Eating disorders are complex mental illnesses that severely impact the person’s health (mentally, physically, socially, … really all aspects of health!). And despite being a mental health issues, we cannot recover from an eating disorder without food.

In many cases (if not all), food is the medicine. Therefore, effective treatment requires a holistic approach that includes a registered dietitian specializing in the treatment of eating disorders. 

From prevention to early detection to treatment, and finally maintenance, the role of the dietitian in eating disorder care is crucial. While we can all agree that eating disorders are not JUST about the food, food  (including eating behaviours, food thoughts/beliefs and emotional ties to food) is a central point of treatment focus.

A recent study in Australia found that while 91% of eating disorder manuals included nutrition-related content, only 36% made specific reference to including a dietitian on the multidisciplinary treatment team1. Based on these statistics, we can see that food, nutrition, and eating behaviours are accepted as core topics in eating disorder treatment. Despite this, some ambiguity remains about the role of the dietitian in eating disorder care.

So what exactly is the role of the dietitian in eating disorder care? How can including a dietitian on the multidisciplinary team benefit treatment outcomes? 

In this blog post, we’ll explore the various roles dietitians play in the prevention, early detection, treatment, and maintenance of eating disorder care.


Listen to this week’s episode to hear Marie-Pier talk through the role of dietitians (episode 154),


NOTE:

In this blog post, we are talking about anti-diet and eating disorder dietitians. We do acknowledge that not all dietitians follow our philosophy and unfortunately the dietetic profession has caused a lot of harm.

Prevention

With the increasing influence of diet culture and the thin ideal in the media, dieting and disordered eating behaviors are becoming more and more common which we know is a BIG risk factor in the development of an eating disorder.

When it comes to the prevention of eating disorders, a dietitian’s role can be split into three major categories – education, advocacy, and healthy food relationship modeling.

Education:

Dietitians are our most trusted source of evidence-based food and nutrition-related information. With the rising popularity of social media and fitness influencers, more and more “information” (alternatively read “misinformation”) is available. Following the fast fashion trends we see in the clothing industry (a.k.a. quick turnover of styles resulting in mass production of cheap textiles which contributes 8-10% of global carbon emissions2), diet trends and fads are emerging and changing just as quickly with equally detrimental impacts.

With endless posts telling people what to eat, what not to eat, when to eat, and how much, it can be confusing sorting through all of the information available on the internet. This is where dietitians play an important role.

Dietitians work to combat the ample amounts of misinformation people are exposed to about food and nutrition daily. They help to teach people how our bodies use food for fuel, while still acknowledging the social, cultural, and spiritual roles that food plays in our lives as well. Dietitians also help people to unlearn unhealthy thoughts and behaviors about food to support healthy relationships with food and the body. 

Whenever you’re exposed to information about food and nutrition on the internet and you’re not sure what to make of it, a dietitian is always a great place to turn for advice!

Advocacy:

As a regulated health profession, dietitians as a whole must advocate for policies and decisions related to food, nutrition, and health systems. So what exactly does this mean for eating disorder care?

Dietitians can advocate to governments and agencies to promote better standards of care for the prevention and treatment of eating disorders in a variety of ways, including:

These avenues of advocacy are just some of the behind-the-scenes ways dietitians work to decrease stigma and improve the accessibility of health services for people living with eating disorders.

Healthy Food Relationship Modelling:

As dietitians, we can model what a healthy relationship with food looks like for our community and clients. This can be a powerful protective factor for folks.

Early Detection

When it comes to early detection and screening for eating disorders, dietitians are in a prime position. Based on their knowledge and expertise, dietitians can help people identify unhealthy or disordered food rituals and eating behaviors before they become full-blown eating disorders. For early warning signs, check out this blog post.

