Eating disorders are complex psychiatric disorders that require a treatment team for full recovery. Many wish that a prescription, a few doctors appointments and handouts would be enough to “cure” them of their eating disorder. This is NEVER the case. Eating disorders disrupt every aspect of an individual’s life. Work, academics, health, cognitive functioning and relationships are all impacted by the eating disorder. Anyone who has worked in the field of eating disorders, or has suffered from an eating disorder, will know that multidisciplinary care is required in order to address this complex disorder. A primary care physician, an individual therapist, a family therapist, a psychiatrist and dietitian are all recommended for the best outcomes. Let’s examine how the dietitian fits in and why he or she is a critical part of the team.
The Dietitian’s Skill Set
To start, here is a list at what dietitians are credentialed to do in the treatment of eating disorders:
- Assess the current diet of the patient and determine the level of macro and micronutrient deficiency
- Order and interpret specific tests such as lab work, bone mineral density scans, and hormone levels
- Conduct physical examinations in order to determine the presence or absence of malnutrition and muscle wasting
- Assess vital signs to include weight to assess for acuity and progress
- Interpret growth charts to assess for weight loss and stunted growth in pediatrics and adolescence
- Administer assessments to determine the type of eating disorder
- Identify a person’s food rituals, aversions and phobias
- Provide psycho-education on how the body uses food to fuel the body
- De-stigmatized “good” food and “bad” food to help the client see that all foods are a part of a healthy diet
- Recommend appropriate levels of exercise that progress with the patient
- Design meal plans as a stepping stone in the recovery process
- Review records of food intake and make adjustments to meal plans in order to achieve weight restoration
- Provide support and structure to parents and caregivers as they walk alongside their loved ones during the recovery process
- Collaborate with other clinicians to provide well-rounded support to both the client and family
Stages of Dietetic Intervention
As you can see, the dietitian serves many functions as a part of the treatment team. They identify the problem and work with the team to help the client re-learn how to feed themselves. One of the scariest parts of treating a loved one with an eating disorder is watching them lose their ability to do a very basic human function: sensing that they are hungry and feeling safe enough to eat. The role of the dietitian over time is to re-orient them to their hunger and help them take steps to eat. This process always begins with a high level of structure and supervision. Early in treatment, this might look like a parent plating all of their teenagers’ food, telling them to sit at the table and watching them eat it all. Or for an adult patient, it might mean eating in a group (either virtual or in person) to have support as they eat meals according to their meal plan.
As a client progresses in treatment, they need less supervision and emotional support. They are gradually given back the option to make their own food decisions and are encouraged to resume an age-appropriate relationship with food. Each case is unique, and the dietitian works with the rest of the treatment team to determine the when, the what and the how of this transition. For a teenager, this progression typically starts with school lunches. Instead of a supervised lunch with a school counselor, the teen begins to eat their lunch with peers in the cafeteria. During this phase the dietitian will begin to assess the client’s ability to read their own hunger and tolerate some of the uncertainty of making food choices. A session might include questions such as:
“How was it for you today to see other girls your age eat pizza and soda for lunch? How did they approach their meals? What sort of thoughts were you having about your own serving?”
“Eating with others has caused you anxiety in the past. How did you feel this anxiety in your body during the lunch period this past week? Did it affect your ability to finish the lunch your mom packed?”
“You packed lunch for school yesterday. Your mom said you did not eat it because your friends decided to go out for Subway and you wanted to join them. I love the spontaneity and freedom of that decision you made. How did your thoughts and body feel after that lunch?”
In the latest stages of treatment, the dietitian fades into the background. The goal of every eating disorder dietitian is to eventually be “fired” by their client. Nobody needs a nutrition professional to tell them what to eat long term. If the dietitian has done their job correctly, the client will be able to read when they are hungry, will be able to feed themselves adequately and will feel comfortable getting lots of pleasure and satisfaction from their food. This can take months or years for clients to achieve, but a good dietitian is always working toward this end. If you or someone you love is not experiencing this level of freedom in their eating, please encourage them to start their treatment and make sure they include a dietitian as a key member of the team.
If you or your loved one would like to get started on their journey to recovery and would like to work with a Registered Dietitian who specializes in eating disorders, please book your initial appointment with me, Joy Metevier. I look forward to working with you!
