Eating at Restaurants While in Recovery from an Eating Disorder

For many people, eating out at restaurants is an enjoyable activity. Dining out saves us time and reduces the effort of cooking. Going out to eat allows us to appreciate foods that are different from those we prepare at home. Eating at restaurants is a social experience and allows us to spend time with others. However, for people with eating disorders, eating out at restaurants can be a distressing experience. Eating disorder thoughts and behaviors can interfere with this otherwise enjoyable activity.

In people with eating disorders, thoughts and emotions related to eating, shape, and weight make it difficult to eat out with others. This interference is often upsetting, can strain relationships with loved ones, and severely impairs an individual’s quality of life. Research has found that dining out at restaurants is associated with increased negative affect, psychological distress, and poor body image in people with eating disorders.

Here are some of the Reasons Why Dining at Restaurants can be so Challenging:

  1. Restaurants are (obviously) centered around food. We eat in many places: at home, at work, at school, and elsewhere in our communities. But restaurants are fully devoted to food. Restaurants therefore lead to strong reactions among individuals with eating disorders. Restaurants provide ample food cues: sights, smells, sounds, and reminders of food are hard to avoid.
  2. Binge eating episodes often occur at restaurants. One study found that one third of binge episodes took place at restaurants. Research has found that people who binge eat perceive restaurant eating as uncontrolled and excessive. While many people binge eat when alone, restaurants offer a high-risk environment for binge eating. Delicious foods are accompanied by heightened negative emotions like fear, anger, and shame. This makes it difficult to prevent loss of control eating.
  3. Restaurants provide unique food-related challenges. Restaurants may serve particularly tasty or highly processed foods. Many restaurants offer “diet” foods. It is commonplace to have calorie labels in menus. Serving sizes at restaurants are often larger than typical. Many places offer an overwhelming number of food choices. Many people worry that such challenges are “triggering” or make eating disorder symptoms worse. Unfortunately, research in these areas is limited and findings are mixed. For example, in the case of calorie labels on restaurant menus, one study did not find calorie menu labels to be associated with changes in eating disorder symptoms, body image, mood, or anxiety. However, other studies have found that calorie labels affect restaurant ordering decisions in some individuals with eating disorders, sometimes resulting in higher or lower-calorie orders or associations with more weight-related concerns, dieting, and unhealthy weight-control behaviors. In any case, it’s impossible to deny that messages in our society make recovery challenging. This is particularly true in restaurants, where food is often given moralistic labels like “guilt-free” and we are potentially exposed to different messaging about food than we receive elsewhere.
  4. Restaurants can feel like eating in the spotlight. The social aspect of eating is particularly challenging for those with eating disorders. There is an expectation that if you go to a restaurant, you will eat. There are further expectations as to when, where, what, and how you will eat. Eating at restaurants can therefore lead to feeling scrutinized, critiqued, watched, or judged. This discomfort can come from your family/friends, fellow restaurant patrons, servers, and wait staff. It is not uncommon to feel anxious or nervous when placing an order. Many people with eating disorders feel overwhelmed and rushed when ordering food. Moreover, it is possible that people will make comments about food. They might comment on how they will be eating, note how much or little someone ordered or ate, ask if you “saved room for dessert,” or describe food as “heavy,” “light,” “healthy,” “filling,” “indulgent,” or “rich.” Restaurants are often crowded, and being around many people further exacerbates anxiety and distress. Dining out does not mean eating disorder urges and behaviors go away; in fact, added stress and discomfort can further encourage compensatory behaviors such as purging. When eating around others, the experience of feeling “surrounded” by the “food police” may feel especially upsetting, particularly when being out in public interferes with typical compensatory behaviors.

Learning how to dine out is an important part of the recovery process. Restaurants are an unavoidable part of normal life and are the primary source of food for some individuals. Therefore, we have to encounter them as part of recovery. So while the idea of eating out may lead to stress and feelings of dread, it is important to keep trying with the goal of slowly reducing the negative emotions associated with dining out over time.

