Researchers looked at how doctors and therapists decide which foods people with eating disorders should include or exclude from their meal plans. After reviewing 8 studies, they found that there’s no clear agreement on the rules. Some clinicians allow people to skip foods for religious or allergy reasons, while others have different approaches. The study shows that treatment centers need better guidelines to help patients safely reintroduce foods they’re afraid of eating. This research highlights an important gap in eating disorder treatment that needs more attention.

The Quick Take

  • What they studied: How doctors and treatment centers decide which foods to include or exclude when creating meal plans for people with eating disorders
  • Who participated: The review examined 8 research studies involving adolescents and adults (ages 12 and older) with eating disorders being treated in hospitals, clinics, and community settings
  • Key finding: There is no consistent approach across treatment centers. Some allow food exclusions for allergies or religious reasons, but rules about vegetarianism and veganism vary widely between clinicians
  • What it means for you: If you or someone you know is getting eating disorder treatment, the meal plan rules might differ depending on where you’re treated. It’s important to discuss food choices with your treatment team to understand their reasoning

The Research Details

Researchers conducted a scoping review, which is a method for mapping out what research already exists on a topic. They searched six different medical databases in January 2025 looking for studies about meal plan food exclusions in eating disorder treatment. They included only English-language studies and had no time limits on how old the studies could be. Starting with 3,693 studies, they carefully reviewed each one and selected 8 studies that directly addressed their question about food inclusion and exclusion in meal plans.

The 8 studies they included used different research methods. Half were intervention studies (where researchers tested a specific treatment approach), and the other half used different designs. About 62% of the studies involved people with eating disorders sharing their own experiences, while 38% were led by clinicians and treatment professionals. This mix of study types and perspectives helped the researchers get a complete picture of current practices.

Understanding how meal plans are created is crucial for eating disorder treatment because food choices can be emotionally charged for people with these conditions. By looking at what research currently exists, this review helps identify where treatment guidelines are missing. This information can help doctors and therapists develop more consistent, evidence-based approaches to meal planning that work better for patients.

This is a scoping review, which is a good way to map out existing research but doesn’t combine data from multiple studies like a meta-analysis does. The small number of studies found (only 8) suggests this is an understudied area. The fact that the studies used very different methods and approaches means the findings can’t be easily compared. This review is most valuable for showing what gaps exist in the research rather than providing definitive answers about the best meal planning approach.

What the Results Show

The review found that clinicians generally allow food exclusions when there are clear medical or religious reasons—such as allergies, intolerances, or dietary restrictions based on faith. However, the approach to other food preferences varies significantly between treatment centers and individual clinicians.

One major area of disagreement involves vegetarianism and veganism. Some clinicians permitted these dietary choices while others did not, showing there’s no standard practice. This inconsistency could be confusing for patients moving between different treatment settings or seeking a second opinion.

The studies also described various meal planning tools and approaches used to help patients eat a wider variety of foods. These included meal preparation classes, menu planning sessions, and food cards (visual tools showing different food options). However, these approaches were used inconsistently across different treatment settings, and there’s limited evidence showing which methods work best.

The review noted that about half of the studies were intervention studies testing specific meal planning approaches, while others simply described current practices. The involvement of people with eating disorders in designing and leading some studies (62% of studies) was important because it included their perspectives on meal planning. The clinician-led studies (38%) provided information about professional practices and decision-making. This mix of viewpoints showed that both patients and professionals have valuable insights about meal planning that aren’t always aligned.

This review is notable because it appears to be one of the first comprehensive looks at how meal plan exclusions are handled in eating disorder treatment. The authors note that minimal research has previously focused on this specific question. The findings suggest that eating disorder treatment guidelines have not kept pace with the need for clear, evidence-based recommendations about food exclusions and how to safely reintroduce feared foods—a core part of eating disorder recovery.

The biggest limitation is that only 8 studies were found on this topic, which is a very small number. This suggests the research area is underdeveloped. The studies used different methods and looked at different populations, making it hard to compare results directly. The review only included English-language studies, so important research published in other languages may have been missed. Additionally, the review doesn’t provide a definitive answer about the best approach to meal planning—instead, it highlights that more research is needed to develop clear guidelines.

The Bottom Line

Based on this review, there is currently insufficient evidence to make strong recommendations about specific meal plan exclusions. However, the research suggests that meal plan decisions should be individualized and based on legitimate medical needs (allergies, intolerances) or personal values (religious beliefs). Treatment centers should develop clear, written policies about how they handle food exclusions and communicate these to patients. More research is urgently needed to determine the best approaches for safely reintroducing feared foods during eating disorder recovery.

This research is most relevant for people with eating disorders and their families, as well as doctors, therapists, and nutritionists who treat eating disorders. Treatment centers should use these findings to develop more consistent policies. People seeking eating disorder treatment should feel empowered to ask their treatment team about their meal plan philosophy and how they decide which foods to include or exclude. This is less relevant for people without eating disorders or those not involved in eating disorder treatment.

Changes in meal plan approaches and the development of new guidelines will likely take several years. Patients should expect that meal plan changes happen gradually during treatment, typically over weeks to months. The process of reintroducing feared foods is usually slow and supported by a treatment team to manage anxiety and ensure success.

Want to Apply This Research?

  • Track weekly meal plan changes and new foods introduced, noting the date, food item, anxiety level (1-10 scale), and how you felt after eating it. This creates a personal record of progress in food reintroduction.
  • Use the app to set weekly goals for trying one new food or reintroducing a previously avoided food. Share these goals with your treatment team and log your experience to build confidence and track patterns.
  • Monitor trends over time by reviewing monthly summaries of foods tried, anxiety levels, and successful introductions. This helps you and your treatment team see progress and identify which approaches work best for you.

This research review summarizes current practices in eating disorder meal planning but does not provide medical advice. Meal plan decisions should always be made in consultation with your treatment team, including doctors, therapists, and registered dietitians who specialize in eating disorders. Individual needs vary significantly, and what works for one person may not work for another. If you or someone you know is struggling with an eating disorder, please seek professional help from qualified healthcare providers.