Eating disorders are both physical and psychological illnesses. These two pieces often overlap. For example, in order to work on the emotional part, it’s important to have adequate nutrition, otherwise the brain cannot function properly. This is just one why recovering from an eating disorder takes a team. This includes a therapist, physician, psychiatrist and last but not least, a registered dietitian. All clinicians on the team are crucial in providing you or your loved one with the tools and techniques needed for recovery.
Since I am a dietitian and all, I’m going to spend some time discussing what makes a dietitian a critical member of the team 🙂
1.Degree in nutrition:
Dietitians are the only members of the treatment team who have gone to school to specifically learn about nutrition science. (Just as an MD is the only one to have gone to medical school). The eating disorder can have a lot of knowledge about nutrition. However, this knowledge is often false or twisted to make it seem scary. We get information about nutrition from the media, but again, this information is false or twisted to make it seem scary.
So, dietitians can use their background in nutrition science to help clients better understand what may be happening in the body.
.This knowledge can often be used to fight back against the eating disorder. For example, the ED might say “grains are bad.” But, in reality, grains are the main energy source for the body. They have essential vitamins and minerals. And they make meals more satisfying. When the “grains are bad,” thought pops up, often times it’s useful to use true nutrition knowledge to fight back against that voice. Additionally, dietitians can better properly assess the nutritional needs of a client to assure appropriate intake for adequate nourishment and to repair and restore the body.
2. Role model:
It’s incredibly important for clients who are struggling with food to eat with member of their treatment team. This often falls on the dietitian because, well, we’re the ones talking about food. We also have a positive relationship with food we can model for our clients. Challenging and processing “fear foods” in session is definitely intimidating. However, food challenges are essential for recovery. We know that nutritional variety and flexibility is a solid marker for recovery. So doing this in session can be a more supportive way of reintroducing foods that may have been cut out or limited because of the eating disorder.
3.Challenge ED Food Related Thoughts:
As someone is beginning to form a new, and more positive relationship with food, it’s crucial for eating disorder thoughts to be challenged. The dietitian can easily pinpoint and gently call out both loud and subtle disordered food and body thoughts. The “grains are bad” example I used early. That’s definitely a “loud thought” and may be easier for someone to gently call out and redirect. A thought like “I need to watch my portions” is more subtle. “Watching portions” still implies a level of restriction. Having a positive means giving oneself unconditional permission to eat and trusting the body to provide one with signals. Any external food rule (like “watching portions”) can interfere with these bodily signals and possibly amplify food shame and guilt.
The end goal of eating disorder recovery is intuitive eating. My hope as an eating disorder dietitian is that I can follow my client all the way through recovery and guide them toward intuitive eating. There can be triggers as one starts to listen to the body and allow themselves to eat based on these signals. These triggers include… weight changes, eating less/more of certain foods, comments from other people…etc. A dietitian can support their clients through these triggers and learn how to cope with them.
When choosing your outpatient team, you have the right to ask questions and decide whether or not a potential dietitian or therapist (etc) is going to be a good fit for you. Most of us are willing to schedule a 15-20minute phone call to answer these questions and get to know you.
I’d like to discuss what you should ask for with RDs. Here are some questions you can ask:
What is your experience in working with eating disorders?
Of course, you’ll want to make sure the dietitian has experience in working with eating disorders. Think about it: you wouldn’t ask an oncologist to do surgery on a broken foot. You certainly would run the risk of doing more harm since it’s not their area of medicine. Working with eating disorders is a specialized illness that requires extensive training and supervision. You may want to ask if the dietitian has their CEDRD or if they are considering working toward it.
Do you practice from a Health At Every Size © framework?
When recovering from an eating disorder, it’s highly important to work with a dietitian who believes in HAES ©. I love this article by Lisa Pearl on why HAES is a Cornerstone for Recovery. She states “two of the biggest reasons to encourage a HAES® approach is for the prevention of eating disorders and the elimination of weight stigma and its devastating effects on psychological, behavioral and physical health!”
What are your other specialities?
Along with the question regarding HAES, you’ll want to check to see what other specialities the RD has. Other specialities can certainly be a great thing! If you or your loved one is struggling with another medical diagnosis that involves nutrition (like diabetes or a gut related illness), it can be awesome to find an RD who may have more knowledge in that particular area. However, you’ll want to watch out if the dietitian also specializes in “weight management.” Weight management is actually quite a diet-y term and can be harmful in someone’s quest for full recovery. See above about the importance of HAES!
How many clients do you typically see a week?
Eating disorders are complicated. And a dietitian can spend up to 10 hours a week coordinating care with other members of the treatment team. Typically, “full time” for a dietitian working with eating disorders could be anywhere between 20-30 clients a week. You’ll want to make sure the RD has time during the week to collaborate and breaks from seeing clients for their own self care. This way, they will have time to devote to seeing you (or your loved one), coordinate care with other members of the team AND have time for their own self care. Which is very important for all of us!