What should dietitians know about eating disorders? Eating disorders are difficult cases and many dietitians do not feel completely skilled in handling them. It’s important for a dietitian to be aware of the emotional, nutritional and medical components. Even if they don’t specialize in eating disorders. Clients with eating disorders often enter our office doors. Which makes sense! Dietitians discuss food-related behaviors and beliefs with their clients. Let’s talk about the dietitian’s role in screening for eating disorders.
This blog was written by our previous dietetic intern, Karaline Kelbaugh. It was edited by Alex Raymond, RD, LD, CEDRD-S.
Reminder: Screen ALL Clients for an eating disorder
Any person can be susceptible to developing an eating disorder.
Eating disorders do not discriminate based on weight, gender, ethnicity, race, age or socioeconomic status. Anyone can be struggling. Read our blog about screening questions for eating disorders. Because of the stereotypes we have with eating disorders, dietitians often make the assumption that certain clients have eating disorders while others do not. Making sure we dive deep into clients’ food behaviors, rules and dieting history is important. Making assumptions can be dangerous. Especially if it means delaying someone’s treatment.
Dieting behaviors can be eating disorder behaviors
Dieting is just one precursor to an eating disorder. Get a clear picture of the following:
- Has your client cut out certain foods or food groups?
- Does your client feel guilty taking a day off of exercise?
- Does your client use fitness trackers or count calories?
- Has your client followed or is currently following a specific diet? (Keto, Weight Watchers…)
- How does your client talk about their body?
- Does your client feel guilty after eating?
- Is your client engaging in disordered behaviors like binging, purging, restricting or compulsive exercise?
It is important to listen carefully to what your client is telling you. Even to the passing comments said during a session.
A Team Approach Is Best
Working with a team will set your client up for better overall care. A team typically includes you, as the eating disorder dietitian and an eating disorder specialized therapist. As well as a psychiatrist, physician and anyone else who is going to be helpful in the client’s recovery. The dietitian is responsible for a client’s relationship with food and nutrition stability. A doctor provides medical expertise and a therapist provides emotional support.
“Mainstream” Nutrition Education Isn’t Helpful for Eating Disorders
“Mainstream” nutrition education is not helpful for individuals struggling with eating disorders. Often the media and social media discuss foods we should “cut out.” Or encourages us to eat certain other foods in order to change our bodies. Rarely is food discussed in a neutral or positive light. When supporting clients in recovery from an eating disorder, we need to shift from a good food/bad food mentality. Instead, focus on practicing enjoyment, flexibility, nourishment, and fun with food.
Never Promise Weight Loss
The truth is we don’t know what’s going to happen to someone’s body after they recover from an eating disorder. (Even if someone doesn’t have an eating disorder, we don’t know how their body will change throughout their lives!). Recovering from an eating disorder includes body trust and appreciation. If our clients are constantly trying to change their bodies, it is difficult to feel at peace. Part of the eating disorder dietitian’s role is to explore body image on a deeper level. And discuss the idea of body respect and appreciation.
Metabolism Takes Time to Heal
Another point to keep in mind is that during periods of restriction, purging or other compensatory methods and/or binging, the body’s metabolism shifts. It slows down to preserve nutrition and in order to function properly. In many cases, metabolism becomes hyperactive when a person starts eating enough and regularly. On top of that, hunger/fullness cues often shift in eating disorders. Causing a person to lose touch with these cues. In order for metabolism and hunger/fullness cues to return to “normal,” a person needs to be feeding themselves enough and often, as well as getting enough sleep and working on appropriate coping skills. This takes time. And by time, I mean months and months. Just not a couple of weeks. It’s important to give clients reassurance they they are doing the right thing with food
The Gut Also Needs Some Time to Heal
Additionally, the gut may need some time to heal if your client has been engaging in behaviors such as purging, restricting or binging. It is important to have compassion for your clients as they begin the process of normalizing eating. Clients might report physical side effects like bloating, gas, constipation, acid reflux, nausea, and pain. These side effects are physical as well as mental. When a client is reintroducing foods, anxiety increases. We know that anxiety is connected to the gut as well. Validate clients that this is difficult and remind them that eventually this will pass.
Refer Out If Needed
The process of counseling patients with eating disorders is difficult at times. Reminder: the eating disorder has kept clients safe. So, it’s very difficult for them to give up. Eating disorder dietitians often face resistance, which is usually stemming from fear and anxiety. Ultimately, seeing the growth of your patient overtime as they recover is a rewarding process! Finally, if you do not feel comfortable or knowledgeable enough, it is perfectly acceptable to refer out to someone who specializes in eating disorders. There is no shame in admitting that someone else would be better suited to handle a particular client case. In fact, this may ultimately be the best option you can choose for the health of your patient.
If you are interested in learning more on how to help your clients, check out this blog post on Eating Disorder Warning Signs as well as this article on How to Assess for a Higher Level of Care. Additional resources on eating disorders are also provided on our website here. If you have any further questions, feel free to reach out to us, and we would be happy to discuss.
Our eating disorder dietitian nutritionists are located in College Park, Maryland, Columbia, Maryland, and Alexandria, Virginia, Colorado, and Pennsylvania. Read more about the Courage to Nourish team here. We’d love to support you in eating disorder recovery.
Helping my clients cultivate meaningful connections and interests outside of their eating disorder is a true passion of mine. I like to think my clients and I are on a team to navigate recovery. I love working with high school and college students as well as athletes seeking to have a better relationship with exercise. I am a proud anti-diet dietitian and work with my clients through a Health At Every Size © and intuitive eating framework.