The Exchange System Meal Plan in Eating Disorder Recovery
A common theme in eating disorder recovery is following an individualized meal plan to encourage meeting adequate nutrition and hydration. Ideally, this recovery meal plan is prescribed by someone’s dietitian with examples of meals and snacks discussed to meet the plan. These plans can take different forms, and one of the most common is the exchange based system. This is similar to the diabetic exchanges, developed in 1950 and updated in the 70s to mid 80s.
What is an exchange system meal plan?
The exchange system meal plan is to be designed by a dietitian, for encouraging variety and also meeting the right amount of each food. These meal plans are broken down into 6 food groups and serving amounts for items that meet each food group exchange: starches, proteins (meat and meat substitutes), fats, vegetables, fruits, and dairy sources. There are also categories of combination foods and miscellaneous foods that can meet varying exchanges to allow for some flexibility.
These meal plans can vary in flexibility. For example, the typical plan is 3 meals and 3 snacks; however, someone struggling to meet 3 meals per day may start with 3 meals or 2 meals and 1 snack, then slowly increase to 3 meals and 2-3 snacks. Meals could include all the exchanges with the exact amount required to meet at each eating time, or could incorporate ranges. Snacks can also be exact exchanges or include terminology such as the number of food groups to meet, or choices between 2 different pairings of exchanges. This increase in flexibility can be part of the initial plan, or added in as 100% of exchanges are met from the dietitian-prescribed meal plan. Typically weight restoration meal plans require the most structure, and maintenance plans, with the later goal of intuitive eating, are less rigid.
The food groups of an exchange system plan
The exchange system classifies food groups into 6 categories, plus adds in a section for miscellaneous and combined foods. Below are the 6 groups described, with a quick blurb on why it’s important to incorporate the food group.
Starches
The starch group is made up of carbohydrates, the human body’s preferred source of fuel to be for cellular activity. Starches can include grains, starchy veggies, or pre packaged snacks. One exchange is approximately 15g of carbohydrates. Some examples are:
⅓-½ cup dry oats
½ cup bran cereal
½ cup grits
½ cup cooked pasta
½ cup cooked rice
½ cup cooked couscous
> ⅓ cup to ½ cup cooked quinoa
1 slice bread
½ bagel (full bagel = 2 starches, up to 3 if >40g carbs per serving)
1 bagel thin
1 mini muffin (1 starch) or full size muffin (starch and fat)
1 granola bar such as Quakers Chewy bar or 1 Nature Valley’s Crunchy Honey Oat bar from 2 pack
½ cup corn
½ cup peas
1 small potato or sweet potato
¾ oz of crackers, chips, or pretzels
Proteins (meats and meat substitutes)
This group includes animal products and vegetarian options. Proteins are the building blocks of muscles and can act as hormones or enzymes in the human body. Some examples to meet 1 protein exchange include:
1 egg
1 oz ground beef
2 slices turkey bacon
1 oz chicken breast or chicken thigh
1-1.5oz of vegetarian chicken
⅕-¼ block of tofu
⅓ cup of low fat or full fat greek yogurt, ½ cup for non fat
1 hot dog (chicken or turkey)
1 oz lunch meat (tofurkey, ham, turkey)
½ cup cooked beans
1T nut butters
Fats
Fat exchanges are important for long lasting energy, protecting our organs (visceral fat), temperature regulation (subcutaneous fat), hormonal health, and supports the absorption of fat soluble vitamins A, D, E, and K. Here are some examples equivalent to 1 exchange of fat:
2 tsp nut butter
1 tsp margarine or butter
1 tsp oil⅛-¼ avocado
2T sour cream or cream cheese
⅛-¼ cup shredded cheese or ¾ -1 slice cheese (full fat)
1T creamy salad dressing
2T lite or vinaigrette dressings
2T mixed nuts or seeds
Vegetables
