Roles in Recovery – A day in the life of a dietitian working with eating disorders

By: Caty Saffarinia

Food, body image, obsession, control, dieting, and weight are all factors that have become very prominent in society. Who wore it best? What is the best diet to follow to lose weight? How can I look like a supermodel? Media has created a “thin” culture by advertising fad diets, telling people what diets to follow to lose weight in a short period of time, and by showing off celebrity’s body types and looks. These all contribute to people having poor body images and developing a bad relationship with food. Dietitians are an important part of the healthcare team caring for those with eating disorders and I was thrilled to get experience in this field. I am already familiar with Center for Discovery (CFD), since I previously worked there as a diet technician and counselor.  CFD is a residential facility for adolescents, ages 10-19, who struggle with eating disorders.

Food is essential to sustain life, but those who struggle with eating disorders have a different relationship with food – to the point of obsession. For some, food causes disordered eating that includes rituals, avoidance, discretion, fear, and many other emotions and behaviors for people struggling with eating disorders.

Why I want to work with adolescents with eating disorders

Throughout my teen years some of my peers experimented with restricting, binging, and purging as a way of building self-confidence and control over their own looks and beauty.  Watching them suffer from these diet trends, made me want to learn more and combat “negative” talk about food.

My interests were further deepened by experiences with a friend struggling with anorexia nervosa. She felt that the only way to control her life was by the food she consumed, which eventually turned into an unhealthy obsession. Over the years she became emaciated as her self-confidence began to dwindle.  She was plagued by her obsessive thoughts and behaviors surrounding food and body image.  Unfortunately, after several years she lost her battle.  This loss helped me realize the importance of nutrition. Helping individuals with eating disorders became my passion.  My goal was to help transform these devastating situations into powerful success stories. I became more motivated than ever to help those struggling with fear of food and poor body image to gain a sense of control in a healthy manner.

From diet tech to dietetic intern

The nutrition program at CFD instructs that all foods fit in balance, variety and moderation. I really like this belief because it shows clients that there are no “bad” foods. Incorporating this into their treatment is essential for their recovery. I kept this in mind during my internship rotation at CFD. As I worked with my preceptor and the clients, I learned how to utilize nutrition counseling when meeting with clients in individual sessions and how to get clients to talk about foods they fear the most and what they are willing to do for their recovery. When I worked at CFD as a diet technician, I learned about the importance of connecting with patients through empathy, honesty, and patience to create a safe place for recovery. I practiced creating a level of trust with clients to break down barriers in the way of their recovery. I used this skill by meeting the client where they were at with their recovery and focused on achievable goals. Building trust with clients benefited me during my internship because it allowed me to connect with clients and made it easier for them to share their emotions and challenges with me and my preceptor.

My Preceptor, Maureen, and me holding the All Foods Fit model

I was able to use the knowledge I gained from my education and work experience to help me navigate my way through my dietetic internship, specifically my clinical rotation. I have also had the amazing opportunity to work in a hospital with great dietitians as preceptors for my clinical rotation, where I learned so much more about diagnosing patients with malnutrition and following lab trends to assess for refeeding syndrome. For my second clinical rotation, I got to go back to CFD and shadow two dietitians that I formally worked with when I was a diet technician. It was like going home…to where my passion began to flourish.

It was wonderful to see all of my old coworkers and to actually be a part of the treatment team and see the role the dietitians have in the treatment of adolescents with eating disorders. When a new client arrives, the dietitian meets with them to gather a diet history and full nutrition assessment. They also get a 24-hour food recall from the clients to give them a better idea of how much they were consuming prior to arrival. Based on this information and their growth chart, the dietitian is able to calculate required energy, protein, and fluid needs, as well as determine if the client needs weight gain, weight loss, or weight maintenance. CFD uses the diabetic exchange system for all clients. The dietitian uses the required needs to provide the client with the appropriate amount of exchanges to allot and plan for during meal planning. As a part of treatment, each client’s family comes to the site midway through treatment. They meet with the dietitian and therapist together, without the client present, to discuss the client’s progression and so that the dietitian can provide the family with an explanation of how the exchange system works. After meeting, the client joins the family and they share a meal together. During this meal the family is responsible for checking the client’s food measurements for accuracy. The client describes the “table rules” to their family, which include: no food talk, no shoes, hands on the table, no fidgeting, no micro-biting, and completing the meal within the allotted 30 minutes. Following the meal, the clients share “triggers” that might affect their recovery as well as any concern they have about completion of treatment. The dietitians have individual sessions with clients, where they discuss how the client is doing with meal/snack completion as well as developing goals relating to food and nutrition as part of their recovery. The dietitians offer clients support and work with them on trying a “fear” food as part of an exposure therapy. Throughout treatment, the client’s weight and food compliance are assessed by the dietitian. CFD has a treatment team meeting, where the dietitians, therapists, doctor, psychiatrist, facility manager, and program director all meet once a week, to discuss the progression or regression of each client and if they are eligible to “phase up,” meaning the client has shown improvement, both physically and mentally, and is following their treatment plan with the intention to recover.  Based on this, the client is then considered for discharge from residential and referred to an outpatient team.

I was only able to shadow at CFD for a few days and didn’t have enough time to see everything. Two other important things that the CFD dietitians do is to run weekly nutrition and kitchen skills groups. The dietitians run a nutrition group to provide all clients with additional nutrition education relating to the mind, body, and proper health. They also run a weekly kitchen skills group where the residents pick a sweet or savory food to make together and then they eat it as part of their exposure therapy to fear foods. This helps them reintroduce these foods back into their life.

The dietitians at CFD utilize the mindfulness and intuitive eating principles, in addition to nutrition counseling. Mindful eating teaches the clients to get in touch with their satiety cues by using their five senses and staying aware/present while eating. With intuitive eating clients must learn to focus on their individual recovery, as well as reject the diet restriction mentality, make peace with food, honor feelings without using food, honor health, and respect your body.

Working with adolescents with eating disorders as a dietetic intern reaffirmed my goal to make a difference helping those struggling with eating disorders to recover and gain a healthy relationship with food, mind and body.

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