Dietitians in eating disorder treatment
Often scary at the start but loved by the end. It’s a tough job to negotiate with an eating disorder; anorexia does not want to give up control, rituals, or routines or release the grip of fear foods, but NEDRC’s Dietitians have the skills and experience to empower you to gain control over the eating disorder and challenge it, realising that you are stronger than your eating disorder. Giving trust and allowing them to build a therapeutic relationship with you builds your own strength also. You may not agree with everything at first (particularly while you are malnourished, even though you might not feel you are!), but remember you are here to move slightly beyond your comfort zone each week with the goal of recovering. Lack of nutrition and sufficient, varied nutrition impacts your mind and body’s functioning.
NEDRC’s experienced Dietitians, therapists, Nurses and team help people with all types of eating disorders each day. We focus on the thoughts and beliefs that present with anorexia, bulimia, binge eating disorder, ARFID, and others each day. People with an eating disorder can have some deep, firm beliefs, and it takes time to help figure these out. The experience our team have from additional training and clinical experience is second to none. They use their knowledge and experience to understand your goals for recovery and work hard to help you achieve these.
What is a Dietitian?
A Dietitian is a health professional who has a bachelor’s degree or a master’s Degree specialising in food and human nutrition, as well as a period of practical training in a Hospital and a community setting. Dietitians apply the science of nutrition to promote health, treat and prevent malnutrition, and provide therapeutic dietary guidelines for people dealing with an eating disorder. Dietitians are the only qualified and regulated health professionals who assess, diagnose, and treat dietary and nutritional problems in individuals. The titles “Registered Dietitian” and “Dietitian/Dietician” are protected by law so that only qualified practitioners who have met the required education qualifications and continue to maintain their knowledge and skills through continuing professional development can use those titles.
CORU is responsible for the regulation of health and social care professionals under the Health and Social Care Professionals’ Act, 2005, in Ireland.
What is the difference between a Dietitian, nutritionist, or nutritional therapist?
Registered Dietitian is protected by law in that Dietitians registered with CORU have recognised educational and clinical experience in treating people with conditions such as eating disorders.
Dietitians have completed a BSc. (Hons) in Human Nutrition and Dietetics or a related science degree with a postgraduate diploma or master’s degree in Dietetics and have the qualification to treat people with medical conditions in clinical settings. Including people with anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID).
Nutritionists may/ may not have BSc or MSc degrees in Public Health Nutrition, Human Nutrition, or Nutritional Science and are qualified to provide information about food and healthy eating and often work in roles including public health, health improvement, and health policy.
Nutritional therapists, there are all sorts of courses of differing lengths that claim to train nutritional therapists, many of which are online. A nutritional therapists are not eligible to register with CORU. Nutritional therapists may offer non-evidence-based nutritional tests such as food intolerance testing or hair analysis. Some may also offer treatments such as supplements, detox diets, and food exclusions for which there is little robust scientific evidence.
Although some nutritional therapists can have some experience with eating disorders, this may not be to the level needed, and at times, if the education provided is not evidence-based, this could lead to a misunderstanding of the person’s condition.
Being a registered dietitian is a reflection of the education and professional development a person has done to be regulated by CORU. The clinical experience and professional knowledge are recognised by healthcare professionals as evidence-based and in the best interest of the person.
https://www.indi.ie/about-us/what-is-a-dietitian.html
What does a Dietitian do for anorexia?
A clinical definition of how a Dietitian can support a person would not reflect the true value a Dietitian can offer.
Two example areas are malnutrition and misinformation.
Malnutrition occurs when our bodies do not have enough energy/fluids to maintain normal bodily functions. Broken down into two areas: energy and fluid to repair and renew our bodies.
Our bodies need fuel/energy to function each day; an example of this would be when studying for an exam, our bodies need fuel to power our basic functions (breathing, movement, heat), but when studying we also require fuel for cognitive function, memory storage, and recall. When our bodies do not have enough, they will prioritise the essential functions and divert energy from the nonessential tasks. One of these tasks could be the assignment being studied for; our brain will not understand the importance of this project, and although effort may be going into understanding the material, our bodies cannot store and recall the memory. This can sometimes be described as a brain fog.
Another area where our bodies require fuel is in repairing the damage done on a daily basis and cell renewal. Our bodies are creating new cells each day, and without the building blocks, it is not possible for our bodies to be as efficient as designed. Yes, they will do their best to maintain normal function (survival), but the section will receive less and less; sometimes this can be noticed in brittle nails, hair weakening, and poor wound healing in the skin.
An example of how this can work against a person is when they are exercising and not giving their body the required fuel. As a person works out or does repetitive movements, we strain and stretch muscles; some of these become damaged. Our bodies would normally use our supply of food to rebuild these muscles, but when malnutrition has prevented availability, our bodies are unable to repair and restore. This creates the situation that a person could be training to get strong but, in fact, getting weaker by training. Combining this with an eating disorder and the law of diminishing returns (the first time an action is done, give a greater reward than subsequent times) can lead to the person increasing the time and intensity of the workout only to increase the damage without even realising for quite some time.
How does malnutrition show in a person?
There are many ways that malnutrition can show in a person. An assessment by a Dietician can identify this, but for people in the community, some signs may be noticeable to a non-healthcare person. Two examples of this would be reduced cardiac circulation and thermal regulation evidenced by an inability to create or retain heat- feeling “cold all the time”.
