Meal plan inclusions and exclusions in the inpatient, outpatient and community setting for adolescent and adult eating disorder care: a scoping review.

Abstract

Background/aim: Minimal research has been conducted on meal plan food exclusions and there is limited evidence to guide introduction of feared foods in eating disorder treatment. This scoping review aimed to explore the evidence on food inclusion and exclusions in inpatient, outpatient, and community settings for adolescents and adults.

Methods: A scoping review was performed and reported according to Preferred Reporting Items for Systematic and Scoping Review guidelines. All English language primary research studies from the earliest time point exploring meal plan exclusions in people aged > 12 years old with an eating disorder were included. The search was conducted in January 2025 in six databases with no date limits.

Results: Of the 3693 studies screened, eight studies were included. Non-randomised intervention studies comprised 50% (n = 4), 62% (n = 5) of studies involved consumers and 38% (n = 3) were clinician-led. Clinician-led practices varied with most permitting exclusions for religious or medical reasons i.e. allergy, or lifelong dislikes. Vegetarianism and veganism were inconsistently permitted amongst clinicians. Various meal planning approaches were utilised to improve dietary variety including meal preparation (n = 1), menu planning (n = 2), and food cards (n = 2) in consumer-led studies.

Conclusion: This review outlined the various approaches utilised in meal plan exclusion rationale across inpatient, outpatient, and community settings. Findings highlight there is limited literature exploring meal plan exclusion rationale in the treatment of eating disorders. Of the available literature, no consensus could be concluded due to high heterogeneity. Evidence-based practice recommendations for meal plan exclusions should be included in future eating disorder guidelines to facilitate consistency in clinical practice.