Investing in our health is just that; an investment. It takes commitment, dedication and perseverance. And in some situations, it is also a financial investment as some individuals may not have an extended health benefits plan that covers dietitian services and psychotherapy, two services that are essential to eating disorder recovery.
When considering working with a Registered Dietitian, it’s essential to understand that it is not a quick-fix, one-and-done sort of thing. Dietitians offer so much more than a band-aid solution to a problem. They work with clients on an ongoing basis to help us live long, thriving lives. This is especially true when working with a dietitian to overcome an eating disorder. Diet culture has been ingrained in our brains for as long as we can remember, so naturally, it will take some time to reverse the damage and change our perceptions as we restructure our beliefs around food. It will take time to recognize that there are certain unhelpful behaviours clients may be using that although may have once played a role, are no longer needed in one’s life.
This is something that is rooted in the behaviour change model, which is based on ongoing interpersonal interactions with a trained professional whom may suggest small, attainable changes in behaviour as the individual becomes ready1. Making small changes is beneficial because if the goal seems achievable, we are more likely to be successful in accomplishing that goal. It also helps us to overcome barriers by planning how we will respond to situations before they arise so that we are better equipped to cope in the moment and can start to put planned actions into practice until they eventually become natural2. Implementing these behaviours is a gradual process and developing a trusting relationship with our healthcare team helps to create a collaborative environment where open discussion can occur regarding what is working and what needs to be adapted.
According to the Transtheoretical Model of Change, there are five different stages of change; pre-contemplation, contemplation, preparation, action, and maintenance3. The pre-contemplation stage reflects a time before we even begin thinking about changing and may still be resistant to change or be in denial of needing help. The contemplation stage demonstrates the process of thinking about reaching out for help and support, followed by the preparation stage where we begin to feel ready to seek help. The action stage is the process of beginning to attempt to implement change, and then maintenance involves the prevention of relapse. Individuals can also move back and forth between these stages of change, which emphasizes the importance of seeking help individually. Meeting with a Registered Dietitian ensures that an individual can receive the personalized support based on their needs in that moment,what they are ready for or what they need at a specific time. Here at change.creates.change, we often use motivational interviewing to assess how to best help our clients move through the different stages of change, and we focus on demonstrating acceptance and empathy4. Our dietitians are also able to adapt to resistance and take a different approach if needed, as well as supporting self-efficacy. We help our clients to feel empowered that they have the ability to be successful in the recovery process.
Because we work exclusively with those looking to repair their relationship with food and their body, the change.creates.change team focuses on offering packages and not stand-alone sessions in the beginning of the nutrition counselling relationship. This is to allow time to establish a strong rapport and provides clients the opportunity to affect behaviour change. Furthermore, it is to ensure clients have adequate support and monitoring as they move through the stages of refeeding, which can have some uncomfortable physical and psychological effects for clients with disordered eating.
1Duffy, F.D. (2012) Counseling for behaviour change. Goldman’s Cecil Medicine (Twenty Fourth Edition). Retrieved from: https://www-sciencedirect-com.proxy1.lib.uwo.ca/topics/medicine-and-dentistry/behavior-change
2Hsieh, H., Kanda, Y., Fuji, S. (2019) Incorporation of coping planning to the behaviour change model that accounts for implementation intention. Transportation Research Part F: Traffic Psychology and Behaviour. Vol. 60. Retrieved from:https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S136984781830086X?via%3Dihub
3Dawson, L., Mullan, B., Sainsbury, K. (2015) Using the theory of planned behaviour to measure motivation for recovery in anorexia nervosa. Appetite. Vol. 84. Retrieved from: https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S0195666314005091?via%3Dihub
4Wilson, G.T., Schalm, T.R. (2004). The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders. Clinical Pyschology Review. Vol. 24. Retrieved from: https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S027273580400039X?via%3Dihub