What’s the Food Exchange System & Its Place in ED Recovery?

Kitchen preparing for meal planning

Food exchanges were created by the American Dietetic Association in 1950, in coordination with the American Diabetes Association and the US Public Health Service to establish guidelines to help target issues within the American eating habits.

It was again revised and republished in 2013. Exchange simply means types of foods that can be substituted with another item within the same category. The categories are carbohydrates, protein, fat, dairy, fruits, and vegetables [1].

How Exchange Systems Support in Recovery

In recovery, meals and exchange-based plans are individualized to each person. A meal plan is essential to a person’s treatment and recovery plan. There are many benefits to an exchange-based plan.

One is that the person learns what proper portion size looks like at each meal and snack, and begins to understand how their body feels throughout the process of relearning a healthy relationship with food.

Secondly, individuals will gain support from their treatment team while practicing their new meal plan to help distinguish between eating disorder thoughts, personal true-self thoughts, as well as any co-occurring disordered thoughts that might arise.

Third, an exchange system can offer reduced anxiety around food and mealtimes due to being able to choose from each category.

Through work with a dietician, the individual can learn how to select a well-balanced meal or snack based on the types and food choices within the categories [2].

Food exchange systemFourth, exchange systems bring consistency to the treatment team to help ensure that all members are aware of what foods are being ingested if they are within the exchange program, as well as knowledge of what portion sizes count for one serving size or more.

It eliminates the guessing game between patient and therapist in treatment and recovery. This allows for other supportive individuals to be able to use the exchange system to help with a meal or snack and know what the person needs to be doing to reach their goals.

Mealtime Realities

Regardless of being in treatment or not, mealtimes can be a struggle for an individual with an eating disorder. It comes with thoughts around meal prepping, serving size, amounts of food, and what types of food to eat.

Without a meal plan, this can be a very daunting process. Dieticians are a critical part of the treatment and recovery process [3]. Working with a client can help the sufferer learn to re-train their body and mind to look at food differently.

Professionals can work with individuals to rehearse and prepare for real-life challenges, such as grocery shopping, meal preparation, and eating.

For those in treatment, exchange systems can help a client learn to slowly increase their range of foods and portion sizes [3]. It allows for flexibility within a meal plan and learn, through simple measuring techniques, how to model, label, and prepare appropriate amounts of food.

This is significant for those with eating disorders to learn, in a supportive manner, how to build a healthy relationship with food. It aids in being able to learn visually what portion sizes look like and realize that measuring is not a normal behavior in society.

Exchange programs also allow for individuals to have a plan in mind of which foods from which group they need to make up their meal or snack. It allows for confusion or looking at every option available. It can keep grocery shopping and decision making a bit more stress-free.

ED Recovery and Eating

There are ways to help support recovery and meal planning. Apps for Smartphones and tablets are becoming an increasingly used tool for sufferers to track their food exchanges.

Food photo

One App is RiseUp + Recover which is a free application [4]. It is user-friendly and has options for meal logs, a meal check-in sheet, coping skills, and some extra features to help with meal completion.

It will automatically set up three meals and snacks when opened, but it can be customized as well. There is an option to email to a primary therapist and nutritionist logs.

Recovery Record which is also free is available for users to customize the app according to individualized treatment and recovery goals [4].

It allows for meal planning, and exchange tracking and asks specific questions after completing a meal or snack also to track emotions and situations. Other items pertain to eating disorder behaviors as well.

Final Thoughts

Some final conclusions about the exchange system program in eating disorder recovery are that this type of meal planning can be extremely helpful to someone working their recovery.

It can help take confusion and complexity out of the planning process, allow for flexibility and slow but steady progress to open up food choices and variety.

Regardless of the meal plan system, an individual uses, being able to have a treatment team that can aid in relearning how to have a healthy relationship with food and their own body is the key to a successful recovery.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Food Exchange (US). (n.d.). Retrieved September 06, 2017, from http://www.diabetes.co.uk/bmi/food-exchange.html
[2]  Structured vs. Flexible Eating in Eating Disorder Treatment: When Is the Right Time? (n.d.). Retrieved September 18, 2017, from https://www.waldeneatingdisorders.com/structured-vs-flexible-eating-in-eating-disorder-treatment-when-is-the-right-time/

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.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on December 18, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on December 18, 2017.
Published on EatingDisorderHope.com