Working with anorexia: a dietician’s story

31 Mar, 2015 Categories: Blog

Poor eating habits and unhealthy views surrounding food are primarily symptoms of eating disorders – they are not the cause. A dietitian can act as a specialist within a multi disciplinary team as a consultant to other professionals advising on nutritional aspects of care. Having been a part of the support system for Ariel myself, here are some of the things one must remember when they are providing assistance to anorexia nervosa patients.

Eating disorders aren’t always black and white

The food thoughts and behaviours of a person with an eating disorder are usually chaotic, unhealthy and unrealistic. They are basically caught up in black and white thinking and grounded in perfection. (For example, “If I eat this today, I will get fat, and if I get fat, I am ugly.”)

Since dieticians are considered experts in food content, nutritional food values and metabolism, someone with an eating disorder might see us as an extension of the very food they’re trying to limit, and may resist listening to us at first. By controlling their intake of food, a young person with an eating disorder may feel like they have a certain amount of control over their bodies. For someone with an eating disorder, food is the tool that they use to rely on to manipulate, gain control and empower themselves.

Luckily in my experience as a dietician, I can take advantage of my knowledge to teach anorexia sufferers the benefits of proper eating habits. Rather than simply saying, “you must eat,” a dietician can emphasise on the role of food in increasing the quality of the skin, physical activity, bone density, etc. Take for example a teenager who’s self conscious about their appearance. Limiting food can impact the quality of their skin, and highlighting the correlation between their eating habits and their appearance could help chip away at the ice that’s preventing them from eating.

It’s about building trust

We need to understand that there is no cookie cutter method in treating anorexia, rather, it’s about educating children and adolescents with eating disorders and helping them make informed decisions about meal choices. Meal portion size and content should be explained in a clear and transparent manner in order to establish trust in the relationship between a dietitian and the young person. The key to a successful story with anorexia is the following:

  • Building trust
  • Acceptance
  • Cooperation
  • Mutual understanding
  • Confidence
  • Genuine care and attention

I am a necessary evil on the road to recovery

The dietitian’s role with young people is to help them gain balance and a healthy food perspective, but dietitians are the ones that are disliked and feared the most out of a multidisciplinary team that treats eating disorders. You need to have thick skin with treating someone with eating disorders, as I’ve often heard many negative remarks, such as a 12-year-old girl snapping and asking me “if I do as you say this week, can I stop coming to this clinic?” Another remark was, “How many times do I have to sit for these sessions before I meet the requirements?”

Nevertheless, the credibility and knowledge as professionals about food – the tool that young people with anorexia use to gain control, gives us dietitians an edge in treating the disorder. With the help of a psychologist that works on the negative thoughts of anorexia, a dietitian can manage to correct and challenge someone’s assumptions and ideas about food and weight. A strong, well-structured meal plan helps them feel safe, secure and empowered.

Everyone has a different field of experience

Moreover, the language that a dietitian uses during consultation sessions with anorexia patients can either open doors for behavioural change towards food or result in a complete shut down. The choice of language that is used depends on the age, cultural, and ethnic background of the individual. Eventually, when the dietitian/patient relationship develops, the choice of language becomes more effective. The choice of words for an eight year old that takes her older sister as her idol is different from the words that are used with a 12-year-old rebel seeking popularity and acceptance at school with her peers.

Finally, at the core of anorexia nervosa treatment is the establishment of a strong patient/dietitian relationship or else the simplest information about food will sound like a foreign language to them.