Table 3 Description of meal support (MS) and study outcomes
From: Meal support intervention for eating disorders: a mixed-methods systematic review
Author/s | Article type | Study Setting | Study Country | Aim | Number of participants, videos, units | Description of Meal Support (MS) | Outcomes |
|---|---|---|---|---|---|---|---|
1. Couturier and Mahmood (2009) | Quantitative | Child and adolescent inpatient psychiatric unit | Canada | Retrospectively assess whether the implementation of MS had an impact on the use of nasogastric feeding in AN patients | Group1: Pre-MS implementation: 12 children (< 18y) with AN restricting or binge purging type Group2: Post-MS implementation: 9 children (< 18y) with AN restricting or binge purging type | • Staff provided supervision for meals and snacks • Staff provide emotional support, whilst being directive about required food consumption. | • Incidence of nasogastric feeding decreased (p < 0.02) • Weight on admission was lower in the post MS group (P < 0.03) • No difference was found in Weight change, rate of change and discharge weight length of stay, and readmission rate |
2. Kells et al. (2013) | Quantitative | Tertiary children’s hospital | United States of America | Examine the effect of MS on outcomes during inpatient medical hospitalization | Control: 52 patients with diagnoses of ED NOS, AN, both restrictive and purging types, and patients who are pre-diagnosis | • MS was described as a modification of MFBT, - • MS was not part of standard practice. • MS was provided by staff | • Mean weight increased • length of stay decreased • overnight bradycardia decreased. |
3. Kells et al. (2017) | Quantitative | Tertiary children’s hospital | United States of America | Examine the effect of standardized MS on weight gain, length of stay, vital signs, electrolytes, and use of liquid caloric supplementation in hospitalized adolescents and young adults with restrictive eating disorders | Intervention: 56 patients with diagnoses of EDNOS, AN, both restrictive and purging types, and patients who did not meet diagnostic criteria | • MS was described as a modification of MFBT • MS started at admission as part of standard practise • MS was provided by staff | • No significant difference between groups was found |
4. Taylor et al. (2021) | Quantitative | Private clinical practice | Australia | • Examined whether treatment gains were maintained when trained parents continued the programme at home and during meals out | 26 children and their parents | • MS was individualised and targeted to the needs of the patients. • MS involved changing the mealtime environment, providing incentives for appropriate food intake, setting realistic and achievable mealtime goals, persistent presentation of food, and teaching practical eating skills (e.g., chewing, biting, using utensils). | • Food intake increased. • Variety of foods increased (mean = 92 different foods) • Decrease of inappropriate mealtime behaviours. • Treatment gains were maintained during follow-up at a mean of 2.3 years. • Parental satisfaction and treatment acceptability were reported high. |
5. Beukers et al. (2015) | Qualitative | Specialist inpatient eating disorders unit | The Netherlands | Identify interventions used by health professionals in a specialist eating disorder centre to restore normal eating behaviour for adolescents diagnosed with anorexia nervosa | 8 health-care professionals trained in diagnostics, motivational aspects, CBT, FBT, (relapse) prevention, and dietetics were videotaped during mealtimes | • MS was provided in a group setting with patients at various stages of recovery. • Staff provided emotional support and direction to patients and patients who were further along in the recovery journey provided peer support. | • MS aspects identified included: monitoring and instructing, encouraging, and motivating, supporting, and understanding, educating. |
6. Hage et al. (2015) | Qualitative | Inpatient eating disorders unit | Norway | Determine the structure of a meal, revealing the operating scripts. | 22 staff members (nurse, social workers, child welfare officers) 40 meals were filmed, 10 of each meal type (breakfast, lunch, dinner, and evening meal) | • Patients were supervised by staff during mealtime. Food intake was monitored over a 30-minute period. If meals were not completed within this time, a nutritional replacement was offered. | • Video recording analyses identified 3 mealtime phases: pre-eating (serving and positioning), eating (division of labour and dialogue), and completion (end of meal preparations). |
7. Long et al. (2012a) ^ | Qualitative | Public NHS and private eating disorder services | United Kingdom | Investigate in-patient perceptions of mealtimes on eating disorders units. | 12 patients with AN | • Patients participated in group meals in the inpatient unit for a minimum of 2 weeks, • Staff was eating alongside patients while supervising food intake. | • Interviews relating to patient experience of mealtimes revealed Three themes were identified: mealtime delivery (logistical factors influencing meals), individual outcomes (cognitions, emotions, behaviours, and physical sensations during meals), mealtime characteristics disengagement, perceived battlegrounds, and a desire for involvement in more decision making at mealtimes) |
8. Watt and Dickens (2018) | Qualitative | Child and Adolescent Mental Health Services | Scotland | Explore mental health clinicians’ perspectives on community mealtime management with children and adolescents diagnosed with an eating disorder | 6 mental health clinicians with experience of delivering or referral for the intervention completed semi structured interviews | • MS was delivered by a specialist intensive community team (ICT) in the home environment. • Family prepared meals in accordance with the agreed diet plan • Meal duration was set at max 30 min. • ICT clinicians provided support and supervision during a meal. | • Interviews relating to clinician’s experience in delivering MS revealed 3 themes: technical and emotional aspects mealtime management, and the combination of food intake and nutritional supplements. |
9. Cairns et al. (2007) | Mixed methods | Eating disorder treatment centre, British Columbia Children’s Hospital | Canada | Evaluate the helpfulness of the contents of a video and manual for training parents and caregivers in providing meal support for eating disordered youth. | 40 self-report questionnaires consisting of closed and open-ended questions were collected from parents or caregivers | • A DVD and manual were provided to parents and carers to introduce concepts of MS, help parents and caregivers empathise and outline support strategies. | • DVD and manual resources were found beneficial in providing insight into emotional processes of eating disorder patients and teaching practical MS strategies. • Resources were reported as usefulness dependent upon the patient’s stage in recovery. |
10. Long et al. (2012b) | Mixed methods | NHS and specialist eating disorder units | United Kingdom | Study 1: Assess the current mealtime practices within UK eating disorders units. Study 2: Investigate staff perspectives of these mealtimes, including their involvement and understanding of patients’ experience | Study 1: 6 (out of 22 identified specialist eating disorder inpatient units Study 2: 16 staff members of 3 specialist eating disorder inpatient units participated in an interview | • Patients’ meals were supervised by staff • Staff could opt to eat with the patients. | Study 1: MS practises varied within and between units. Study 2: Three themes were identified: preparation, roles during mealtime, and barriers. |