Working with anorexia: a dietician’s story

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.


Anorexia: The Family Invader

It was the 12th of December 2014. My husband and I were sleeping in our room when our door opened and behind the door stood my daughter, crying. She had been trying to tell us what had been happening before fainting and collapsing on the floor. That night ended with the family in the emergency room. My daughter had hypoglycemia and hypertension.

For moments that seemed like forever to me, I thought I was going to lose my child. This is the most heartbreaking feeling any mother would have to face. My heart jumped to my throat in panic, despair and confusion.

My child’s illness is Anorexia Nervosa. The hypoglycemia and hypertension were just the symptoms of her Anorexia manifesting itself. To me, it was a ghost or a shadow, invisible and mysterious. It stole my daughter and I was helpless, my hands were tied and I couldn’t fight back.

That stranger invaded my whole family. We all became anxious, worried, unhappy and angry. My daughter, my sunshine – my only sunshine – used to be so healthy, happy, energetic and lovely. When that invader came in, it took over her and transformed her into a depressed, lonely and weak child. We all suffered with her, because we didn’t know what to do to make her feel better. Anorexia stole all the happiness and joy.

Thankfully, anorexia is curable disease. But that does not make it any less serious or dangerous. I’m not going to lie to you, anorexia can kill. And it does not discriminate whether you’re big or small, rich or poor, black or white; any individual can fall victim to anorexia’s negative thoughts.

I’m incredibly grateful to my daughter for opening up to me before it was too late. She did the right thing by waking me up that night, and she has let me walk with her through her journey of recovery. Honestly, she is the one who saved a mother’s heart from a permanent fracture by saving herself.

I’m so proud of her because she’s a very brave and responsible young lady who has a will as strong as steel and yet is as delicate as a butterfly. Until this moment she is battling that invader and although she is just at the beginning of her journey, I’m 100% sure that she can beat it.

So for every mother:

  1. Be aware of the symptoms of anorexia;
  2. Don’t be afraid to seek professional help if you have doubts that your child might be suffering;
  3. Read to know more about the illness;
  4. Know that one of the early stages is denial of a problem by the child or the parents, or both.

I would like to let you know that if your child is suffering, you are not alone. The journey is full of bumps and requires a lot of patience. But you have to believe in your child in order for them to have the faith and strength to beat it.

Finally, a special thanks to my daughter’s therapist and all her team members.


I named my eating disorder Ursula

[infobox]Ariel is a 17-year-old girl who battled anorexia in the UAE. Her name has been changed to protect her identity.[/infobox]

I named my eating disorder Ursula, the villain from my favourite childhood movie ‘The Little Mermaid’. In many ways, my anorexia had presented characteristics that I saw in Ursula.

Anorexia – Ursula – is devious, manipulative, and controlling. She claims to be my friend and says that she wants the best for me when in fact she only wants me to do what’s best for her. She convinced me that I needed her help to reach my weight goals when I felt helpless and out of control, and told me that listening to her would give me happiness and power.

Ursula is like a snake oil saleswoman. She has a talent of making great sense and making persuasive points when trying to strike a deal. Listening to her only made me lose an important part of me just like Ariel lost the voice that was very special to her. The more attention I paid to Ursula, the more powerful she got, and the tighter her mighty tentacles wrapped around my body to get a good grip on me.

Ursula caused me to isolate myself and hide away from my family who became increasingly worried; the same way Ariel deviated away from her family and caused her father much distress.

She changed me into someone I wasn’t. I was no longer a happy, healthy and cheerful girl, but instead I was in constant misery and despair as I lost myself and had become weak, sad and continually exhausted.

Ursula planted very negative thoughts in my mind, which I still fight to this very day. Things like “You are not good enough,” “You can never succeed,” and “I’m the only one who can help you. Do not listen to anybody else,” got embedded into my subconscious mind. When I’d give in and listen to her, she became greedy and wanted me to do more, go further. She was never pleased with whatever I had to offer, constantly nudging me to stop eating. The truth is, she never will be pleased until she kills Ariel – me.

The more time and attention I paid to these negative thoughts, the bigger they grew, and the stronger Ursula became.  It was only after being taken to the hospital for what Urslula had done to me and sought help for my disorder that I realized Ursula’s weakness was having someone stand up to her and challenge the thoughts that she tries to make me believe.

I have learned that to defeat any ruthless force, whether anorexia or some other villain, the key is to fight back and never give up. Whatever battle I am going through, I remember that I am Ariel, and I am not alone.

– Ariel