Understanding Anorexia Treatment: What to Expect During the First Week in Residential Treatment

Someone making the life-changing decision to begin anorexia treatment might be afraid of what to expect in daily life at a residential treatment center. Worries about the “unknowns” of treatment can be anxiety-provoking and keep people from seeking help.

There is, however, an even scarier unknown, and that’s the reality regarding the dangers of un-treated anorexia.

Fear and Expectations about Daily Life in Residential Treatment

The fact is that [1] 0.6% of the US population is dealing with lifelong anorexia. Out of that number, only 33.7% ever receive treatment. While .6% may seem like a small number, an eating disorder has [2] the highest death rate of any mental illness, especially for women 15 – 24 years old.

This number, .6%, also means that nearly 10 million Americans never receive the help they need. There are several reasons why so many people never get the help they need, but not knowing what is “behind the curtain” of residential treatment should never be one of them.

It’s common to have questions about food and therapy during anorexia treatment. Eating disorder treatment websites have great information that can answer any questions you would have. They can let you know how they approach food, how meals are planned, and what foods they offer.

What to Expect with Food in the First Few Days of Anorexia Residential Treatment

On that first day of arrival, a client can expect to have both a detailed nutritional assessment and a medical work-up that includes:

  • Gathering information about the history of the eating disorder and the current eating disorder symptoms
  • Review of lab work (blood and urine tests), history, and physical, as well as an EKG completed prior to admission
  • Height and weight

This assessment is a chance for clients to get to know their dietitian and the nursing/medical staff.

Women Weighing Herself

Blind Weigh-ins

You can also expect someone in residential anorexia treatment to have ‘blind weights’. Blind weights mean that the patient is weighed on a regular basis, but only staff will know what the scale says. Clients might be frustrated with this, but there is a good reason for blind weights.

Knowing your own weight during anorexia treatment can place the focus where it shouldn’t be. The focus is not the weight. The focus is on taking care of oneself: medically, nutritionally & psychologically.

Meals at Treatment

From the first day of treatment, meals are taken with other clients, under the support and care of the staff. Meals are an important collaborative experience between a person with anorexia and the residential treatment center staff.

The staff helps each person process what is happening before, during, and after the meal. Learning to attend meals is also about learning to enjoy the company of other people at the table, rather than focusing on food.

diet plan

Creating a Personal Meal Plan

Each person in anorexia treatment works with their dietitian to create a personal meal plan. This includes breakfast, lunch, dinner, and snacks during the day. Weight restoration is important for someone struggling with anorexia, but it can be emotionally difficult.

During treatment, what a client can’t finish eating during the meal will be completed by drinking a nutritional supplement such as Boost, Ensure, or other caloric/nutritional supplements. . This process is done with the utmost compassion and respect for the client and his/her struggles.

The weight restoration process is slow and collaborative to allow the client to adjust both physically and mentally. The first few weeks might be difficult, but therapy will help clients understand that food is nutrition and fuel for the body.

What to Expect with the Therapeutic Process in the First Few Days

Clients will jump right into the therapeutic process from the first day. At Castlewood, for example, clients have:

  • Individual sessions with a therapist 4 times a week
  • Individual sessions with a psychiatrist once a week
  • Multiple weekly processing groups in the education and development of coping skills & life management skills
  • Group therapy 6-8 hours per day from the first week to help gain insight, and develop connections and interpersonal relationships

Learning to Listen and Talk

Eating disorders can be extremely isolating because the disorder demands secrecy. Learning to listen and talk through therapy loosens the grip an eating disorder has on an individual.
The treatment process isn’t all talk therapy and nutritional stabilization.

There is downtime for doing personal homework assignments and attending social outings. These outings help clients learn to take part in life without the eating disorder. When clients are stable, they go on outings to art museums, pottery painting, and excursions to the zoo, to name a few.

Restaurant outings are also a part of the socialization process. The goal of these outings is to help clients learn to experience life without being held hostage by the disorder. They’re also a chance to practice social skills in a supportive group, and among peers who understand.

Social Outings

At Castlewood, social outings are held on a weekly basis. As a person with anorexia improves, they are allowed to have passes to go to the mall, the movies, or attend a community event. These passes are with a peer or a group of clients, without the staff, to allow clients time to practice relapse prevention skills.

Getting out in life and increasing autonomy are important milestones in the anorexia treatment process. This autonomy and level of socialization are difficult to imagine during that first week of treatment, but it is possible!

Contributor: This article was written in collaboration by the Castlewood Treatment Team. Castlewood is a residential eating disorder treatment center that has facilities in St. Louis, Missouri, Monterey, California and Birmingham, Alabama.


  1. Hudson JI, Hiripi E, Pope HG, Kessler RC. “The Prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.” Biological Psychiatry. 2007; 61:348-58.
  2. Shisslak, C.M., Crago, M., & Estes, L.S. (1995). “The Spectrum of Eating Disturbances”. International Journal of Eating Disorders, 18 (3): 209-219.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on November 5th, 2015
Published on EatingDisorderHope.com

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