However, folks may seek a dietitian’s help for something not related to their eating disorder (either if they are unaware or maybe don’t feel ready to address it yet). Instead, this concern may be masked with complaints of4:

There are also physical signs that dietitians (along with other health care professionals) can look out for that may be signs of an eating disorder. These include, but are not limited to:

*IMPORTANT NOTE : Not everyone who has an eating disorder loses weight or lives in a small body. Folks of all body sizes can have an eating disorder. To further investigate the thoughts, feelings, and behaviours that someone has about food and their body, dietitians can also use something called the SCOFF questionnaire. The SCOFF questionnaire is made up of five brief questions and can be used to screen for Anorexia Nervosa and Bulimia5.

The SCOFF questionnaire:

Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone (15 lbs) in a 3-month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?

*One point for every “yes”; a score of ≥2 indicates a likely case of anorexia nervosa or bulimia.

Like many other illnesses, early detection and intervention can improve the speed of recovery and reduce short- and long-term side effects6. If you or someone you know is showing warning signs of an eating disorder, a dietitian is a great person to turn to for guidance.

Treatment

As we’ve discussed, dietitians play an integral role in the treatment of eating disorders. Dietitians primarily work with the patient alongside a multidisciplinary team

So what does the dietitian add to the treatment team? What exactly is their role?

The dietitian’s exact role may change depending on the needs of the patient, the multidisciplinary team they’re working on, and the treatment setting. Overall, when it comes to eating disorder care, the scope of practice of a dietitian includes, but is not limited to, the following:

No two eating disorders are the same. Dietitians have a variety of skills and knowledge that they bring to the table. This allows them to meet people where they are in recovery and provide the tools they need to be successful.

It is also worth noting that while the person living with the eating disorder is the most affected, those around them are also impacted by the eating disorder. Dietitians can help support parents and others in the support system by providing education, dispelling myths, and planning meal support for the person living with the eating disorder.

Use the link here to book an appointment with a dietitian on The Balanced Practice team!

Maintenance

Recovery from an eating disorder is a long process, and relapse is always something that people need to be cautious of. Recovery from an eating disorder is possible, and continuing to work with a dietitian can help to maintain the progress made.

After completing treatment for an eating disorder, dietitians can help people continue to heal their relationship with food and their body. Ongoing maintenance can include individual and group sessions discussing topics like mindful eating, intuitive eating, hunger and fullness cues, emotional hunger, and fullness, Health At Every Size (HAES), body neutrality, and much more.

In recent years, many dietitians have adopted an anti-diet, weight-neutral, and pro-recovery approach to their practices. Through continued education and learning, dietitians can provide up-to-date information to folks who follow and addresses changes in the media and society.

As we discussed in our previous blog post on The Role of Community in Eating Disorder Recovery (you can find the post here), having a community support group can be extremely helpful when in the maintenance phase of recovery.

Recovery is a journey, and it’s important to remember that you always have people in your corner supporting you as you learn and grow.

Conclusion:

Eating disorders are complex illnesses that impact all aspects of an individual’s life. As a result, the role of the dietitian in eating disorder care is varying and adaptable to the needs of the individual. Here at the Balanced Practice, our dietitians take an anti-diet, weight-inclusive, and trauma-informed approach to eating disorder care. If this sounds like a good fit for you or someone you know, check out our services!

If you would like to work with an anti-diet registered dietitian, check out the dietitian at The Balanced Practice.

Written by: Olivia Kuhlmann, RD, MPH, CDE

Reviewed by: Marie-Pier Pitre D’Iorio, RD, B.Sc. Psychology 

References:

[1] https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00344-x

[2] Stallard, E. (2022, July 29). Fast fashion: How clothes are linked to climate change. BBC 

News. https://www.bbc.com/news/science-environment-60382624 

[3] https://www.dietitians.ca/Advocacy 

[4]https://www.camh.ca/en/professionals/treating-conditions-and-disorders/eating-disorders/eating-disorders—screening-and-assessment 

[5] https://www.bmj.com/content/319/7223/1467 [6] https://www.nationaleatingdisorders.org/blog/why-early-intervention-eating-disorders-essential