Written by: Becky Mehr, MS, RDN, CEDRD-S
Director of Outpatient Nutrition at The Renfrew Center
Nutrition counseling is an ongoing process in eating disorder treatment in which a health professional, usually a registered dietitian, works with an individual to assess his or her usual dietary intake and identify areas where change is needed.1 The nutrition counselor provides information, educational materials, support, and follow-up to help the individual make and maintain the needed dietary changes.
Nutrition counseling is an important component of treatment for an eating disorder. Nutrition counseling is a therapeutic process; it helps to balance intake which leads to health not only physically but mentally. When nutrition counseling is coupled with individual therapy the therapeutic process is richer, meaning that one will connect more deeply and quickly to the function of the eating disorder behaviors.
What is a Registered Dietitian Nutritionist?
The Academy of Nutrition and Dietetics states a “Registered Dietitian Nutritionists (RDNs) are the food and nutrition experts who can translate the science of nutrition into practical solutions for healthy living.”2 A Registered Dietitian Nutritionist has earned a bachelor’s degree that includes course work in food and nutrition sciences, microbiology, chemistry, physiology, biochemistry, as well as foodservice systems management, business, and economics. RDNs have completed an accredited, supervised practice program, a 1200-hour internship that provides experiences in multiple areas of nutrition and passed a national examination through the Commission on Dietetics Registration. Lastly to maintain their registration, RDNs must continue to engage in continuing professional educational requirements.
When should I reach out for Nutrition Counseling?
Nutrition counseling is a vital part of eating disorder treatment and recovery. Unfortunately, many individuals avoid having a registered dietitian on their team out of fear of judgment or being misunderstood, past negative experiences with a dietitian without eating disorder expertise, financial barriers, and ambivalence about changing their behaviors. It’s important to reach out for nutrition counseling when you recognize your relationship with food is impacting your day-to-day life. Other key times to reach out are when other treatment team members make that recommendation, you step down from a higher level of care or you’ve fallen into a relapse.
What to expect in Nutrition Counseling?
If you’ve never worked with a nutrition counselor before, they will assist you with accountability, meal/snack support and monitoring of your weight (only if clinically indicated) to assist with support around the medical complications that can occur with an eating disorder.
Here are some additional things to help you understand what to expect:
1. Deep dive into past and current eating patterns.
During the initial assessment, you will be asked questions to understand your relationship with food and your body. You will also discuss future relationship goals surrounding food and your body. This helps build the framework for upcoming sessions to explore how the antecedents (past) impact the present (current) and the best way to work together to have a different relationship with food (future).
2. Provide nutrition education.
As you work with your registered dietitian, they will provide you with nutrition education and help you build awareness around the irrational and misleading information about food. This misinformation is often revealed when discussing fear foods, social eating, and diet history. The dietitian will help you sort through the thoughts and beliefs about food to help you recognize what is true and helpful and what is disordered and unhelpful. Using their science-based background on how the body functions, they will you help you reappraise judgmental and rigid thoughts to a more neutral, flexible interpretation.
3. Focus on eating behaviors.
Yes, in nutrition counseling, there will be a focus on the eating behaviors. However, this is hopefully done in a collaborative manner to address what, why and how behaviors impact YOU. The focus of nutrition sessions is to set goals for behavior change and to assist with creating a new relationship with food and the body. Typically, the behaviors that show up around food also show up in other areas of our life. By identifying and gradually eliminating the avoidance behaviors (e.g., food rituals), emotion driven behaviors (e.g., slow or rapid pace due to fear) and safety signals (e.g., your lucky stress ball at every meal), one is practicing tolerating distress; AND that skill can be applied to situations outside of food.
How do I find a Nutrition Expert?
It’s important to find someone who specializes in eating disorders. It can be helpful to ask your therapist or another member of your team for a recommendation. When looking for a nutrition counselor to work with during your recovery journey, look for someone who is credentialed with the RDN designation or an RDN and CEDRD/CEDS. The CEDRD/CEDS credential, awarded by the International Association of Eating Disorder Professionals (iaedp) indicates that a dietitian has demonstrated clinical expertise and has acquired additional education and skills in the field of eating disorders.
Working with a dedicated team member that specializes in nutrition counseling is key to recovery. Having a team member devoted to focusing specifically on addressing avoidance in daily eating patterns is an important component for the treatment of eating disorders. Reaching out for Nutrition Counseling at any time can be frightening, BUT once a therapeutic relationship is established it can be so rewarding. Having a nutrition expert on your team dedicated to supporting YOUR relationship with food IS a game changer for your recovery. Nutrition Counseling provides you with technical and practical skills that can be applied throughout the recovery process and compliments your work with your therapist.