Eating Disorders: Nutrition Education And Therapy - Nutrition Education and Therapy

Written by HealthyPlace.com Staff Writer

WEIGHING CLIENTS

It is important to wean clients off of the need to weigh themselves. Clients will make food and behavior choices based on even the most minimal change in their weight. I believe it is in every client's best interest to not know his actual weight. Most clients will in some way use this number against themselves. For example, they may compare their weight to that of others, may want their weight to never fall below a certain number, or may purge until the number on the scale returns to something they find acceptable.

Relying on the scale causes clients to be fooled, tricked, and misled. In my experience, clients who don't weigh are the most successful. Clients need to learn to use other measures to evaluate how they feel about themselves and how well they are doing with their eating disorder goals. One doesn't need a scale to tell them if they are bingeing, starving, or otherwise straying from a healthy eating plan. Scale weight is misleading and cannot be trusted. Although people know that scale weight changes daily due to fluid shifts in the body, a one-pound gain can make them feel that their program isn't working. They become depressed and want to give up. Time and again I've seen individuals on a very good eating regimen get on the scale and become distraught if it doesn't register a loss in weight that they expect or if it registers a gain they fear.

Many clients weigh themselves several times a day. Negotiate an end to this practice. If it is important to get weights, ask a client to weigh only in your office with her back to the scale. Depending on the client and the goal, you can make agreements as to what information you will reveal, for example, whether she is maintaining (i.e., staying within 2 to 3 pounds of a certain number), gaining, or losing weight. Every client needs reassurance about what is happening with her weight. Some will want to know if they are losing or maintaining. Those whose goal is weight gain will want reassurance that they are not gaining too fast or uncontrolledly.

When clients are on a program of weight gain or are trying to lose weight, I think it is best to set an amount goal; for example, I will say, "I will tell you when you have gained 10 pounds." Many clients will refuse to agree to this, and you may have to set the first goal as low as 5 pounds. As a last resort, set an amount goal such as "I will tell you when you get to 100 pounds." However, try to avoid this method, because it lets clients know how much they weigh. Remember, weight gain is extremely scary and disturbing to clients. Even if they have verbally agreed to gain weight, most do not want to, and their tendency will be to try to stop the gain.

FINDING AND CHOOSING A NUTRITIONIST

There are many things to consider when choosing a nutritionist to work with an eating disordered individual. It has already been mentioned that a registered dietitian is the safest bet to ensure adequate education and training in the biomechanics of nutrition. It has also been stated that those registered dietitians who are further trained in counseling skills and are called nutrition therapists are even a better choice. The Yellow Pages of the phone book or The American Dietetic Association, which has a consumer hotline at 1-800-366-1655, may be able to provide readers with the names and numbers of qualified individuals in the caller's area.

The problem is that many individuals do not live in an area where registered dietitians, much less nutrition therapists, are available. Therefore, it is important to consider other ways of finding competent individuals who can provide nutrition treatment. One way is to ask a trusted therapist, doctor, or friend for referrals. These individuals may know of someone who can provide nutrition counseling even though he does not fit the registered dietitian or nutrition therapist category. Occasionally other health professionals such as a nurse, medical doctor, or chiropractor are well trained in nutrition and even in eating disorders.

In instances where a registered dietitian is not available, these individuals may be useful and should not necessarily be excluded from consideration. However, it is not always true that some help is better than no help. Misinformation is worse than no information. Whether or not the person being consulted to provide the nutritional aspect of treatment is a dietitian or a nurse, it is important to ask questions and gather information to determine if they are qualified for the position of working as a nutritionist with an eating disordered individual.

INTERVIEWING A NUTRITIONIST

Interviewing a nutritionist over the phone or in person is a good way to obtain information regarding his or her credentials, special expertise, experience, and philosophy. It is important to keep the following considerations in mind:

An effective nutrition therapist should:

• be comfortable working with a treatment team;
• be in regular contact with the therapist;
• know skilled therapists and be able to refer the client to one if necessary;
• understand that the treatment of eating disorders takes time and patience;
• know how to provide effective interventions without a meal plan;
• know how to address hunger and satiety issues; and
• be able to address body image concerns.

An effective nutrition therapist should not:

• simply provide a meal plan;
• give and expect a client to follow a rigid meal plan;
• indicate the client will not need therapy;
• tell a client she will lose weight as she normalizes eating behaviors;
• shame the client on any level;
• encourage a client to lose weight;
• suggest that certain foods are fattening, forbidden, and/or addictive and should be avoided; and
• support a diet of less than 1,200 calories.

Karin Kratina, M.A., R.D., is a nutrition therapist specializing in eating disorders. She believes that dietitians who work with eating disorders should be nutrition therapists but also recognizes that this is not always possible. She has provided questions to ask a professional for nutritional counseling. Karin has also provided the response she would give to each question to help the reader better understand what kind of knowledge, philosophy, and response to look for.