What is the dietitian’s role in eating disorders?

Eating disorders are complex and can affect everyone differently, which is why dietitians play an integral role in a client’s treatment and recovery plan. Even though no client is the same, there are some overarching ways that you, as a nutrition professional, can nutritionally support them.

Eating disorders (ED) are a serious health issue and need to be carefully handled to ensure a full recovery. Since EDs go hand in hand with nutritional intake and diet, it is no surprise that registered dietitians play an integral role in the treatment and recovery plan. As a nutrition professional, you can work with your client to recognize the difference between physical hunger and satiety cues, help them repair their relationship with food, and ensure that they get the proper amount of calories and nutrients through custom meal plans. These things, among many others, make your role a vital aspect of a client’s recovery. But how else can you help, and what should you know before taking on an ED client?

Before discussing how you, as a dietitian, can help with EDs, let’s understand what an eating disorder is, as well as some common ones you may encounter.

Understanding eating disorders

An eating disorder is defined as a serious mental illness, characterized by an unhealthy preoccupation with eating, exercising, and body weight or shape [11].

While the exact cause of eating disorders is unknown, research has found a few factors that may contribute.?

• Genetics: Your genes may play a role in EDs. Studies have examined twins, and the results show that if one twin had an eating disorder the other one was 50% more likely to develop one as well [1].
• Personality: Certain personality traits (neuroticism, perfectionism, and impulsivity) are often linked to a higher risk of developing an ED [1].
• Culture: Society’s perceived pressures to be thin, as well as cultural preferences for thinness, and exposure to social media may lead to an ED [1, 2].
• Brain structure and biology: Although not thoroughly studied, a few studies suggest that a person’s levels of serotonin and dopamine can be a factor in ED development [3].?

Types of eating disorders

Dietitians should be acquainted with the different types of eating disorders before attempting to treat or manage any patients. While there are many more EDs, here are some that are most commonly seen and treated.?

Anorexia Nervosa

This is the most well-known eating disorder, with people viewing themselves as overweight even when they are dangerously underweight. This tends to develop in adolescence and young adulthood and affects more women than men [4]. Common symptoms can include:

• Restricted eating patterns;
• Intense fear of gaining weight;
• Distorted body image;
• Being severely underweight.?

People with anorexia nervosa tend to restrict themselves by fasting, doing excessive exercise, and/or participating in extreme dieting. If left untreated, the affected person’s bones can begin to thin, develop brittle hair and nails, and have infertility, with more severe cases resulting in heart, brain, and/or multi-organ failure [4].?

Bulimia Nervosa

This is another very well-known ED, and also tends to develop throughout adolescence and early adulthood. Those with this condition frequently eat large amounts of food in a short period of time until they become painfully ill. They often then choose to purge to relieve discomfort and lose the calories they accrued. Some common symptoms include:

• Recurrent episodes of binge eating;
• Recurrently purging to prevent any weight gain or caloric intake;
• Self-esteem overly influenced by the body.?

They often experience many side effects like sore throat, gut discomfort, dehydration, and hormonal disturbances [5]. Moreover, those affected have a higher risk of causing permanent damage to their stomach, intestines, and esophagus.?

Binge Eating Disorder

This is one of the most common eating disorders and can develop at any point in life. People affected have similar symptoms as those with bulimia, but do not restrict calories or purge in order to compensate for binges. Common symptoms include:

• Eat large amounts of food rapidly, even if not hungry;
• Feelings of shame, disgust, and guilt when thinking about the behavior;
• No use of purging like excessive exercise, vomiting, or laxatives.

Those with this disorder often are overweight or obese, which can increase their risk for heart disease, strokes, and type 2 diabetes [6].?

Pica

This eating disorder involves eating things that are not considered food, such as ice, chalk, soap, cornstarch, and paper. This is most often observed in children, pregnant women, and those with mental disabilities [7]. Depending on what they ingest, this could be fatal or cause poisoning, infections, and internal injuries.?

What credentials are necessary?

If you want to work with those affected by eating disorders, it’s recommended to obtain the Certified Eating Disorder Registered Dietitian (CEDRD) credential. This is the best way to fully understand the medical, therapeutic, and nutritional needs of EDs so you can provide the best evidence-based care.?

How can dietitians help?

When working with clients who suffer from an ED, it’s important for you to develop a strong rapport due to their high risk of relapse. Instilling a sense of trust between yourself and the client is necessary to ensure they feel safe, supported, and encouraged, all while meeting their nutritional and dietary needs. Here are a few ways that dietitians can be involved with the ED treatment and recovery process.

