At BANA, there are general expectations for clients engaged eating disorder treatment:
- Following BANA policies and procedures
- Attendance in scheduled sessions, or contacting BANA to cancel/reschedule when unable to attend
- Required weekly weighing, done collaboratively with clinician or dietitian
- Completion of daily self-monitoring logs
- Completion of assigned homework
- To regulate eating, with the support of the BANA clinical team
- Attempts to use treatment tools or meet collaboratively outlined goals, when applicable
Once a week, clients will be weighed through a collaborative weighing process. Weighing is a pertinent part of treatment, and clients will be taught how to understand weight fluctuations, as well as how to challenge beliefs about weight/“number on the scale” and it’s relation to food and eating. When applicable, weekly weighing is also utilized to monitor weight restoration or maintenance.
Clients will be asked to complete daily self-monitoring logs. BANA asks that these logs are completed in “real time”, meaning as events are occurring. This “real time perspective” provides the most accurate picture of the eating disorder, and allows clients to develop awareness around their behaviours, moods, and thoughts.
Self-monitoring logs request information on wake and sleep times; eating and drinking times – along with food content, quantity and portion sizes; eating disorder symptoms that occurred; length and type of exercise engaged in (if applicable); as well as thoughts, events and emotions that occurred throughout the day.
A core foundation of any eating disorder treatment is regular (or mechanical) eating – sometimes referred to as “eating by the clock”. Generally speaking, this refers to the time of which and how frequently a client is eating.
Clients will be asked to aim for 3 meals and 3 snacks a day, going no more than 3-4 hours without food. Clients, their clinician and dietitian will set goals and develop tools to assist the client in this process.
Regular eating has been shown to:
- Reduce majority of episodes of binge eating
- Address restricting and fasting behaviours, thereby reducing physiological and psychological deprivation
- Provide a sense of control around eating
- Allow for stronger, more trust-worthy hunger and fullness cues to return
- Reduce preoccupation with eating and food
- Paired with healthy exercise, allows the body to find it’s “set point”
- Provide direction for food portioning and balancing work, as well as intuitive eating
After every session, clients will be assigned homework. It is expected that client’s complete homework, as well as consider how homework can be applied ongoingly in order to create change. Homework is a foundational part of treatment, as it strategically encourages clients to incorporate new skills and tools in their day-to-day lives, and within the environment at which the eating disorder was developed and/or maintained.
If homework is incomplete, the clinician and/or dietitian will address this with the client, and problem-solve barriers. Homework may include an assigned reading, reflection activity, worksheet, behavioural experiment, exposure exercise, meeting a goal, etc.