Do I Need to See an Eating Disorder Dietitian? Here’s How They Can Help
If you’ve been diagnosed with an eating disorder or suspect that your relationship with food is negatively impacting your life, you may have wondered “do I need to see an eating disorder dietitian?”
The short answer is for many people, yes.
An eating disorder dietitian does much more than create meal plans. They can help you meet your energy and nutrition needs, understand what “normal” eating looks like, support you in building a more positive relationship with food and your body and work alongside your GP, psychiatrist and psychologist to support eating disorder recovery.
Before I delve further into what an eating disorder dietitian does, let’s talk more about eating disorders.
What is an eating disorder?
The National Eating Disorder Collaboration (NEDC) describes eating disorders as “serious mental illnesses; they are not a lifestyle choice or a diet gone ‘too far’.” This is such an important statement, because something eating disorders are experts is convincing people that they aren’t “sick enough” or that their eating disorder isn’t as “bad” as someone else’s.
Eating disorders can affect anyone – they don’t discriminate. That means any individual, no matter their age, weight, gender, sexual orientation, gender identity, culture, socioeconomic status or body shape can experience an eating disorder. There are many different types of eating disorders, including:
Anorexia Nervosa (AN) – this is often the eating disorder that people are most familiar with due to how it is commonly portrayed in the media.
Bulimia Nervosa (BN) – characterised by episodes of binge eating followed by compensatory behaviours (which most people think means vomiting but it can also be excessive exercise or misuse of laxatives or diuretics)
Binge Eating Disorder (BED) – the most common type of eating disorder in Australia
Other Specified Feeding or Eating Disorders (OSFED) – this is individuals who don’t meet criteria but are experiencing symptoms of an eating disorder. It is just as serious as any other type of eating disorder.
Avoidant/Restrictive Food Intake Disorder (ARFID) – avoidance or restriction of food that is not due to body image concerns
Unspecified Feeding or Eating Disorder (UFED)
Rumination disorder
Pica
If you’d like to learn more about each type of eating disorder, I’d highly recommend exploring NEDC’s or the Butterfly Foundation’s website further as they have much more information and resources that explain each one in depth.
So now you have a diagnosis and a little bit more information about eating disorders, where to from here?
Who is involved in an eating disorder treatment team?
Best practice suggests that an eating disorder multidisciplinary team (MDT) should include:
General Practitioner (GP) (and/or psychiatrist or paediatrician) who creates the care plan, oversees the treatment and does regular medical monitoring as necessary.
Psychologist who provides psychological treatment and support, addressing the thoughts, emotions and behaviours associated with eating disorders.
Eating disorder dietitian who provides nutrition support.
What does an eating disorder dietitian do?
An accredited practising dietitian plays an important role in eating disorder recovery. Most people think of dietitians and meal plans, however dietetic treatment goes well beyond this. Dietetic intervention can include:
Education on what a “normal” relationship with food looks like
There is so much misinformation online that it can be difficult to know what “normal” eating looks like. An eating disorder dietitian can myth bust common misconceptions and help you have more sustainable eating patterns, rather than continuous dieting, restriction, bingeing or loss of control around food.
Medical nutrition therapy and support in refeeding safely
A dietitian is trained to provide evidence-based nutrition care that is tailored to each person’s individual needs and circumstances. For people experiencing eating disorders, this can include how to safely refeed and meet energy and nutrition needs based on where an individual is in their recovery.
Challenging food rules and fear foods
Eating disorders tend to love rigid rules or beliefs around food. Although some may be based on healthy eating advice (e.g., eat plenty of vegetables), food rules are much more rigid and can create feelings of guilt or shame if not followed. An eating disorder dietitian can help an individual identify and gently challenge these food rules and fears during treatment. Importantly, the goal isn’t to remove all structure from eating, but to move towards flexibility and choice.
Tailor advice to the individual
An eating disorder dietitian combines current evidence and clinical guidelines with your day-to-day life, goals, preferences, past medical history, support network and so much more. This allows nutrition advice to be realistic, practical and tailored to you, rather than being a one-size-fits-all approach.
Every person's recovery is different, so dietetic support is tailored to their unique needs. The list above highlights just some of the ways an eating disorder dietitian can support recovery.
A lot of this work is done alongside psychological support and regular correspondence with the MDT is another important role of a dietitian that is often unseen.
Some accredited practising dietitians may also be credentialed eating disorder clinicians (that’s me!). What this means is that the dietitian has the experience and training to provide effective and safe eating disorder care as per the Australia and New Zealand Academy for Eating Disorders (ANZAED). This credential is voluntary, meaning a dietitian does not need to hold it to provide eating disorder nutrition support. However, it can help people find clinicians with additional specialised training and experience in eating disorder care.
Based on the current evidence and best practice guidelines, an accredited practising dietitian is an integral part of the eating disorder treatment team and anyone experiencing an eating disorder would benefit from working alongside an eating disorder informed dietitian. So how come at the start I said most, not all people, should see one?
Do I need to see an eating disorder dietitian?
I think it’s always important to acknowledge that whilst there are recommendations around eating disorder treatment, it may not always be possible for some individuals. And that’s ok. There are also situations where seeing an eating disorder dietitian may feel too difficult, inaccessible or simply not be the right step at this stage. Some valid reasons may include:
Cost: If you are eligible for the Medicare Eating Disorder Treatment and Management Plan (EDP), Medicare does subsidise appointments, however, seeing a GP, psychologist, psychiatrist and dietitian on a regular basis still has out of pocket expenses. Medicare does cover some cost but not enough, unless you reach the Medicare Threshold and get up to 80% of out-of-pocket expenses. Speak to your team about whether you are eligible to access an EDP. Note: Some private health insurance policies may also provide rebates for dietetic appointments depending on your level of cover.
Burden of appointments: Similar to above, seeing at least 3-4 different health professionals several times in a month can be overwhelming and draining.
Past experiences: The evidence-base has evolved over the years and continues to evolve. What dietitians were once recommended to teach, such as an emphasis on weight loss and diets we now know can be harmful depending on the individual and context. Maybe you saw a dietitian previously and felt judged or uncomfortable and you still have that negative association in mind. That’s fair enough! It might take some time for you to find a dietitian that is the right fit.
It’s scary!: One thing I didn’t mention before about eating disorders, is that eating disorders can be a type of coping mechanism. We know it’s not a healthy coping mechanism, however they usually have a purpose. Maybe when life was out of control, the one thing that could be controlled was eating. Now, other members of the treating team will of course challenge the eating disorder. But from my experience, most eating disorders hate the dietitian the most. I don’t take this personally, because it’s often the eating disorder responding to change, rather than a reflection of the individual or our relationship, however it can still feel scary for some people. In this case, I understand how challenging it can be to see a dietitian. I also know that as scary as it can be, a dietitian is there to support you to achieve your goals and support your recovery.
If you resonate with any of the points above, I’d recommend working with your GP and psychologist initially, and then reaching out to a dietitian when the time feels better, or when you need the nutrition support.
Eating disorder recovery can be overwhelming, but you don’t have to do it alone. Whether you’re newly diagnosed, been experiencing an eating disorder for a while or you want to improve your relationship with food, reaching out is the first step.
If you’d like to learn more about how PR Nutrition can support eating disorder recovery, we offer a free 10-minute connection call to give you the opportunity to ask any questions, learn what working together looks like and see if it feels like the right fit for you.
Recovery is possible with the right support, and know that no matter what your situation is, please know that you do not have to wait until things feel “bad enough” to ask for support. You are worthy of help at any stage of your recovery.