What is Nutrition Therapy?
Nutrition Therapy is an essential component of eating disorder treatment. Typically provided by a registered dietian or nutritionist, nutrition therapy includes a combination of nutrition education, meal planning, cognitive behavioral therapy and goal setting. It also may include hands-on exposure and skills work. Nutrition therapy helps the individual recovering from an eating disorder cultivate a healthier relationship with food in order to gain the skills and education needed to feed oneself for health. As part of the multi-disciplinary team approach, the nutrition element of treatment focuses on food-related behaviors, allowing time in psychotherapy to be spent examining the underlying issues leading up to the development of an eating disorder.
Not surprisingly, nutrition therapy is often met with a great deal of resistance. In the nutritionist’s office, patients face their fear head on. Imagine you are deathly afraid of snakes and suddenly find yourself in a cobra den, and you’ll get a sense of what it’s like for an individual with an eating disorder to sit in a nutritionist’s office. However difficult it may be, sitting with this fear (in a safe environment) is an important part of recovery.
What is a Registered Dietitian/Nutritionist?
The dietitian or nutritionist works as an integral part of the multi-disciplinary team. This person has extensive knowledge of food, nutrition and metabolism. In addition to providing counseling and education, he or she will help the team determine a healthy weight goal, energy needs, risk of malnutrition, and strategies for behavioral change.
Many people wonder what the difference is between a dietitian and a nutritionist. Here is the short and simple answer: A registered dietitian (RD) is credentialed through the American Dietetic Association, whereas no credentialing is required to call oneself a nutritionist. Many dietitians will refer to themselves as “nutritionists” or “nutrition therapists” but the letters “RD” after their name signify that they are credentialed. You can learn more about the credentialing process by clicking here.
It is important for the nutritionist on the team to have prior eating disorder experience and/or receive close supervision from someone who has this expertise. Most dietetic programs do not offer training in eating disorders beyond class review. Here are some important questions to ask a dietitian:
- Have you ever worked with eating disorders? If so, for how long?
- What is your treatment philosophy and/or approach to nutrition counseling?
- Do you collaborate with other clinicians? If so, how have you done so in the past?
- Where do you receive support around eating disorder cases you are currently working on?
What Can I Expect at the Nutritionist’s Office?
It can be intimidating to start this process; so it might be helpful to know a little bit about what to expect. Here are some things a nutritionist is likely to address during the first few visits:
- What you hope to get out of nutrition therapy
- Prior experience working with a nutritionist/dietitian
- Main concerns around eating/weight
- Your medical history
- Family medical history
- Medications and over-the-counter supplements
- Your weight history (note: some of this can be obtained from your doctor)
- Your diet history
- Diet recall (i.e. you may be asked to verbally recall what you’ve eaten)
- Diet history (i.e. past diets, nutritional issues, allergies, etc.)
- Review of eating disorder behaviors
- Review of physical symptoms
- Lifestyle (work, school, relationship, etc.)
- What motivates you in your recovery
What is a meal plan?
A meal plan is a tool used in eating disorder recovery that provides a framework for healthy eating. The nutritionist will formulate a meal plan catered to the patient’s individual nutritional needs. Many dietitians use the exchange system for this purpose. The exchange system includes food portion estimates or “exchanges” from each food group (i.e. grains, proteins, fruit, vegetables, milk/dairy, fats, sweets). These exchanges are used to map out a balanced, varied eating plan.
The meal plan provides structure and an external guideline for patients with eating disorders. It is helpful to have this external framework initially, since most people with an eating disorder lose the ability to recognize physical hunger cues. Eating mechanically by way of the meal plan provides the foundation for internal food regulation. Think of the meal plan like a set of “training wheels”. A person won’t need them forever, but in the initial stages of treatment, it can be very helpful.
What are other strategies used in nutrition therapy?
After an assessment of a person’s history and goals, the nutritionist will determine what strategies will be most helpful. Here are some strategies a nutritionist often uses:
Nutrition Education and Counseling
A large part of nutrition therapy includes education and behavioral counseling. Nutritionists specializing in eating disorders encourage healthy eating while emphasizing the importance of pleasure and moderation in the eating process. Individuals with eating disorders hold a lot of distorted thoughts about food and their bodies. The dietitian helps challenge and reframe these thoughts, while providing accurate and helpful information on nutrition and metabolism to support the recovery process.
Motivational Work and Support
Since most patients arrive at treatment with a high level of ambivalence, the nutritionist will often do some motivational counseling to help move them towards change. It is important that the client be invested in the work, but a certain degree of uncertainty and fear is normal. A good dietitian or nutritionist will determine what motivates their patients and help support them through difficult changes.
Exposure and Skills Work
The dietitian will often coordinate with the psychotherapist and/or other members of the team to learn strategies for helping the patient be somewhat relaxed during this type of work. Examples may include the following:
- creating a plan for when challenging foods will be incorporated
- strategizing around how to manage challenging food situations
- trying challenging foods in session
- visiting the grocery store
- eating at a restaurant
Mindfulness/Appetite Awareness Training
Once a client is ready, it’s beneficial for them to move towards internal regulation of food intake. In order to provide the skills needed for this, the nutritionist or dietitian will do some mindful eating and appetite awareness training. Here are some activities that may be used to enhance this part of the recovery process:
- keeping a food journal and rating hunger and fullnes levels
- mindful eating exercises in session
- providing guided meditation opportunities and/or tools
Amy Gardner, MS, RD