time for self-reflection. Would it be worth trying something new?  Consider what you would do if your car was stuck in the mud and the first two tow trucks to the scene couldn’t pull you out because they didn’t have the right tools. What would you say to a third one that came along with a different towing device?  Trying something new can sometimes help you to get unstuck. Even if you have tried food logs before and just couldn’t commit to the process, perhaps approaching an old tool with a new perspective or deeper understanding of how it works, could make all the difference.

CED-2014-19334-Mandala-FINALNot wanting to try food logs or other therapeutic tools suggested by your team, can be a form of avoidance. Consider whether you might be avoiding an awareness of particular behaviors or feelings.  Are you trying to avoid being accountable to make changes?  Are you avoiding acknowledgement of your body’s basic needs?  If any of these resonate with you, try being honest with your dietitian or therapist about why you may have been resistant to doing food logs in the past.  Ask for some strategies to make them more manageable or less anxiety-producing. Food logs do take time and you may not always like doing them, but there’s no denying that they can play an important role in facilitating positive change with the support of your treatment team. At the end of the day, doing food logs is temporary. A healthy relationship with food and your body lasts a lifetime.

Written by Hannah Huguenin, R.D. and Kate Clemmer, LCSW-C

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Are you struggling with an eating disorder but you’re not sure where to go for help? Contact The Center for Eating Disorders at Sheppard Pratt at (410) 938-5252 to do an initial phone assessment or visit eatingdisorder.org to learn more.  You may also want to check out our upcoming free events and workshops.

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Hannah Huguenin MS, RD, LDN

Registered Dietitian

Hannah Huguenin received her Bachelor of Science degree in Dietetics with a minor in Chemistry from Olivet Nazarene University in Illinois. She received her Masters degree from the University of Kansas Medical Center in Kansas City where she also completed her Dietetic Internship. During this internship, Hannah completed a rotation on an acute care eating disorder unit at the Research Medical Center in Kansas City. She has been with The Center for Eating Disorders since 2008, and provides individual nutritional counseling for the outpatient population. In her role at the Center, she provides ongoing support to help patients decrease eating disorder behaviors, meet their nutritional goals and improve their relationship with food through nutrition education.
 
 
Kate Clemmer, LCSW-C
Community Outreach Coordinator

Kate Clemmer earned her Master of Social Work degree from the University of Maryland, Baltimore in 2005 with a focus on Management & Community Organization and a specialization in Child, Adolescent & Family Health. Before joining the Center for Eating Disorders in 2008, Kate provided school-based therapy to adolescents and families in Baltimore City and coordinated a multi-school health education and prevention program. As the CED’s Outreach Coordinator, Kate currently facilitates trainings and workshops in the community, provides outreach to individuals interested in the Center’s services and coordinates the Center’s annual community events. These events include an annual Symposium for health professionals, the Love Your Tree Body Image Campaign, and National Eating Disorders Awareness Week. Kate also facilitates the Center’s community support group for individuals with eating disorders and their friends/family, held on Wednesday evenings.

 

Photo credit: freedigitalphoto.net and (in order) Stuart Miles, Boaz Yiftach, Africa

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