Do I Need a Dietitian?

What is a Registered Dietitian?

A registered dietitian (RD/ RDN) holds at least a bachelor’s degree in nutrition science (or related discipline) from an accredited university. Many dietitians have MS, MA, MPH, MSW, or PhD degrees as well. University programs in dietetics must meet specific standards set by the Academy of Nutrition and Dietetics. All students complete a supervised internship and must pass a standardized credentialing exam. The curriculum for registered dietitians includes a solid background in the sciences, research and the scientific method, normal nutrition, nutrition related to various disease conditions, food science, food service, counseling and education, and management. Registered dietitians work in a variety of settings from hospitals, schools, and clinics to corporate wellness programs and private practice.

Role of the Registered Dietitian in the Treatment of Eating Disorders

Adapted from a slideshow created by Kelly Hinds, RD and Lindsey Stenovec, MS, RD. Found here, with references.

When working with a client with disordered eating, the registered dietitian takes the role of Nutrition Therapist (NT). The NT is responsible for the following functions:

  • Nutrition Counseling
  • Nutrition Education
  • Medical Nutrition Therapy

A well-trained NT works as part of a multidisciplinary team, understands underlying psychological issues, undergoes professional supervision and continuing education, and understands the relationship between psychology and eating. The NT can recognize when underlying issues need to be worked out in therapy before moving forward with a nutrition plan.

NTs working with eating disorders are skilled in communicating nutrition messages appropriately and are able to develop highly individualized treatment plans. The most important benefit of involving an NT on the treatment team is that it frees the psychotherapist to concentrate on therapy rather than food.

Aspects of Nutrition Counseling

  • Establish that it is not only about what to eat, but how to eat
  • Focus on resolving the client’s relationship with food, not simply restoring weight, as the goal of treatment
  • Reinforce that return of normal weight does not dispel the abnormal eating behaviors or disturbed attitudes about food
  • Discover and challenge distorted beliefs/fears about food, weight & exercise and how they may enable eating disorder behaviors
  • Process patient’s use of food: emotional eating, self-punishment, sense of communication or control
  • Process barriers to progress – lack of motivation, underlying issues, lack of structure/planning
  • Make incremental changes to the meal plan with consideration of patient’s nutritional needs, level of progress and readiness for change
  • Use desensitization and exposure therapy to increase flexibility with:
    • Fear food challenges
    • Food rituals
    • Social eating
    • Dining out
    • Grocery shopping
    • Cooking
  • Work on learning hunger and satiety cues, distinguish between physical and emotional hunger, weave in concepts of “normal,” mindful, or intuitive eating for pleasure and wellness, and use a Health at Every Size Approach

Aspects of Nutrition Education

  • Basic education on macronutrients and micronutrients
  • Function of nutrients in the body
  • Effects of nutrient deficiencies
  • Food facts and fallacies
  • Anatomy and physiology
  • Physiological effects of malnutrition and semi-starvation
  • Refeeding process
  • Weight and metabolism
  • Effects of compensatory behaviors (purging, laxatives, diuretics, diet pills, exercise etc.)
  • Relationship between food and mood
  • Assist clients in planning menus to meet needs
  • How to grocery shop
  • How to cook

Aspects of Medical Nutrition Therapy

The NT will monitor nutrition-related labs and medical complications with ongoing communication and coordination of care with physician. Main focus includes:

  • Establish goal weight range
  • Laboratory data
  • Weight history
  • Family weight history
  • Body composition
  • Monitor weight changes and educate accordingly
  • Fluid shifts
  • Refeeding effects
  • Natural weight cycles
  • Prescribe healthy exercise
  • Prescribe meal plan
  • Optimize resting metabolic rate

Points on Scope of Practice

  • It is not the role of the dietitian to do psychotherapy. Patients attempting to discuss therapy in nutrition sessions are typically distracting from the real issues.
  • It is not the role of the psychotherapist to do nutrition therapy. Patients attempting to discuss food in therapy sessions are distracting from the real issues.

Collaboration Between RD & Psychotherapist

There is some clear overlap in both roles. Each team member will:

  • Model communication with the team & reinforce purpose of the team
  • Reveal how food, weight, and body image behaviors mirror life
  • Help the client to develop sense of trust and connectedness in people and self
  • Help the client identify needs
  • Help the client develop alternative ways to cope
  • Support and encourage change in ED behaviors and highlight development and growth
  • Increase awareness of body

Functions unique to the NT include:

  • Teaches ways to change food, exercise and weight-related behaviors
  • Educates on normal & abnormal eating, hunger, metabolic rate
  • Assists the client in understanding connection between emotion & food behavior
  • Teaches the client how to develop healthy relationship with food
  • Updates team regarding food, exercise & weight

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