As the amount of available energy reduces, the body makes some choices on where to spend the energy it has. Some functions are essential and must be maintained, such as energy to our brains. Our digestive system absorbs energy from our GI system, and our blood is used to transport the energy around our bodies. If we need to maintain the amount of energy going to our brain in an environment with a limited supply, we need to reduce it from other areas. Our bodies achieve this by altering our circulation and reducing blood flow to areas not critical for survival. Our bodies constrict the blood vessels going to our hands and feet, and this reduces the blood flowing to these areas while increasing the blood flow to other areas.
This has two effects: firstly, our blood warms our hands and feet, and without this supply, they can reduce in temperature and feel colder. This can be noticed by a blue/purple colour on hands and feet. Additionally, the blood flow carries nutrients and energy needed for movement and growth; our nails could become brittle.
Additionally, as our bodies have less than required to function, thermal regulation can also be reduced.
This can result in a person not being able to produce enough heat to feel warm and will commonly describe this as always freezing; they can’t get the heat into them. This person could be wearing extra layers of clothing, but without the body producing the heat, it could have little effect on increasing the body temperature. Another indication of this could be a person who is always holding a hot water bottle, trying to transfer the heat into them. A challenge can be without cardiac circulation; the hot water bottle effect may only be to the local area.
These signs can commonly be seen visually in a person and can give an indication that malnutrition could be present. An experienced Dietician can recognise this and identify the areas requiring help.
What do Dietitians do in cases of malnutrition?
In eating disorders, a multidisciplinary team (MDT) is needed to address each area of the condition. A Dietitian’s role is to identify where a person needs support in restoring balance to their bodies, from energy to vitamins and minerals.
Different eating disorders will present with special requirements, and a registered Dietitian has the clinical experience to identify the areas of greatest need and develop a plan to work toward restoring balance to the person’s system.
NEDRC Dietitians receive the support of our Psychiatrists, Psychologists, Psychotherapists, Mental Health Nurses, Family Therapists, Social Workers, Peer Support Workers, Chefs, and other health care staff. They are well equipped to identify the areas of need and coordinate psychological support when helping the person restore nutritional balance to their body. NEDRC’S Dietitian work closely with our team, in particular our Chefs, who designs a meal plan to support and address the needs of the individual. While also providing education on how to resort and maintain balance and address misconceptions about food they may have- “myth busting”.
Misinformation about eating disorders
Social media has enabled any person to have an opinion on topics they may not fully understand or may be battling with themselves and how other factors could influence the outcome they present on their videos or posts. Sometimes only select information is given on a plan or action, and results can be presented to show the person giving the information as highly informed or influential. Without proper regulation and standards, this information may not be evidence-based and may create a misunderstanding of the importance of core sections of a balanced diet or meal plan.
There is a higher risk in eating disorders with influence and misinformation compared to other areas such as skin creams, beauty products, etc. As the effects on the person could lead to a greater level of complications. Please be mindful of the sources you take your information from.
Therefore, professional advice from a registered Dietitian is fundamental along with the multidisciplinary team in supporting a person with an eating disorder.
The benefits of a Dietitian in a Multidisciplinary Team compared to single therapy
Eating Disorder Nutritional Therapy: Our experienced, registered Dietitians have regular, ongoing, individual sessions with clients to directly address issues regarding food and nutrition and create a personalised meal plan. Staff also eat meals, portion, and prepare food with our clients to better support and explore each client’s difficulties with food. The ultimate goal for clients is a healthy relationship with food. Towards that aim, our programme includes food and nutrition-related groups, restaurant and grocery shopping outings, and mealtimes dedicated to nutritional healing and education.
Our team holds a great deal of empathy for those struggling to recover from their eating disorder. Our professionals understand the fear that comes with even thinking about letting go of the eating disorder and commit to meeting each client where they are upon arrival, slowly and compassionately exploring and challenging the client’s relationship with food.
While ensuring nutritional stability, our Dietitians patiently help clients challenge eating disorder beliefs and identify individual ways to create healthier i.e. non-disordered ways, ideas and thoughts about food and body image.
With the help of the staff, clients:
- Complete initial dietetic assessment upon admission.
· Explore client/family history related to food, including cultural, social, and spiritual (if relevant).
· Create an initial meal plan supporting nutritional recovery while meeting the client where they are.
· Work 1:1 with the Dietitian on identifying food fears, food rules, likes, dislikes, etc.
· Work 1:1 with the Dietitian and staff in the kitchen.
· Engage in food-based recovery challenges. - Cooking 1:1 with the Chef or Dietitian
· Attend cafe/restaurant outings (as recovery evolves)
· Develop independent meal plans
· Explore Intuitive Eating
· Explore beliefs and fears related to food and develop compassionate ways to challenge them. - Identify obstacles outside NEDRC and explore ways to overcome them with support and independently.
· Work together to rediscover the freedom and joys of life associated with a healthy relationship to food
Families of clients on NEDRC’s Programmes also receive weekly Dietetics group skills and education on nutrition, food, behaviours and practical advice on how to care for their loved ones at home. Opportunity is available weekly for families to ask questions they may have and ensure we are all working together with the same aim- recovery for their loved one.
If you would like to discuss the concerns you have about a love one, contact NEDRC in confidence. We are happy to listen and guide you through.
NEDRC can help you and your loved one take that vital step to regain a happy, healthy life. Please use the contact details below to find out about our eating disorder treatment options available to you and your loved one. Contact NEDRC
Telephone: 01 564 4450 or Mobile: 087 7755996 / Email enquiries@nedrc.ie
For referrals from Healthcare/ Therapeutic professionals please contact via : referrals@nedrc.ie or healthlink@nedrc.ie or online via Healthlink
Healthmail users can send referrals to healthmail@nedrc.ie