How to Handle Eating out at Restaurants When in Recovery from an Eating Disorder:

  1. Talk to your therapist or other treatment provider. The most important thing is to come up with a restaurant plan that works for you. Everyone is different and your treatment provider will help you decide on an individualized strategy. Clinicians work together with clients to create and implement a plan for approaching restaurant eating. Clinicians can collaborate to determine what to prepare for. Your therapist can help you work towards a more flexible and healthy way to respond to eating out.
  2. Know that there is no “right way” to eat at restaurants. In eating disorder recovery, we must aim for progress, not perfection. Depending on where you are in recovery, a different approach to restaurant eating may be necessary. At some stages in treatment, reducing or eliminating restaurant eating may be recommended. If you are not properly nourished, rested, taking medications, or attending treatment, it will be especially challenging to face dining out. At some stages in treatment, avoiding eating out may be the exact opposite thing to do! Remember that this is your recovery journey and there is no timeline you “should” follow and nothing that must be “perfect.”
  3. Plan ahead. Plan ahead on your own, with your treatment provider, and with your family/friends to set yourself up for success. We must accept that we cannot plan out every detail, but having a general plan in mind for what will happen and what to do will help you feel capable. For instance, knowing where you will eat, who you will eat with, what food will be available, and when you will go to the restaurant will be useful. Planning ahead with your support systems is important, too. What coping skills/strategies should you use if you become upset? How will you let your dining companions know you need support? Can you take a break from the table or reach out to someone if things become particularly difficult? Depending on where you are in recovery and what you find anxiety-provoking, it will be useful to have more or less control over the situation. Will it help to choose the restaurant yourself? What about looking at the menu online and deciding in advance what to order? You can practice in your head what it will be like to be at the restaurant and imagine ordering and eating the food. See here for more suggestions on planning.
  4. Bring several “tools” in your “toolkit” to the restaurant. You can plan for various skills and strategies to use in response to eating disorder thoughts or behaviors. This will look different from one person to another. It might help to set a goal or an intention before the meal that you can keep in mind throughout. You can take time before or after the meal to journal or log how you are feeling. It could be useful to talk with your family or friends about topics to discuss during the meal; perhaps TV shows, movies, music, books, fun memories, or other enjoyable subjects. You can be ready to “ground” yourself with breathing if you get overwhelmed. Perhaps ask for accountability after the meal to prevent purging or other compensatory behaviors. Brainstorm ways to distract yourself or self-soothe to “take the edge off” the discomfort.
  5. Try to keep all things equal. Eating at a restaurant is a trying experience, and at the same time, also remember that it is just one meal along your path of recovery. Before and after your meal at a restaurant, do what you can to keep the rest of the day as typical as possible. Continue your other treatment behaviors: self-monitoring, regular eating, self-weighing, and other strategies should not stop just because you’re going out to eat. Keeping things going will help you! For example, under or over-eating prior to going out could lead to you feeling overly hungry or having overly strong urges to binge eat at the restaurant. Following your recommended meal plan will help to keep you on track. Similarly, after the meal at the restaurant, you should make an effort to stay on track regardless of how well or poorly you feel the meal went. Remember the values and goals you’re working towards as part of treatment, and ask yourself whether your actions before, during and after the restaurant meal are consistent with those values.
  6. Choose to lean into this challenge. Avoiding eating at restaurants or “gritting your teeth” and suffering through the entire experience will make it difficult to learn that you can make it through this! By avoiding the things we fear, we never have the chance to learn that we can face them. Intentionally ask yourself what feared outcome you’re afraid of—what’s the worst thing that could happen when you eat at a restaurant? (Are you afraid of feeling uncomfortable and having to leave the restaurant? Are you afraid someone will make a rude comment about what you are eating? Are you afraid you will gain weight immediately after eating?) Articulate what you’re afraid of, and then decide on a plan for how to survive and make it through. You won’t be able to come up with a plan to make sure the feared outcome never happens, but you can think through how to face that fear and decide how you would react if it were to occur. You will survive, and you will not be in danger or in distress that you cannot overcome. Think of the meal as a way to expose yourself, face your fear, and try an experiment. Maybe this time the goal is to sit in the restaurant and decide what to order. Next time, you can order a food that feels more comfortable to you! You can work your way up to eating foods that are more uncomfortable and challenging! You may even look at dining out as an opportunity for “challenges” or “exposures” to try applying “planned flexibility.” See here for more information: Challenge and fear foods.

 

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About the Author:

Kelsey E. Clark, MS is a third-year clinical psychology doctoral candidate at Drexel University in Philadelphia, Pennsylvania, working under the mentorship of Adrienne Juarascio, PhD. Kelsey is active in eating disorders research, clinical work, and advocacy. Kelsey has been awarded an Academy for Eating Disorders RSH Scholarship and The Renfrew Center Foundation David H. Barlow Award for Research Excellence. Kelsey’s research is focused on improving eating disorders treatment and understanding emotion-related processes that maintain eating pathology. Kelsey serves on the Academy for Eating Disorders Research-Practice Committee and has advocated with the Eating Disorders Coalition and the National Eating Disorders Association.

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Written – 2020

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