Mealtimes in the context of eating disorders: working towards evidence-based protocol

Background: Mealtimes are understood to provoke anxiety for individuals with eating disorders. Despite these difficulties associated with eating and the key role weight restoration plays within in-patient treatment, little attention within the literature has focused on investigating the optimum eating environment to encourage greater food intake of those within in-patient care. Contrastingly, within non-clinical research, a vast number of studies have been conducted exploring the implications of the presence of different external stimuli within the eating environment, and their ability to both increase and decrease intake, and alter the mealtime experience. To date, the implementation of mealtimes on eating disorders wards is not evidence-based and there are no standardised guidelines from which to work. Objectives: The present thesis has four broad aims: (1) to gather data to inform of current mealtime practices implemented within eating disorders services; (2) to assess staff and service users experiences of current mealtime practice; (3) to investigate environmental factors in relation to intake and eating psychopathology; and (4) to inform mealtime protocol regarding the possible impact of environmental factors. Main findings: A number of findings are presented within the current thesis. First, the variety between the mealtime practices currently implemented within in-patient eating disorders units is presented. Following this, qualitative studies highlight the difficulties associated with mealtimes from the perspective of staff and service users. Additionally, both staff and service user interviews identify the successful approaches used within mealtimes, and offer suggestions for the improvement of their implementation. Finally, the findings suggest that environmental distractions are seen to be capable of altering consumption in a laboratory setting and decreasing anxiety within several clinical case studies. Implications: The findings of this thesis provide evidence that environmental factors are capable of decreasing mealtime anxiety, thus increasing ease of intake, amongst those individuals receiving in-patient eating disorders treatment. Recommendations are made as to how units may consider these factors when designing and implementing mealtime protocols. Further suggestions to clinical practice are made following qualitative findings within this thesis. Lastly, future research is proposed in order to increase the evidence-base of mealtime protocol.