Dicing, Smearing, Wasting: Maladaptive Mealtime Behaviors in Hospitalized Patients With an Eating Disorder

BACKGROUND: Maladaptive mealtime behaviors (e.g., cutting food up into small pieces, eating foods in a particular order) are common among individuals with eating disorders (EDs) and are associated with higher meal anxiety, lower caloric intake, and longer duration of treatment (Gianini et al. 2015). Few studies have focused on maladaptive mealtime behaviors, which are often overlooked in ED treatment. METHODS: The current study used a retrospective chart review of inpatients with EDs (N = 142) admitted to a behavioral specialty unit to create a comprehensive list of maladaptive mealtime behaviors and examine their correlates with respect to admission psychopathology and treatment progress. RESULTS: We identified 31 unique maladaptive mealtime behaviors. The most commonly observed behaviors were aimed at disposing of food (i.e., hiding, refusing, wasting) or dicing and cutting up food. Greater variety of maladaptive mealtime behaviors was associated with lower normative eating self-efficacy, lower admission BMI, longer hospital stays, and slower rates of weight gain, but were unrelated to BMI at discharge. DISCUSSION: Maladaptive mealtime behaviors were a marker of illness severity (i.e., lower BMI and inability to engage in normative eating without distress). These behaviors may impair the progression of treatment by slowing down weight gain and contributing to a longer hospital stay. Maladaptive mealtime behaviors represent an understudied intervention target to help normalize eating behavior, facilitate faster nutritional rehabilitation, and shorten hospital stays.