What is my *actual job* as the dietitian on your eating disorder team?
When I was a new dietitian and didn’t yet know that I wanted to spend my career supporting people with eating disorders, the question of what a dietitian’s job is on an eating disorder team was a bit of a mystery to me.
Food seemed to be at the center of the treatment, and yet I had heard the saying “eating disorders aren’t about food”. If they’re not about food, but also they are about food, where does that leave the dietitian?
Today I am sharing what I would tell my former self about my job today.
These are what I consider five of the most central aspects of my role as the dietitian on your outpatient eating disorder treatment team.
Help you make sense of your eating disorder behaviours and symptoms
When you’re in the thick of an active eating disorder, it can feel really sticky to know where your identity and values end, and where your eating disorder symptoms begin. Learning about some common ways that eating disorders show up and how they tend to affect the brain and body can help shift from feeling like there is something flawed about you to feeling like the symptoms happening to you make sense.
Let’s imagine a person who is feeling increasingly anxious and hypervigilant, has begun lying to their loved ones about their food or exercise habits, and is starting to feel uncomfortably full from eating even small quantities.
Or another person who is having a lot of trouble focusing, has begun spending time binging and purging in hiding from their family, and is feeling themselves starting to withdraw from relationships.
These people are likely coming into an appointment with me feeling a tremendous amount of shame, and perhaps feeling like they don’t recognize themselves.
As a starting point, I want them to know that there is nothing wrong with them. Many of the things they are experiencing are exactly what we expect when the body and brain are malnourished, and will improve with renourishment.
2. Shower you with empathy
On the note of shame, this quote from Brene Brown was such a lightbulb moment in my career:
“If you put shame in a petri dish, it needs three ingredients to grow exponentially: secrecy, silence, and judgment. If you put the same amount of shame in the petri dish and douse it with empathy, it can’t survive.” - Brene Brown
I sometimes have sessions with clients where I leave feeling like I didn’t really “do” or offer anything concrete.
This Brene Brown quote makes me realize that what I do have to offer during those sessions is overflowing empathy.
We know that shame and eating disorders tend to be deeply linked. And while it may be your therapist digging deep into how shame gives oxygen to your eating disorder and how your eating disorder gives oxygen to your shame, I can certainly help to douse it with empathy.
3. Collaborate with you to build a (living) nutrition plan
One of the things that makes eating disorder recovery so incredibly challenging is that a very central part of the treatment (food) is the very thing that creates such an intense fight or flight reaction. And so for someone in the thick of an eating disorder, deciding what to have for lunch is not deciding what to have for lunch. It is more like being in a burning room desperate for a way out, with someone asking you to recite the periodic table. What we need is for someone to show us where the exit is.
This is where a nutrition plan comes in. Building some scaffolding around how you are going to nourish yourself means fewer decisions, so that your energy can be directed toward the huge effort of actually eating and being with the intense emotions that come with that.
A nutrition plan can look so many different ways depending on the person and deserves a blog post of its own. And it is ever-evolving throughout the recovery process as your needs change.
4. Help you identify - and challenge - beliefs about food that you’ve absorbed over time
Diet culture is the air we breathe. So we often aren’t even aware of beliefs that we hold about food - and that goes for people with or without an eating disorder!
Exposing people to nutrition education that isn’t rooted in judgement, rigidity or rules can be a brand new experience.
Let’s imagine a scenario, inspired by the brilliant Evelyn Tribole. Let’s say a person started having negative thoughts about bread when they were 12 and they are now 35. We’ll be conservative and imagine they experienced this voice telling them how bad bread is once per week. That adds up to 1196 times. Ouf. Do I expect their inner narrative about bread to change after one conversation about it? Of course not. Do I think it’s possible? ONE HUNDRED PERCENT.
Understanding where these beliefs came from and poking holes in them can allow us to plant seeds where new beliefs can start to grow. Doing this type of re-learning is incredibly effortful but empowering - and tends to become more and more doable as our brain becomes nourished (see #3!)
5. Help unearth your vision of what you want from recovery
When I finished school as a dietitian, I believed my job was to meet with a client, tell them what their problem was, tell them what the solution was, and then pat myself on the back when they got to where I thought they should be.
I’m cringing as I type that because just… no.
When a human being sits in front of me, I’ve come to realize they are the ones who know best how to get them to where they want to go. They may not always KNOW they know, but they do.
Me telling someone all the reasons they “should” recover from their eating disorder has proven to be very unhelpful. But when I offer the paint, canvas, and brushes, people tend to create an incredibly beautiful picture of what they want their lives to look like, and the ways their eating disorder is holding them back from that life.
What an absolute honour to walk alongside you toward that picture.
Looking for dietitian support? I offer virtual nutrition counselling to adults in Ottawa and the rest of Ontario.
Learn more about my services.
This blog post is not a substitute for personal eating disorder care and is intended for educational purposes only.
