For some people, eating can be difficult. There are all manner of reasons why this might be the case, from lactose intolerance to gluten intolerance, nut allergies, even an allergy to citric acid, but for some people, the issue is broader — and therefore much more difficult — than that. It is about eating. Not types of food, or what’s in food, or how food’s been prepared, but eating. They struggle to put a mouthful of food into their mouths, to chew, and to swallow. For anyone who has to deal with this on a regular basis, it’s at best frustrating. Sometimes, it can be downright terrifying. This isn’t being off of your food for a day or two, this isn’t being not very hungry one evening, this is a persistent and prolonged inability to eat.
If you share your life with someone who struggles to eat, you might struggle to know what to do. The advice that I’m able to offer here isn’t a solution, and it certainly isn’t medically ratified. It's a guide. This next bit is really important, though; some people will require professional medical attention. Please, encourage them to seek it. What I’m suggesting is the culmination of years of observation and experience, not medical training. This will help to treat the symptoms, but not the cause of struggling to eat. The cause is a deeper, more complicated issue that needs to be tackled on an individual basis; not eating is the park where it comes out to play.
Struggling to eat can be something that someone battles with for their entire life, or experiences periodically, or experiences as a solitary — but prolonged — episode. I think, though, that whichever form it takes, tackling it requires much the same approach. Aside from addressing the underlying cause, there are six points that can help someone who struggles to eat.
- Recognise the triggers
- Don’t make mealtimes a battleground
- Pay attention to portion size and service
- Involve people in preparation
- Identify 'Holy Grail' foods
- Develop a routine
Even for people who deal with struggling to eat for a life time, there will be periods where things are noticeably worse, usually following some event or incident. For someone who has to tackle not eating periodically, there will, most likely, be a trigger instigating these episodes. If these triggers can be identified, it will help to minimise the impact they might have on not being able to eat. Sometimes, the triggers can’t be avoided entirely, but if you know that it is coming your way, at least you can make adequate preparations.
For most people I know who struggle to eat, the primary trigger is stress. That stress can take different forms, for example being in unfamiliar situations or surroundings or having to deal with something emotionally demanding, but it’s stress all the same. And more often than not it is stress that can be linked back to a lack of control. Subsequently, if they can’t control where they are, they can control what they eat. Recognising the triggers helps to restore an element of control. It’s a very good place to start.
Sometimes, though, those stressful situations will be beyond control. They can be unavoidable or completely unforeseen. In which case, dealing with the fall out of the stress — that is, not eating — will be the next step.
First and foremost, do not turn mealtimes into a battleground. Dealing with mealtimes is probably the most difficult aspect of struggling to eat: it’s uncomfortable for everyone. All the same, it is important to maintain the routine and ritual of mealtimes, because it helps to create stability and propagate the feeling that eating is a healthy and normal activity. But by commenting on things and making them an issue, it only exacerbates the situation. More stress will result in a feeling of less control, which means eating becomes even more problematic. Don’t comment on how little someone has eaten; don’t comment on how much someone has eaten; don’t make references to people’s weight; don’t make suggestions; don’t make 'encouraging' comments; and, if you’ve cooked, don’t feel offended that your food hasn’t been eaten. None of this will help. The fewer stressful associations that can be made with the dinner table and with food, the better. Trust me. In short, don’t push the issue, and definitely not at the dinner table.
Which leads us on to what, when, where, how, and how much to serve. We’ve already established that not being able to eat is related to loss of control. If a person loses even more control over mealtimes, for example, how much is served to them, they’ll struggle even more. Allow people to serve themselves. One potato, one slice of chicken, five peas, and a carrot baton is better than nothing.
Dinner plates are large. Dinner plates can be daunting. Dinner plates can make people feel inadequate if they can not either fill it or eat everything that is on it. Use a salad plate. Or even a tea plate. That one potato, one slice of chicken, five peas, and a carrot baton will be suited so much better by a smaller plate. Eating in small quantities will often necessitate eating more frequently, too, so be prepared with left-overs and food that can be made into mini-meals.
The control factor can also mean that if people who struggle to eat are involved in preparing their meals, they will be more likely to eat them. Of course, this isn’t always the case, and in fact the complete opposite can happen, but it is worth remembering. Even people who are hopeless cooks can get involved in the kitchen and the sense of accomplishment at producing a meal can do wonders.
So now the question is what to cook. I wouldn’t necessarily suggest doing anything particularly different, or cooking anything terribly special. I’ve already mentioned that ritual can be important, and so is not making a fuss. Preparing special meals would counter both of those points. However, it is likely that people who struggle to eat will have one or two foods that they are virtually always able to manage. Examples I know of are fruitcake, spaghetti Bolognese, and cheese on toast. It is worth working out what these 'Holy Grail' foods are and having available either a small stock or the required ingredients. Growing overly reliant on these foods could of course become problematic, but never underestimate the power of spaghetti Bolognese for breakfast.
So finally, think about routine. If the little-and-often philosophy works, go with that. If there is one particular time of day when someone is more likely to eat, consider making that the primary meal time. I know quite a few people who can just about always eat breakfast, and although for an entire family sitting down to eat a roast dinner at 7am on a Tuesday is probably unappealing and definitely impractical, there are ways to build it into daily life. And if it means that someone eats at least one full meal each day, then it is worth it.
None of this is proven, and dealing with the causes of not being able to eat should take priority, but watching someone grow progressively thinner is heartbreaking and hopefully this can help. Remember though, it is about the person who struggles to eat being in control, not anyone else.