Meal plan inclusions and exclusions in inpatient, outpatient and community settings for adolescent and adult eating disorder care: a scoping review.

Abstract

Background: Eating disorders (EDs) such as anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and other specified feeding or eating disorders (OSFED) are complex psychiatric conditions are marked by distorted eating behaviours, rigid food rules, and significant medical risk. Nutritional rehabilitation is often supported by structured meal plans and variation exists in how food exclusions are managed during ED treatment. There is limited research guiding clinicians on meal plan exclusions and inclusions of ‘feared’ foods across inpatient, outpatient, and community settings. Aim: To explore how meal plan inclusions and exclusions are used in eating disorder treatment across inpatient, outpatient, and community settings for adolescents and adults. Methods: Scoping review conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews. Key findings: Healthcare setting: Four studies were completed in outpatient setting; two studies across inpatient settings; and two studies with mixed models (inpatient + outpatient). ED Diagnosis: This study included eight studies with consumers diagnoses of AN, BN, BED and OSFED. 75% of consumers had a diagnosis of AN. Participants: Five studies included consumers/parents. Three studies described clinician roles. Conclusions: Meal plan exclusions were primarily consumer-led, with limited use of standardised clinician protocols. Including feared foods and promoting dietary variety were linked to improved eating behaviours and recovery outcomes. Further research is needed to explore psychological outcomes, clinician decision-making, and the impact of neurodiversity on meal planning. Developing standardised, evidence-based guidelines is essential to ensure consistent and effective treatment across settings.