The Role of the Dietitian in Eating Disorder Treatment

A dietitian is a central part of anyone's recovery and often the most feared and the most misunderstood. People typically expect the sessions to be solely about what to eat and when to eat it. That can be extremely exposing and uncomfortable, if not upsetting or even infuriating for people seeking help. It's easy to see why it's hard for people to follow through with the appointments with this expectation. 

However, there is a big difference between seeing a skilled dietitian specifically trained to treat people with eating disorders and an otherwise good one. 

Expert dietitians who specialize in treating people with eating disorders have very different training. They typically have worked with a therapist or treatment program to learn therapeutic techniques about eating disorder treatment. So these sessions tend to be a cross between a typical dietitian session and therapy. In other words, the appointments are best described as food-centered therapy. 

In addition to setting out a meal plan and an idea of when to eat and what to eat, the treatment involves discussing fears of food, the emotions triggered by eating and the experience of progressing in recovery. 

By centering the food-focused aspect of treatment with the dietitian appointments, therapy sessions can more freely focus on psychological and emotional aspects of recovery. The complementary nature of these two appointments allows for much more direct attention to all components of wellness. Trying to use therapy both for food and therapy often slows recovery and limits progress. 

Assembling a team of a therapist and dietitian who know each other and work together in a similar style can be of enormous help to treatment as well. It's a big step to understand and accept the true nature of why dietitian appointments are essential for recovery. Doing so is representative of a true dedication to recovery.

The Path through Body Image in Recovery

Body image thoughts constitute the most stubborn and tenacious symptom of an eating disorder. For most people, the ultimate goal of the illness is to lose weight and reclaim their body in an idealized form. The result is a wish, a panacea. Life will be wonderful and the world will somehow be good once the magic weight is attained. 

When a fantasy is imbued with an overarching expectation, the desire is doomed to fail. Logically, no weight can fix an entire life. No body shape solves all of one's problems. But the most common implied thought of an eating disorder is just that. 

Two realities ensue from this eating disorder thought. First, no one wants to give up the goal of weight and body because it means giving up the wish for an easy fix to life. Second, negative body image thoughts have little to do with body, as shown in the study from the last post. When a supposed visual about one's body actually reflects all the ills of one's life, there is no negotiating with the power of these thoughts. Moreover, if body image reflects the negative feelings about oneself, those thoughts have no chance of a fix in the eating disorder paradigm. They will remain forever elusive and only cause misery. 

Healing from these critical, negative thoughts means engaging with the actual issues in life. The negative thoughts stem from feelings about life, relationships and emotions. The supposed easy fix of the body image thoughts is to translate the negative emotions about external realities into negative thoughts about body. Then trying to fix one's body stands in for trying to handle the emotions of life, to no avail. 

It is a tough sell to help people face those feelings. The emotions are scary, and the automatic reaction is to turn to the eating disorder for help. Acknowledging and experiencing the feelings is challenging and unpredictable. Each person needs help to manage the intensity and confusion of the emotions and to know things will turn out ok in the end. This process can be very effective. The hard part is helping someone see the value in ignoring the body image thoughts and instead facing the emotions of life.

Connecting with Body in Recovery

People with eating disorders focus relentlessly on body and weight. This focus may be common in today's world, but the level of obsession in these illnesses is significantly more consuming. The thoughts stop reflecting reality and instead become a powerful internal dialogue that goes beyond just the simple wish to lose weight. For instance, how else can an emaciated person still feel she needs to lose weight?

Outside of illness, others often interpret these eating disorder obsessions as they would the normal wish to lose weight. Without considering the overall pressure about body size in our society, it's crucial to realize the stark difference between this common wish and the eating disorder thoughts. 

Often the obsessions about body and weight in an eating disorder actually has little to do with one's body. Research reflects this quite clearly. In one study, patients with and without anorexia were asked to reflect on their own self image during an MRI. The results for people with anorexia, unlike the others tested, showed that in processing their own body, they did not activate the visual center of their brain. In other words, self-image for people with anorexia did not reflect the actual, visual representation of themselves. 

This information is very helpful in recovery. It's easy to extrapolate from this study that recovery needs to involve connecting with one's body again. An eating disorder separates self-image from the body itself. So recovery means learning to feel, process and experience the feelings in your body. This may not be intuitive about eating disorders but is critical to understand the process of getting well. 

Accordingly, inpatient and outpatient programs often include yoga, walks and various other forms of treatment that involve movement. Therapy must regularly recognize how people experience their lives and emotions in their body, not just in their minds. Recovery is not just an intellectual or even an emotional process but also a physical one. Wresting a life back from an eating disorder involves transforming all components of the human existence.

Food Villains in our Culture

Media coverage of nutrition is based largely on the need for more readers. The public appetite for nutrition advice, news and suggestions is insatiable. Despite the overwhelming evidence that diets don't work, reputable news outlets can't help but report on new diet fads. Nutrition experts all agree that eating advice needs to be very simple, yet the media jumps on the newest nutritional bandwagon for fears of losing ground in the marketplace. 

To clarify for readers of this blog, when research shows that diets don't work, the conclusion isn't that weight loss is impossible. It means that low calorie, short-term diets ignore medical knowledge about weight and set point ranges. Successful weight loss means slow, steady changes in what someone eats combined with regular activity. These steady changes lead to overall health improvement and a shift in one's weight range downward and allows one's actual weight to decrease as well. 

With regards to the newest media trend, it appears that a new generation of food villain has officially arrived. In the eighties, the first official villain was fat, largely propagated by fear of cardiac problems. The nineties and into the aughts left behind fat for carbs, in large part because of the media powerhouse Atkins diet. Currently, the newest villain is sugar based on newfangled information about glycemic index and medical research into gastrointestinal endocrinology. However, like the other villains, medicine is still struggling to prove what is actually true. 

The best way to approach these fads is to acknowledge that food is best eaten in a  large variety and primarily whole foods. Our bodies are designed to eat this way and function best when given food that match what humans have eaten for centuries. 

People with eating disorders or disordered eating tend to eat by strictly following the latest unsubstantiated guidelines and avoiding the newest fear foods. In extreme cases, people eat very strict and often unhealthy diets. Avoiding fat or carbs almost exclusively can cause significant health problems from malnutrition. For example, it is often shocking to someone with anorexia how much damage their body withstands from avoiding fat for years. 

The newest villain is likely to inspire similar unexpected medical effects from people who assiduously avoid sugar. There is no way to predict the effect other than to know that food is meant to be eaten and not overanalyzed. We are designed to eat a variety of food and to eat mostly regular food, not items made in factories. The more we ignore media coverage of the latest diet or food villain, the freer we all are to live our lives fully.