Working as a Registered Dietitian in the field of eating disorder treatment can be both very challenging and very rewarding.  Eating disorder treatment has many levels of care that range from inpatient or residential to partial hospitalization, to intensive outpatient, and then outpatient.  Hospitalized patients will see a dietitian several times per week, whereas an outpatient dietitian will see a patient once per week.

Eating disorders are very serious and complex, and therefore require care by several medical professionals.  A dietitian will work on a multidisciplinary team that includes therapists, family therapists, and psychologists.  In a higher level of care facility, the team can include a medical doctor, nurses, and case managers.  All members of the multidisciplinary team have an important job to do in helping someone with eating disorder treatment/recovery, as it is a comprehensive treatment involving medical, psychological, behavioral, and social practices.

Any person regardless of sex and weight can be struggling with an eating disorder.  A person can be overweight or even normal weight and have an eating disorder.  Eating disorders can affect anyone and are a very serious problem that needs to be addressed sooner rather than later.  Eating disorders have the highest mortality rate of all mental illnesses. 

So, what does a Registered Dietitian offer for a patient undergoing treatment for an eating disorder?  Dietitians play a vital role in the multidisciplinary team, providing nutrition education as well as behavioral and social skills.  The dietitian is known as the food expert, and many might assume they tell patients what to eat and what not to eat.  It is so much more than that.  When evaluating a patient with an eating disorder, the dietitian identifies any malnutrition and the severity of present malnutrition.  The dietitian also identifies the presence of disordered eating habits, which may involve numerous things ranging from restricting to bingeing and/or rituals in eating.  A patient’s knowledge of nutrition and their nutrition-related skill level need to be assessed and identified by the dietitian.  With so much misinformation available at our fingertips, the dietitian needs to know what the patient knows about nutrition and what they think they know to tailor their sessions to best teach them on the way to recovery.  The deficits in nutrition skills and knowledge can prevent the patient from receiving adequate nutrition, potentially leading to more serious health concerns in addition to the eating disorder.

When working with a dietitian, a patient can expand their understanding of important nutrition-related concepts, eliminate self-defeating behaviors and/or thoughts, and work towards building a better relationship with food.  Dietitians working with eating disorder recovery work with the patient to establish food neutrality.  Food neutrality is when we do not label a food as “good” or “bad,” people are not good or bad depending on what they had for dinner; food is neutral, and its purpose is to nourish our bodies.  When the morality of being good or bad is attached to food, we allow for negative thinking behaviors, self-defeating behaviors, and shame and/or guilt can become part of an after-meal experience.  Dietitians work with patients to add variety to their meals and to understand that all foods can fit into their lives.

When working with patients with eating disorders, the dietitian must assess the patient thoroughly to get as accurate of a look into that person as possible.  The more the dietitian understands about a patient, the better they can help and tailor the treatment plan to best fit the patient’s needs.  The first step for a dietitian is to assess the patient’s eating and behavior patterns.  It is helpful for the dietitian to know what the patient is currently eating and if they have any behavior patterns/rituals around food.  Honesty by the patient is crucial when the dietitian is assessing their current intake and behaviors.  Once the initial assessment is complete, the dietitian and patient can begin meeting at least once per week to work on nutrition knowledge and strategies. 

A dietitian will provide nutrition counseling and education to the client.  This will happen over many meetings, as the dietitian will cover new ideas at each session while also making sure the patient does not become overwhelmed.  The dietitian and patient work together during these sessions to help with learning and understanding nutrition-related concepts and strategies to improve eating and behaviors.  An important aspect of nutrition counseling is the involvement of the patient in active learning, coming up with ideas with the dietitian, and setting goals to work towards.  At some point in the sessions, the dietitian can create an individualized meal plan for the patient. With a wide range of behaviors in clients, from restricting or bingeing, a meal plan can provide the structure a patient needs to help with these behaviors while offering variety, choice, and flexibility.  Dietitians can create the meal plan and provide it to the patient, or the patient can be an active participant in creating the meal plan.  If a patient is involved in creating the meal plan, they will learn how to plan meals and create their meal plans in the future.  Patients also learn nutrition and behavior concepts that are fundamental to having a healthy relationship with food.  Planning with the help of a dietitian gives the patient ownership over their meal plan, meal schedule, and the foods on the meal plan, leading to greater success in adhering to the meal plan. 

Working with eating disorders requires dietitians to use both their dietetics knowledge and knowledge of counseling.  Counseling skills are essential for dietitians, as there are often mental illnesses and/or substance abuse issues that could be impacting nutritional intake and overall health that need to be addressed.  Dietitians can help patients learn and work on developing healthier copings skills, such as reaching for a book or game instead of food when they are not hungry.  The dietitian will help the patient learn to listen to their body, honor their hunger and satiety cues, and learn to identify what they might be needing when they are tempted to eat when not hungry.  Eating disorders are complex cases that involve both psychological and nutritional challenges.  The multidisciplinary team approach ensures that the patient’s needs are being met at every level of care.  Dietitians are an integral part of the multidisciplinary team and provide treatment to the patient in a variety of ways.  Increasing nutrition knowledge, improving behaviors/food practices, monitoring nutrition status, teaching healthier coping skills, and helping a patient become more tuned in to their body and its needs are just some of the ways dietitians help in the treatment of eating disorders.