Monitor weight

Part of ED recovery includes dietitians helping to restore weight. While this is going to be different for every client, research has found that a 0.5 to 1 lb/week weight gain can be beneficial and aid in restoring menses [9].

However, not all clients will feel comfortable seeing their weight; in this case, you can “blind weigh” them by covering up the number on the scale or having them face backwards during this process. While recording weight is helpful in the recovery process, it’s not the only parameter for success.?

Create custom meal plans

Regardless of the type of ED, your client has, you can help them reach their caloric and nutrient needs through collaborative meal planning [8]. When working on a custom meal plan, consider having your client eat small, frequent meals that contain a variety of fiber-rich, nutrient-dense foods, with a possible emphasis on fatty acids [10].

Depending on the client, you may need to recommend a multivitamin or supplement to meet their nutrient needs. Additionally, you may want to have your client avoid caffeine (as it can hinder appetite) and lactose-containing foods, as this may cause stomach upset; however, these recommendations will be dependent on your client’s needs and specific ED.?

Normalize eating patterns

Those suffering from an ED typically have many negative thoughts around food, so as a dietitian, it’s your job to help your clients start thinking about “food as fuel” rather than “food as an enemy”, and having them understand the difference between physical hunger and satiety cues.

Since many people affected with EDs feel guilt or shame around certain foods, you can help your clients realize that food provides sustenance and pleasure by encouraging the thought that “all food is good food”. As your sessions progress, you can also help your client become more comfortable with food-related activities (such as cooking, grocery shopping, or eating out).?

Work with other healthcare providers

Depending on the severity of your client’s eating disorder, they may require different levels of care and treatment, such as inpatient treatment, residential treatment, partial hospitalization, or outpatient.

As a dietitian, you would collaborate with other healthcare providers to ensure that your client’s needs are being met. These needs can range from constant round-the-clock care, sessions for a few hours every day, or even sessions just once a week.

Summary

Eating disorders are complex and can affect everyone differently. Dietitians play an integral role in the ED treatment and recovery plan by helping clients repair their relationship with food, normalize eating patterns, and restore their weight. These things, among many others, make your role a vital aspect for those suffering from eating disorders, and with your help, they can make a full recovery.

References:

1. Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). Research Review: What we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research. Journal of child psychology and psychiatry, and allied disciplines, 56(11), 1141–1164. https://doi.org/10.1111/jcpp.12441
2. Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological bulletin, 129(5), 747–769. https://doi.org/10.1037/0033-2909.129.5.747
3. Marsh, R., Stefan, M., Bansal, R., Hao, X., Walsh, T., Peterson, B. (2013). Anatomical Characteristics of the Cerebral Surface in Bulimia Nervosa. Biological Psychiatry, 77(7), 616-623. https://doi.org/10.1016/j.biopsych.2013.07.017?
4. Nagl, M., Jacobi, C., Paul, M., Beesdo-Baum, K., H?fler, M., Lieb, R., & Wittchen, H. U. (2016). Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. European child & adolescent psychiatry, 25(8), 903–918. https://doi.org/10.1007/s00787-015-0808-z
5. NIMH Information and Publications/ (2021). Eating Disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/eating-disorders
6. Kyrou, I., Randeva, H. S., Tsigos, C., Kaltsas, G., & Weickert, M. O. (2018). Clinical Problems Caused by Obesity. ?Endotext .https://www.ncbi.nlm.nih.gov/books/NBK278973/
7. Advani, S., Kochhar, G., Chachra, S., & Dhawan, P. (2014). Eating everything except food (PICA): A rare case report and review. Journal of International Society of Preventive & Community Dentistry, 4(1), 1–4. https://doi.org/10.4103/2231-0762.127851
8. Ozier, A. D., Henry, B. W., & American Dietetic Association (2011). Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders. Journal of the American Dietetic Association, 111(8), 1236–1241. https://doi.org/10.1016/j.jada.2011.06.016
9. Halmi KA. Classification, diagnosis and comorbidities of eating disorders: a review. In: Maj M, Halmi K, Lopez-Ibor JJ, Sartorius N, eds. Eating Disorders. Vol 6. England: John Wiley and Sons Ltd; 2003:1-33.
10. American Dietetic Association. Nutrition Care Manual. Anorexia nervosa: nutrition prescription. https://www.nutritioncaremanual.org/topic.cfm?ncm_toc_id=21689. Accessed January 14, 2022
11. Eating disorders explained. Eating Disorders Victoria. (2021, July 8). Retrieved January 14, 2022, from https://www.eatingdisorders.org.au/eating-disorders-a-z/eating-disorders-explained/?