Vegetable exchanges provide fiber for healthy bowels, and micronutrients such as magnesium, potassium, vitamin C, vitamin A, vitamin K, B vitamins, and many more. Some examples to meet 1 exchange are:
1 cup raw vegetable such as baby carrots, broccoli, cauliflower, or cucumber
½ cup cooked vegetable
1 cup salad with various veggies
Fruits
This exchange provides carbohydrates in the form of fiber and simple sugars for energy. Fruits are also packed with a variety of phytonutrients and antioxidants. Equivalent food sources to meet 1 exchange:
1 medium apple approximately 2 ¾” in diameter
1 medium orange or 2 cuties
1 small banana or ½ larger
4-6 oz juice
1 cup fresh fruit such as berries, pineapple, or watermelon
Dairy
Dairy exchanges include multiple macronutrients and are a good source of vitamin D, calcium, and phosphorus. Some examples to meet 1 exchange:
1 cup 1-2% cow’s milk (1 cup whole milk equivalent to 1 dairy and 1 fat)
1 slice cheese~1-1.5oz
1 cup soy milk
12-16 oz almond milk (60 calorie versions)
⅓-½ cup low fat or full fat yogurt
½-⅔ cup of nonfat
Here are some examples:
● 1oz regular bread: 1 starch exchange = 1 slice, CD size, 1 hand size
● 2-3oz bagel: 2-3 starches exchanges = 1 regular bagel, 2 CDs, thicker than 2 hand sizes for 2 starches
● Clif bar:1 starch, 1 protein, 1 fat exchange = 1 energy bar or granola bar (combination food)
● 1/4 cup nuts or seeds: 2 protein or 2 fats exchanges= 1 golf ball, 1 palmful
● 1oz block cheese: 1 dairy exchange = 1 regular slice pre packaged cheese, 4 dice, 2 full thumb sizes
● 3-4 oz of turkey burger: 3 protein exchange = 1 premade turkey burger, deck of cards, size of fist
● Small potato: 1 starch exchange = size of computer mouse, size of fist
● 1 cup pasta/quinoa/rice/couscous: 2 starch exchanges = x2 baseballs, 2-3 handfuls
● ¾-1 serving of tortilla chips: lays chips, crackers: 1 starch exchange (1-1.5 serving = 1 starch, 1 fat) = 9-12 chips, 12-16 crackers such as Wheat Thins, 5-8 crackers such as Ritz or Club, baseball size, 1 large handful (2 handfuls= 1 starch, 1 fat)
● 1T creamy salad dressing: 1 fat exchange = 1 ping pong ball, 1 thumb size
● ½ cup cooked broccoli or cauliflower: 1 vegetable exchange = ½ baseball, small handful/palmful
Back measuring: why this can be helpful when practicing exchange
Back measuring is a useful technique to check whether eyeballed measurements are actuallyaccurate to the exchange’s serving size. It’s easy to compare hand sizes, skimp onmeasurements, or even over measure when trying to meet nutritional needs with the stress ofan eating disorder inspiring another way. To try this, simply use either the everyday objecttechnique or hand measurements to portion a food source, then test the accuracy by viewingthe nutrition label or actually measure it with cups, spoons, or a scale. If viewing nutrition labelsand utilizing measuring tools is triggering your eating disorder, try this technique with a dietitianor support person at home to do the back measuring, then compare if the eyeballingmeasurement is accurate, or needs adjusting, to meet a prescribed meal plan.When starting on a meal plan in eating disorder recovery, it’s important to work with the rightdietitian and treatment team to support this process. The exchange based meal plan can aid insuccess, but only if implemented appropriately by the individual recovering. This system, like all,has workarounds to give the eating disorder a chance to find the lowest calories for each foodgroup. However, this plan is meant to combat the eating disorder, not encourage it. That’s whyit’s essential to work with an eating disorder dietitian while exploring the exchange basedsystem, and how to address triggers and eating disorder behaviors while meeting the individualexchanges. If you have further questions after reading this blog on the exchange based systemfor eating disorder recovery, reach out to us at Enhance Nutrition to learn more