HOW DOES A NUTRITIONIST HELP WITH EATING DISORDERS

Shannon Western from Ease Nutrition Therapy: As a nutritionist who loves supporting people to heal their relationship to food, I wanted to clarify my role. I am so happy to be the founder and Lead Nutrition Counselling at Ease Nutrition Therapy. I have been asked a few times over the years exactly what a nutrition professionals role is in eating disorder recovery. Thankfully it seems most people have a pretty good idea! But if you're someone who's not totally sure, this article is for you.

Over the years, I’ve been asked a few times what a nutrition professional does to help people with eating disorders. The first time I was asked I was a little confused- I know the work I do helps people so much and can be life-saving for some. But then when I took a second, I realised this person was right to ask.

If you ask someone what a nutritionist does, they would probably say they tell people what to eat. They might say they are scientists with food, people who love vegetables, and who help you eat “perfectly.” Well, when someone has an eating disorder they don’t need a nutritionist like that.

In this article I’m going to make it clear:

• Why you need a nutritionist on your team in eating disorder recovery

• What their role is and what you should expect from them

• How to find a nutritionist specialising in eating disorders

• How to tell the difference between those who say they are trained, and those who are actually trained!

• How to find a nutritionist specialising in eating disorders

Why you need an eating disorders nutritionist

There’s usually three paths people take when they’re struggling with an eating disorder. They might go through paths one to three, or take a different start point.

The most common one I hear about is: You struggle for a long time, and then eventually go see your GP. Note here that most people are not just struggling with an eating disorder. They’re usually struggling with other mental health conditions too, like depression or anxiety. The GP might not be totally helpful but they are at least supportive. They refer you for an eating disorders assessment, but it’s a long waiting list. You might be offered some counselling support. This might be 6-10 sessions with a CBT therapist or a general counsellor. You might be given a lot of space to speak and some excellent tools. But your eating disorder was never really healed from.

Then you usually end up on this second path…

The second path is when you’ve had some counselling sessions, you’re feeling a bit better with general mental health. But your eating disorder has never really been dealt with. You still have the same thoughts and behaviours, but they might be less loud and impacting on your life. But then over time, your eating disorder might morph into different behaviours - something I commonly see is moving from restriction to purging, or from restriction to binge eating. You might feel like nothing really works; you’ve already had therapy! That’s meant to be the best approach, right?

Then you move onto the third path…

Here you feel like you’re just always going to be living this way with food. You feel so miserable, worried, and like there’s no way out. But you feel like there must be more out there. At this point, you still might be on that waiting list that your GP put you on for eating disorder support. You might reach out to a therapist or nutritionist who’s an eating disorders specialist. You’re feeling hopeful. If you’re lucky and found the right person/team, you move on through recovery! But if you don’t love the approach and it doesn’t feel the right fit for you, you might end up feeling even more down.

If you’re someone who’s at this stage; I am here to tell you that there is support available that will work for you. Perhaps the key you’ve been missing is in an eating disorders nutritionist. I’ve written about the "nutrition" side of eating disorder recovery here.

Do you feel like this is what’s been the missing piece in your eating disorder recovery?

How does a nutritionist help with eating disorders?

There are many roles a nutritionist takes on when helping people in recovery. But I think the three main nutrition-specific roles are:

• Supporting nutritional adequacy. Ensuring patients are adequately nourishing their body with enough food, a variety of food, and ensuring weight restoration. This includes supporting people to move towards nourishment, offer supportive strategies and techniques to ease fear/discomfort with food; all at a pace that feels right to the client and nutritionist.

• Helping people to develop a way of relating and behaving to food, exercise, and bodies that eases stress and fosters a greater sense of well-being.

• Using therapeutic techniques, an eating disorders nutritionist offers space for clients to speak about their relationship to food, body image, and relationship to exercise. This also includes everything that influences these e.g. relationships, upbringing, mental health, stress.

Those are the three main roles. But the reason why I think eating disorders nutritionists are key to recovery is the huge range of expertise they hold. Not only are eating disorders nutrition professionals trained in the science of food, how eating disorders affect the body, and the psychology of eating disorders. Experienced professionals are often trained in counselling and therapy techniques, embodiment, and body image healing.

