Phase 1 Structured Eating

Integrated eating has four developmental stages. The first stage is Structured Eating:

Structured Eating gives a form and organization to food and feeding. Mechanical eating is the first step in restoring hunger cues and requires the person to eat bite after bite in the absence of hunger cues until the meal is completed.  In this process an individual is given a structured or semi structured meal plan that includes balanced meals and snacks. Restoration of appetite and normal eating begins mechanically and the stomach and brain begin to communicate again. It may take several weeks or months before appetite returns.  However, without mechanical eating it is difficult to get back into the habit of eating again.

There are some basic components of structured eating: When to eat, what to eat and how much to eat.

When to Eat: As nutritionists we have come a long way from the idea of ‘3 square meal’ philosophy and have evolved to ‘3 meal plus snacks’ . We have learned a lot about insulin levels from treating diabetics enough to understand that eating every 3-4 hours stabilizes your blood sugar and increases the chances of normalized eating. Eating within the first hour of waking is a very good rule of thumb to practice as it literally breaks the fast from sleeping and allows the body to move into more active and potential metabolism. It is well established that eating 3 moderate meals are essential to getting in our basic needs of macro and micro nutrients but balanced snacking is crucial to maintaining optimal energy and having steady hunger signals. How many snacks you might be wondering? Our bodies need food every 3-4 hours so if you consider the average individual who wakes up at 7am and eats their breakfast at 7:30 then they should have a snack by 10:30 and lunch by 1:30 another snack at 4:30 and dinner at 7:30. This would be 3 meals/2 snacks per day. A third snack would be added in if this individual was up before 7 or sleeping way past 10:30. Now that you have your answer as to WHEN to eat, let’s talk about WHAT to eat.

What to Eat: Eating balanced meals and snacks allows for the continuation of creating structure in your eating. A balanced meal is one that includes each of the macronutrient components: complex carbohydrates, proteins, fats, fruit/vegetables. A balanced snack contains a protein, fat and either a complex carbohydrate, a fruit or a vegetable. You may be wondering why it is so important to eat balanced meals and snacks. To further the understanding of how important stable blood sugar is to normalized and healthy eating behaviors, when you eat (see above) is only part of the story. It is not only when you eat that will allow for stable blood sugar but that you’re eating balanced meals and snacks. To understand this better, consider this…Let’s say you got up in the morning and decided to eat a bagel with butter. In this case, you’ve eaten within an hour of waking up but your meal was deficient in protein and a fruit so an hour and a half after you finish your breakfast you’re hungry again. You decide on a salad with chicken but forget to add the complex carbohydrate. By snack time you’re craving those carbs but this time in the form of a giant chocolate chip cookie. By dinner time you’re famished because you’ve not been able to adequately get all your needs met and even though you choose a balanced meal, you’re too hungry and consume too much. This is a scenario that happens all too often.  Consider a different  scenario: you wake up and eat peanut butter and apple on 2 slices of toast. You’ve gotten all the macronutrients down and you feel full and satisfied and will not need to eat again for 3 or 4 hours. At lunch time you decide on a tuna sandwich and bag of chips. The mix of protein, carbohydrates and fats keep you stable until late afternoon. At snack time you are ready to refuel and enjoy a yogurt with berries. By dinner time you’re hungry and decide on a yummy balanced meal containing salmon, roasted potatoes and sautéed spinach. You eat an adequate amount because your  blood sugar has been on track all day long. Bottom line, when you eat and what you eat are very related but even if you get the timing right if the balance is off there is no guarantee you’re eating will be normal. I have alluded to the idea that if you’re eating at the right times and eating the right balance of foods an individual will eat the right amount. But how exactly does that happen?

How much to Eat: In this structured phase of Integrated Eating there is a method to how much one eats on a range…of course. Meals usually consist of 2-3 complex carbohydrate servings, 1-2 servings of protein, 2-4 fat servings and 1-2 servings of fruit/vegetables. Let’s consider what this means in actual food terms. A serving of Complex Carbohydrates equal a slice of bread, ½ cup of cooked grain or pasta, a small potato or half large or ¾ cup of cereal. This does not mean you’re only supposed to eat one of these servings but more like 2-3 of these servings. Proteins vary because there are animal and non-animal proteins.  A serving of animal protein (fish, poultry, beef, pork) is approximately 3 oz while beans and legumes are about ¾ cup. Eggs are protein so usually 1 large or 2 small eggs are one serving. Dairy is also considered a protein so 1oz of cheese is a serving, 1 cup or yogurt or milk and ½ cup cottage cheese.  1-2 servings of protein is usual. Fats occur in some proteins and some mixed carbohydrates but pure sources of fats include oil, butter, avocado, mayo, and salad dressings. A serving is about 2 tsp of oil, 2 Tbs dressings, 1 TBs of mayo, 1/8 avocado and 2tsp of butter. 2-3 servings make up a moderate meal. Fruit/vegetables are usually measured as one small piece of fresh fruit or 1 cup cut fruit or vegetable, ½ cup cooked and ¼ cup dried.  So let’s now apply this to what a meal will look like if you got adequate amounts of these components to make a meal. For breakfast an example of a balanced, well portioned meal would be 1.5 cups oatmeal, with ¼ cup of nuts and ¼ cup of raisins and 1 cup of milk. For lunch, a turkey and cheese sandwich with avocado, lettuce and tomato and a small bag of chips, for dinner,  shrimp stirfry with 4 oz shrimp, 1.5 cups of rice and 1 cup cooked vegetables. Snacks are similar but a bit different. For meals it’s important to have both complex carbs and fruits and vegetables but for snack you can choose which you want to use. For instance, for a balanced snack you can have a banana and 2 TBS of PB or 2 rice cakes with 2TBS of PB. Snacks include: 1 protein, 1-2 servings of fat, and either 1 fruit serving, 1 vegetable serving or 1 complex carb serving. 

This may seem complicated but the structured eating phase of Integrated eating is so important because it lays down the foundation of when, what and how much to eat.  To recap:

  1. Eat within the first hour of waking.

  2. Eat every 3-4 hours.

  3. Eat approximately 3 meals and 2-3 snacks.

  4. Eat balanced, well-proportioned meals and snacks.

Consider these questions to assess your eating:

  1. What do you notice about the timing or schedule of how your eat? Notice when you eat for a day or two.

  2. Are your meals and snacks balanced? If not, what do you notice is missing?

  3. Notice your meal/snack sizes. Are you eating proper portions of each component?