A Registered Dietitian (RD) is an integral part of the multidisciplinary healthcare team that should be involved in eating disorder recovery. An eating disorder is a mental health diagnosis and therefore requires the involvement of healthcare professionals from various disciplines, including a General Physician (GP), a therapist (a psychologist, psychotherapist or social work) and a dietitian. RDs are regulated health professionals who have gone through years of school and training and are qualified to provide evidence-based recommendations to help clients meet their nutritional needs. Dietitians who specialize in eating disorders have undergone further specialized training related to eating disorders to qualify them to work with this high-risk population.
The dietitians at change.creates.change Nutrition Counselling are here to support the client throughout the eating disorder recovery process. As this is intended to be a long term counselling relationship, it is extremely important that time is given to build trust and a strong rapport between the RD and the client. This means that our dietitians will spend time getting to know the client so they feel comfortable discussing their food behaviours, as well and their thoughts and emotions related to eating. This will build the foundation for the dietitian-client relationship so the client feels they can disclose personal information without fear of being judged. Additionally, there is no pressure for the client to set goals right away. It may take time for the client to feel that they are ready to begin changing their eating behaviours and that is completely okay Our dietitians are here to support our clients throughout the entire process, even when the client is not yet ready to change.
Over the first one or two sessions, our dietitians will conduct an in-depth nutritional assessment with the client to determine their usual eating patterns, food intake, feelings and fears surrounding food, supplement use and goals the client wishes to achieve1. Our dietitians will not only explore the factors which influence what the client eats, but also where, how and whether the client eats as well. This aspect of the dietitian-client relationship can be emotionally draining as the questions may stir up some strong thoughts and feelings in our clients. We encourage that our clients take fresh-air breaks during sessions when needed and that they are gentle with themselves following appointments. Oftentimes, our clients report experiencing a “vulnerability hangover” and we ask that our clients use self-soothing skills and reach out to their supports while they process their experience.
One of the main roles of a dietitan in eating disorder recovery is helping the client normalize their eating behaviours. Since an eating disorder is a mental health diagnosis, those suffering from an eating disorder will most often have a distorted view of food, exercise and/or their own body. Our dietitians help clients to work through these distortions and help overcome their fear surrounding food. Normalizing eating behaviours is also important for recovery because the brain must be adequately nourished to function properly and do the hard work that is required in their therapy sessions. One of the ways this may be achieved is through the development of a mechanical eating plan. This eating plan will help the clients’ bodies get used to eating regularly again and help them relearn hunger and satiety cues which may have been diminished by their eating disorder. Eventually, the client will ease off of the eating plan as they relearn these cues and get more comfortable and skilled in eating normally2. This eating plan will be individualized to include a recommended number of meals and snacks per day and examples of food categories that should be included at each meal time to best meet the client’s nutritional needs and reduce the negative physical symptoms of refeeding their body.
Those struggling with eating disorders tend to have misconceptions about nutrition and what foods they should be eating. An RD understands the vital role food plays in the body and why it is essential for health. They have studied the effects of food in the body and why many nutrients are needed each and every day. Our dietitians can also help the client view food in a more positive way. For example, a client may have the misconception that eating foods containing fat will make them gain weight. An RD would explore this food belief in detail with the client while also providing education around why fat is essential for the absorption of fat-soluble vitamins, production of hormones, and maintenance of the reproductive system, among many other functions3.
Our dietitians will also assess the client’s current food skills. This includes their efficacy in meal planning, grocery shopping, food preparation, and general knowledge of food4. In addition to improving the client’s knowledge of food, there may also be the option to work on further developing such skills like meal planning and grocery shopping. Furthermore, our dietitians can provide meal support therapy to provide encouragement and guidance to clients during meal times and reinforce normalized eating through social modeling. Clients may also be invited to go on restaurant outings in order to practice their learned skills in a real-world setting.
Overall, our dietitians at change.creates.change Nutrition Counselling are here to support clients during their eating disorder recovery. They play an integral role in helping to normalize eating behaviours and repair client’s relationship with food, ultimately supporting individuals throughout eating disorder recovery.
- Gurze- Salucore Eating Disorder Resource Catalogue. (2014). The Role of the Registered Dietitian/Nutritionist on the Eating Disorder Team. Retrieved fromhttps://www.edcatalogue.com/role-registered-dietitian-nutritionist-eating-disorder-team-2/
- Mirror Mirror. (2015). Normal Eating. Retrieved from https://www.mirror-mirror.org/noreat.htm
- Centre for Clinical Interventions. (2018). The Facts on Fat [PDF file]. Retrieved from https://www.cci.health.wa.gov.au/~/media/CCI/Mental%20Health%20Professionals/Eating%20Disorders/Eating%20Disorders%20%20Information%20Sheets/Eating%20Disorders%20Information%20Sheet%20-%2025%20-%20The%20Facts%20on%20Fat.pdf
- Practice-based Evidence in Nutrition. (2014). Food Skills. Retrieved from http://www.pennutrition.com.proxy1.lib.uwo.ca/KnowledgePathway.aspx?kpid=22933&trid=22982&trcatid=38