Meals and physical health

In order to best facilitate recovery, there is a structured meal timetable on the ward, and we stick very closely to these times.

Meals take place in the dining room and you will share a table with people who are at a similar stage of the meal plan. A member of staff will join you for the meal, and eat with you in order to provide help and encouragement.

Meal times are as follows:

Sometimes, people with eating disorders develop mealtime habits which are not helpful during recovery. We will help you to follow this guidance which we feel can help towards recovery: 

• No tissues allowed at the dining table
• Reading is permitted at snack times but not during meals
• One drink is permitted per person per meal
• Teaspoons may only be used for small pots
• Straws may be used with cold drinks but not hot drinks
• No knives and forks for sandwiches
• Staff and patients are to remain seated for the duration of the mealtime. They may then proceed to observations
• Patients are asked to complete their meal in the allocated time
• Please avoid dunking biscuits in drinks
• Nightwear may be worn at the supper table, but not at other times
• Please avoid using electrical items (phones, laptops) in the dining room
• Please avoid talking about food at the dining table
• Please be aware of excessive breaking up of food

This may seem like a lot to pay attention to, but hopefully you can see how these behaviours could impact on recovery.

Post Meal Observation

There is a period of observation after meals (one hour) and snacks (30 minutes). During this time, staff and patients sit together in the lounge, because we understand that this is a very difficult time and extra support is often needed. People with eating disorders may also engage in behaviours after meals, which are not conducive to weight restoration.

It is hoped that you can use this time to relax, perhaps watch TV, socialise, play board games, or take part in any interests or hobbies.

Diet Stages

There are four stages that patients work through. The initial diet plan on the ward normally includes regular milk (to help prevent re-feeding syndrome) and half portion meals.

This will be increased dependent on weight restoration, how you are managing emotionally, and how well your body is coping with the re-feeding process. Any special dietary requirements can be discussed with the team dietician, who will also be able to discuss the stages of diet with you in more detail.

We try to be as flexible and accommodating as we can, with regard to your dietary requirements and preferences, and there is a lot of choice available on the ward. However, there will be times when we will encourage you to progress in the diet plan, to improve your overall physical and mental health, as well as helping you to recover the relationship you have with food.

Nasogastric Feeding

Rarely, some patients may require feeding via a nasogastric (“NG”) tube, if there are serious concerns about their health and progress with the programme. This decision would not be taken lightly and would be discussed with patients first.

Your physical health will be closely monitored during your stay.

This is because people with eating disorders have high rates of medical complications which can affect the whole body. Physical monitoring may include:

Blood tests
Initially, these will be daily for the first ten days (to monitor for re-feeding syndrome). If your physical health improves, this will move to 2-3 times a week and then once a week. The results will be discussed with you in ward round.

Blood pressure, heart rate, temperature and blood oxygen levels
Initially, these will be twice a day. This may increase if you are not feeling very well, then will reduce to once a day, when things are stable.

ECG
electronic tracing of the heart, typically checked weekly.

Weight/BMI (body mass index)
this is checked weekly on the morning of ward round. It is always done at the same time of the day, and you will be asked to wear a gown. This is to ensure that it is as fair and accurate as possible.

What to expect when re-feeding
When most people arrive on the ward, their body is deprived of a lot of nutrients. We commence a meal plan which is essential to recovery. However, the body may take some time to get used to eating again. Here are some commonly experienced symptoms:

Water Retention
sometimes called ‘oedema’. It is common to have some mild water retention when you start to increase your intake. It is often noticed in the feet and ankles towards the end of the day, or around the face first thing in the morning. It is usually very mild and passes naturally within a couple of weeks with no required intervention. It is also important to remember that this is not mass. It is water and will pass away.

Gastrointestinal Symptoms 
your digestive tract may take time to adjust to larger quantities of food. Common symptoms include:

• Nausea
• A bloated sensation in the abdomen
• Feeling full very quickly
• Constipation

These symptoms are expected side-effects of re-feeding, which is imperative to recovery. It is worth bearing in mind that they are transient effects on the road to enhanced wellbeing and normally pass after a couple of weeks. However, we understand that they can be very troubling for patients.

Please talk to one of the nursing staff if you are particularly concerned about any of these symptoms, or feel unwell in any way. They will contact the ward doctor, or an on call doctor, if they feel you need a medical review. 

Medication
People with a low BMI have a higher requirement for vitamins and minerals, so you will be prescribed some supplements to take every day. Any regular medication you already take can also be reviewed and prescribed, if appropriate.

Depending on any other problems you may be having, other medications, for example antidepressants, may also be discussed and prescribed. The consultant, ward doctor or pharmacist can discuss various medications with you in more detail.

Medications are administered by nursing staff during daily, regular medication rounds.

Wheelchairs
We encourage some patients, as part of their care plan, to remain in a wheelchair, when travelling between rooms on the ward, or when off the ward. This is partly to do with safety, and partly in order to minimise the amount of energy expended and maximise chances of recovery.

Each person on the ward is unique, and not everyone has the wheelchair as part of their care plan. If you have concerns or questions about this, please discuss them with one of the nursing staff, or the ward doctor. This can be discussed further in the ward round.

If you are in a wheelchair we will also prescribe an injection called

Tinzaparin. This is because when people are less mobile, they have a higher chance of developing a Deep Vein Thrombosis (DVT or blood clot). The injection will help to counteract this.

The majority  of patients on Oaktrees are identified as being at an increased risk of falls, due to various factors such as low BMI, medication, and physical health problems. 

Whilst staff will do their utmost to take measures to reduce the risk of you falling, we cannot always prevent this. However, there are things that can be done to help reduce the risk of falls such as: 

• Please advise staff if you or your relative has a history of falls
• Ensure that you have appropriate slippers and/or footwear available on the ward which fit you well and are comfortable

CWP operates a strict no smoking policy. Smoking is not permitted on any hospital site. It is against the law to smoke inside any CWP building and against CWP policy to smoke within the perimeter of trust property.

Nicotine replacement therapy is available for all you. Please speak to staff if you require any further information about this.

Alcohol and illicit substances are not permitted on the hospital site and will be confiscated if found. We can provide support and advice for alcohol withdrawal as appropriate.

Vapes are allowed on the ward.