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What does an eating disorder dietitian do? (Part 2)

Three More Reasons People Struggling with Eating Disorders need an Experienced Dietitian/Nutrition Professional on their Team (This article is part 2 of 2)
 

In part 1 of this article, two reasons for having a dietitian/nutrition professional experienced in EDs on a client’s team were discussed - to help clients normalize their eating in a way that works for them and to help clients understand the ‘why’ of their disordered behaviors.


Just a note on ‘normal’ eating. It insinuates that there is an ‘abnormal’ or ‘wrong’ way to eat. While eating can be disordered, in that it is in the service of the ED/DE part and not the ‘Self’, there is no ‘wrong’ way to eat if it works for you without being in service to the ED part.


After writing part 1 of this article, I had many thoughts about other reasons it is beneficial to have a dietitian/nutrition professional on the team of someone struggling with disordered eating or an eating disorder. It was hard to pick just 3 more.


Reason 3: We take a holistic view in working with clients, and connect the dots to help clients with their disordered behaviors.


Reason 4: Food is so much more than nutrients and we understand that.



 

Reason 3: We take a holistic view in working with clients, and connect the dots to help clients with their disordered behaviors.


Dietitians understand that food is affected by many factors and many factors affect food.


We do detailed assessments to understand the relationship between food and:

  • Sleep habits

  • Stress levels

  • Schedule

  • Gastrointestinal symptoms/history

  • Financials

  • Medications

  • Food accessibility

  • Who we live with

  • Exercise and movement

  • Etc...

As a dietitian, it is critical to understand the factors that influence food so that solutions are successful.

Lets say a college student with OCD and a restrictive eating disorder tells me they sleep from 10pm-7am, 3-4 days a week and from 1am-7am the other days. Through conversation, it becomes evident that going to bed later is associated with staying up to double-check their work, making sure it is ‘just right’. And while they do schoolwork, they do not consume any food. The next day, after not getting much sleep, their appetite is erratic and they are exhausted from the compulsion of checking their work over and over. Generally, when we do not get enough food, we can feel anxious, depressed, and on edge. In fact, there is some research to indicate inadequate dietary fat, particularly omega-3s, can affect mood negatively (1,2). So, the client works on eating food during the later nights, so their brain can function better the next day. This helps them be more fueled, and better functioning so they can also do the work in therapy required to reduce their OCD compulsion.

Reason 4: Food is so much more than nutrients and dietitians understand that.


Yes, food contains nutrients- macro and micronutrients, antioxidants, vitamins, minerals and more. The synergistic effect of eating a variety of foods is powerful, and we have yet to know all the ways nutrients interact with each other and the body. Nutrition science is fascinating! But, we do not eat just because of nutrients.


Dietitians who do eating disorder work understand this. We may ask clients:

  • What are your emotions after eating that food? Before?

  • What meaning do you assign to the brownie? The salad?

  • How was that food treated in your family when you were younger?

  • What does hunger signify for you? What makes it scary? Comforting?

  • How do you view exercise in relation to food?

Going back to our college student, they report their behavior of eating meals with large amounts of foods high in fiber makes them feel overfull. While this is helpful for their eating disorder, so that it does not eat for a while, their ‘Self’ admits they are very uncomfortable- physically and emotionally- from being so full. It distracts them from their life. So, we work on reducing the amount of fiber and bulk in their diet, eating more foods that are energy-dense, and working on tolerating the sensation of mild to moderate fullness. This last part is important- it is hard for the eating disorder part to sit with the discomfort of knowing they will be hungry again in a few hours and so it is important to provide those feelings space and also help the client understand through experience, that they can handle it.


Reason 5: We collaborate with providers and supports so the client gets the best care.

Recovery from an eating disorder requires support for the client. This support is not just from professionals, like doctors, mental health providers/therapists, psychiatrists, occupational therapists, recovery coaches and more. It is also from the community around the client, like coaches, parents, peers, teachers, and more.


Part of a dietitian’s job is to collaborate with the client’s treatment team and work with the client’s community to provide the best care. To give some quick examples:

  • Knowing a client’s lab values, vitals and weight trends (if appropriate) helps dietitians give appropriate nutrition recommendations

  • Understanding the mental health diagnoses and how they show up for the client around not just food, but other aspects of life, is instrumental in choosing nutrition interventions

  • Learning the parent-child dynamic around feeding to provide feeding recommendations for the child with an eating disorder

Looking again at our college student with OCD, working together with the therapist to understand the client's core fear of the OCD, the compulsions and avoidance techniques the client uses, and how the OCD manifests around food, exercise, weight, and body image. In telling the therapist about the client’s compulsion of staying up late to make the work ‘just right’, the therapist can address it in sessions and potentially provide strategies like exposure and response prevention work to reduce this behavior. And, likewise, the therapist telling me the client is weighing themselves after every meal provides a target to work on in nutrition therapy.

A Few Closing Thoughts


Life is uncertain. We do not have full control over our lives and recovery means accepting this.


Recovery from an eating disorder is a messy, complicated and worthy process that clients do not take alone. We know relationships, both therapeutic and otherwise, are integral to recovery (3).


Dietitians/nutrition professionals trained in eating disorders are there for clients when they do not know what is on the other ‘side’, when there is a lot of uncertainty about what recovery means and what it looks like. Especially around food, exercise and body image.


We hold hope for clients when it is hard for them to do so. We trust our clients to know what is best for them. We partner with them to find their path to recovery. We understand they are on their journey and we are a guiding witness to this.


Thank you for reading, and look forward to bringing you more important topics in this space.


If you or your loved one is struggling with disordered eating, contact me. Getting help early rather than waiting improves prognosis.


With hope,

Kate


Citations:

  1. Tzenios, N., et al. The Relationship between Fat Consumption and Mood Enhancement: A Comprehensive Review. Special Journal of the Medical Academy and other Life Sciences. 2023, 1(3), https://doi.org/10.58676/sjmas.v1i3.23

  2. Currenti, et al. Dietary Fats and Depressive Symptoms in Italian Adults. Nutrients 2023, 15(3), 675; https://doi.org/10.3390/nu15030675

  3. Venturo- Conerly, K. et al. Why I recovered: A qualitative investigation of factors promoting motivation for eating disorder recovery. International J of Eating Disorders 2020, 53(8), 1244-1251. https://doi.org/10.1002/eat.23331



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