Heidi McClain, registered dietitian and Director of Dietary at Highlands Hospital, said that while education is important in the treatment path of anyone who needs intervention as part of their recovery, those with an eating disorder need a little bit of a different approach.
“Patients suffering from eating disorders typically have a high level of nutrition knowledge and are often well versed in the basics of nutrition, so the education provided to an eating disorder patient is far different than what an would provide to most other patients,” she said.
With eating disorder patients, registered dietitians assist in overcoming their “fear foods” and remove the rigid labels patients place on foods.
“I frequently say to all of my patients that there is room for every food in your diet, some just more frequently than others,” said McClain. “Patients with eating disorders often feel that eating a certain food will cause extreme weight gain or other adverse health effects. I frequently say (to them) that just like there is no miracle food that will cure any condition by eating it from time to time, there is also no awful food that will have an extreme adverse effect on your health by eating it from time to time.”
Eating disorder recovery can be frustrating in that a patient who was once severely restricting their calorie intake to perhaps 200 calories per day, now must eat more than another person of their size would require due to a hypermetabolism.
“A higher calorie intake is needed in order to restore their weight, and the registered dietitian can assist them in choosing nutrient dense foods that provide ample calories so that the patient is not overwhelmed by the volume of food he or she must consume,” said McClain.
Setting boundaries and making rules for recovery is another part of the registered dietitian’s job.
One of the biggest rules McClain sets with her patients is that scales are not allowable.
“They are not allowed to weigh themselves,” she said. “We assist the patient in forming a narrative so that all other practitioners they see are aware that the patient should not be made aware of their weight (for example, step on the scale backwards) and no feedback should be given by the practitioner about the patient’s weight.”
Even though McClain weighs her patients with an eating disorder at every visit, this is often not discussed during the visit at all.
“Instead, we discuss how the patient feels and how they are progressing towards other smaller goals, such as including a calcium source at each meal, or eating the recommended number of snacks daily,” she said.
Keeping a food diary, especially a photo food diary, are especially helpful in assessing portion sizes and other abnormalities in terms of how a patient eats.
McClain said establishing a healthy weight and resuming normal menstruation in females is the ultimate goal.
“This often means meeting the patient where they are and allowing the patient to make decisions of what to focus on next in terms of recovery,” she said.
When McClain first meets a patient with an eating disorder, there may be 20 recommendations she wants to give them, however, giving a few recommendations, and allowing the patient to choose which of those recommendations they want to tackle first is the most successful.
“Patients with anorexia, for example, are proud of the extreme control they have over their calorie intake, so allowing the patient to have control over the steps in their recovery is helpful,” she said. “Likewise, allowing a patient with bulimia to form a meal or snack schedule based on their daily routine, with the dietitian’s assistance, is far more helpful than the dietitian dictating one.”
Also, when the body is adjusting to the return of a normal eating pattern, gastrointestinal side effects such as nausea and constipation can occur, which the dietitian is suited to address as well.
Once a patient achieves recovery - both in terms of a healthy weight and in terms of a normalized eating pattern - that patient normally realizes a boost in energy.
“Patients have told me they didn’t realize how much of their life their eating disorder was consuming,” McClain said. “Constantly keeping a tally of how many calories you have consumed that day in order to stay below a very low amount, planning how to hide your eating disorder from family and friends and constantly being on guard can be very exhausting.
“It is this realization that motivates patients to continue their road to recovery,” she added. “Continued follow up visits with the registered dietitian to touch base and assess potential triggers is essential to long-term recover.”