Just as the relationship to food is an integral part of eating disorder development, addressing this with a Dietitian is an integral part of eating disorder treatment and recovery. It is impossible to lead a patient through understanding the nutritional and physical consequences of eating disorders, experiences of a possible referring syndrome, and exploration of appropriate nutrition without a Dietitian present.
Discussing these aspects are so far outside of the professional purview and training of Therapists that addressing them in treatment would truly be unethical.
Even so, a recent survey found that even though 91% of treatment manuals related to adult eating disorder treatment “contained some degree of nutritionally-focused content, only 36% of the manuals recommended a dietitian be consulted as part of the multidisciplinary treatment approach .”
Not only that, “less than 50% of eating disorder specialists agree that patients with an eating disorder should be referred to a dietitian for assessment, education, and guidance about nutrition .” This lack of inclusion of Dietitians in treatment is greatly concerning, as, without them, the risk for relapse is high.
To emphasize why Dietitians are crucial to eating disorder treatment and recovery, it is important to understand their invaluable contribution to the treatment team.
Navigating Malnourishment and Refeeding
Most individuals struggling with an eating disorder are experiencing some semblance of malnutrition. This does not mean all individuals will appear emaciated. However, it is likely that their disordered behaviors have resulted in numerous concerning and dangerous nutritional deficiencies.
Reintegrating nutrition is an important process that needs to be handled carefully, as reintegrating too quickly can result in refeeding syndrome or other physical discomforts. Regardless of the knowledge eating disorder therapists have on nutrition, unless they are trained and licensed, it is not ethical for them to speak to these aspects of treatment and recovery.
As one study acknowledged, these professionals are “well-positioned to help patients eat more, they are not necessarily equipped with the nutritional knowledge about how to treat malnutrition .”
The study goes on to clarify that “Dietitians are highly educated at university in human physiology, biochemistry, pathology and eating disorder behaviour, contributing valuable knowledge and insight to the outpatient treatment team .”
Building on Progress
It is often believed that nutritional rehabilitation is most important in the most intense levels of treatment but may not be necessary as treatment continues to an intensive outpatient or outpatient level of care. While true that nutritional rehabilitation is key to the treatment of severe eating disorders, it is a process that continues throughout the treatment and recovery process.
In their work with patients, “dietitians go beyond creating an energy surplus to support weight restoration, by also addressing energy availability, the timing, and distribution of macronutrients across the day and optimizing opportunities to meet micronutrient needs through dietary change .” These skills must be taught and reinforced throughout treatment recovery, even after a patient moves to the outpatient level of care.
Keeping Pace with a Dietitian in Eating Disorder Treatment
A final valuable way to conceptualize the importance of the Dietitian is to consider that the “nutritional and psychological elements of care can be thought of as being connected by a rubber band, moving in tandem and relative to each other during treatment .”
This example goes on to emphasize that if either the psychological or nutritional element outpaces the other, the “rubber band” of treatment will break. For this reason, patients must engage in both nutritional growth and progress as well as psychological growth and progress at the same pace.
Both of these elements being focused on in tandem increase the likelihood that patients will experience effective treatment and long-term recovery.
Resources: Jeffrey, S., Heruc, G. (2020). Balancing nutrition management and the role of dietitians in eating disorder treatment. Journal of Eating Disorders, 8:64.
About the Author:
Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published December 17, 2020, on EatingDisorderHope.com
Reviewed & Approved on December 17, 2020, by Jacquelyn Ekern MS, LPC