This is not an exhaustive list, I could add to this list after another week working in my clinic. Alongside the three main roles, there are 100s of other roles eating disorder nutritionists play, including:

• Education on kind and how much food a person's body needs

• Calculating energy needs a person needs to weight-restore

• Educating people on the symptoms of starvation and re-feeding

• Effects of macro/micronutrient deficiency. And assessing for symptoms of these

• Helping people understand the effects of a slowed or fast metabolism, and how to heal metabolism

• Food facts and fallacies - bring your list of 100s of food questions and we will answer every one with the science

• How restriction influences hydration (water) shifts in the body and thus body weight on the scale

• The relationship between diet and exercise

• The nutritional needs during certain conditions such as pregnancy, illness, or health conditions

• The difference between "physical" hunger and "emotional" hunger

• How to honour physical and emotional hungers

• How to tune in and respond to hunger and fullness signals

• Support a natural set point weight range for the person

• Develop greater ease eating in social settings, with supportive techniques and practical tools

• Shopping and cooking skills for self and/or significant others

• Nutritional supplement requirements

• Developing a meal plan when necessary

• Helping people move from the depths of their eating disorder to a happy, Intuitive way of eating (this of course takes time!)

• Developing a personal food and exercise philosophy

• Components of negative and positive body image

• Healing negative body image

• Developing psychological and emotional flexibility with food and movement

• Bridge connections between eating disorder symptoms with work in therapy

• Develop insight into why their eating disorder developed, and how it has shifted with life events

• Assessing medical needs linked to your eating disorder, and ordering blood tests, suggesting medications, from your GP

• Understand the social context and experience with systems that shaped the development of their ED

• Integrate aspects of their identity and lived experiences in relation to their food and body struggles

You might be thinking. “I don’t need a nutritionist, I already know everything there is to know about food.”

Does an eating disorder nutritionist just tell you what to eat?

I totally understand why you would think that. When you imagine a nutritionist, you usually imagine someone pushing green juice on you or telling you to snack on unsalted nuts.

But an eating disorders nutritionist is completely different from other nutritionists. That’s why many (including me) use the terms nutrition counselling or nutrition therapist. It just makes so much more sense for the job that we do.

In my clinic, I never ever tell my clients what to eat. You might be thinking, “well hold up, what do you actually do then!?” I invite you to scroll up a little and look at that huge list of things eating disorder nutrition pros do. There’s so much more to my job than simply telling people what to eat.

I’m bias, but I truly believe that having an eating disorder nutritionist on your team is a game-changer. Eating disorders are not all about food. But, an eating disorder psychologist once told me that after all the talking is done and your emotions are settled, you still need to know how to eat in and after eating disorder recovery.

I couldn’t agree more. Which is why I love being an eating disorders nutrition counsellor. I’m so ready to support you too, if you’re ready to reach out.

What training should an eating disorder nutrition professional have?

It can be really difficult to know who the best person to support you is. Not just for eating disorder recovery, but for all things relating to health. There are so many options out there! In this section I hope to bring clarity about titles, training, and things to look out for when choosing someone to help you in recovery.

There’s so many types of nutritionists, who should I go for?

It’s true, there are so many. So many titles and letters after people’s names. In the UK, there are three titles that means people are qualified nutritionists:

• Registered Nutritionists, with the Association for Nutrition (AfN)

• Registered Dietitians, with the British Dietetic Association (BDA)

• Registered Nutritional Therapists, with BANT

The first two types all have degrees in nutrition or dietetics, either 3-4 year bachelor degrees and/or a 1-2 year Masters degree. Nutritional Therapists on the other hand can either be educated with degrees, or have done a 1-month course. It’s a bit trickier to know if people in this group are properly qualified.

What type of training should an eating disorders nutritionist have?

There is no set training course in the UK that all eating disorders nutritionists must complete. There are a few things I would look out for, including:

• Training in Nutrition Counselling for Eating Disorders

• Trained in Non-Diet Approaches and Intuitive Eating

• Training in CBT-E for eating disorders

• Trained in digestive disorders in eating disorders

• Training in the treatment and management of eating disorders

• Completed training in body image healing

Eating disorders is a big specialist area. So it’s usually best to opt for a nutritionist who solely specialises in eating disorders. This doesn’t mean they can’t support people with medical conditions or other health conditions. But it means if you were to ask their speciality, it would be eating disorders and disordered eating.

Of course, there are some cases where a nutritionist might work in another area that makes sense. Some eating disorders specialists also work in digestive disorders, paediatrics, Intuitive Eating, or sports nutrition. That’s because there’s a lot of intersection between these specialities.

What do I need to look out for? Aka potential red flags

There are quite a few nutritionists who work with eating disorders who also work in weight management. They might call themselves “eating disorder and ob*sity specialists.” In my opinion, an eating disorders professionals should never offer weight loss support. Another red flag that goes with this one is when professionals view people in larger bodies as always struggling with binge eating. And people in smaller bodies always having restrictive eating disorders.