The document discusses the role of registered dietitians in eating disorder treatment. It defines what a registered dietitian and nutrition therapist are and their qualifications. A key role is providing medical nutrition therapy, nutrition counseling, and education. Dietitians work with a treatment team and collaborate with psychotherapists, focusing on addressing eating behaviors and restoring normal eating rather than just weight. Evidence shows nutrition therapy improves outcomes when combined with psychotherapy.

1. The Role of the RD in Eating
Disorder Treatment:
+ If it’s not about the food, then
why do patients need a
dietitian?
Lindsay Stenovec, MS, RD & Kelly Hinds, RD
UCSD Eating Disorder Treatment & Research Center

2. +
Objectives
 Define Registered Dietitian and Nutrition Therapist
 Identify
role of the Registered Dietitian in eating
disorder treatment
 Describe ideal collaboration between Registered
Dietitian & Psychotherapist

3. +
What is a Registered Dietitian?
 Trained Nutrition Professional with the credentials to provide
Medical Nutrition Therapy
 Counseling on behavioral and lifestyle changes related to diet and
exercise for specific diseases and disorders
 Medical professional that acts as a liaison between treatment team,
doctors & nurses
 Trained in motivational interviewing and able to assess readiness for
change
 Nutrition Science Degree from accredited university
 Professional Practice Internship
 National Registration Exam
 Continuing Education Units

4. +
Nutrition is Science
 Medical Nutrition Therapy
 Nutritional Biochemistry
 Chemistry
 Organic Chemistry
 Biochemistry
 Biology
 Microbiology & Food Microbiology
 Food Science
 Anatomy & Physiology

5. +
What is a Nutrition Therapist?
 Works as part of a multidisciplinary team
 Understands underlying psychological issues
 Professional supervision
 Continuing education
 Understands relationship between psychology & eating
 Recognizes when underlying issues need to be worked
out in therapy before moving forward

6. +
What is a Nutrition Therapist?
 Ability to establish rapport with challenging patients
 Communicates nutrition messages appropriately
 Develops highly individualized treatment plans

7. +
Evidence to Support the RD in ED
Treatment
 APA Guidelines recommend Nutritional Rehabilitation as a First
goal in treatment of AN & BN (APA)
 Nutrition therapy or cognitive therapy alone is ineffective,
together they are most effective (APA)
 Some people assume behaviors return to normal with
psychotherapy (Beumont, O'Connor, Touyz, & Williams, 1988)

8. +
Evidence to Support the RD in ED
Treatment
 Insufficient evidence to support that psychotherapy is effective
in changing weight in eating disorder patients (Hay et al, 2003)
 Can’t treat AN without weight restoration and psychotherapy is
ineffective until weight is restored (Mehler et al., 2010)
 Side effects of starvation need to be addressed before
psychotherapy can be effective (Salvy & McCargar, 2002)

9. +
Evidence to Support the RD in ED
Treatment
 The sooner eating disorder behaviors are stopped and nutrition
and physical health are restored the better someone responds
to therapy (Van Son GE et al., 2010, AAP Identifying and
treating eating disorders, 2003)
 Patients and family identify nutrition therapy as an important
component in treatment (Escobar-Koch, et al., 2010)
 Dietitians have strongest nutrition knowledge base of clinicians
treating eating disorders (Cordery & Waller, 2006)

10. +
A team that includes a Dietitian
will…
Free the therapist to
concentrate on therapy
rather than food

11. +
The Role of the Registered Dietitian
 Nutrition Counseling
 Nutrition Education
 Medical Nutrition Therapy

12. +
Nutrition Counseling
 It is not only about what to eat, but how to eat
 Resolving the client’s relationship with food, not simply
restoring weight, is the goal of treatment
 Return of normal weight does not dispel the abnormal eating
behaviors or disturbed attitudes about food

13. +
Nutrition Counseling
 Discover & 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
 Incremental changes to meal plan with consideration of
patient’s nutritional needs, level of progress and readiness for
change

14. +
Nutrition Counseling
 Desensitization & Exposure Therapy to Increase Flexibility
 Fear Food Challenges
 Food Rituals
 Social Eating
 Dining Out
 Grocery Shopping
 Cooking

15. +
Nutrition Counseling
 Hunger & Satiety Work
 Physical vs Emotional Hunger
 Continually weave in concepts of Normal Eating for
enjoyment & wellness
 Health at Every Size
 Mindful Eating

16. +
Nutrition Education
 Basic Education on Macronutrients & Micronutrients
 Function of Nutrients in the Body
 Effects of Nutrient Deficiencies
 Food Facts & Fallacies
 Anatomy & Physiology
 Starvation symptoms
 Refeeding Process

17. +
Nutrition Education
 Weight & Metabolism
 Effects of Compensatory Behaviors (purging, laxatives,
diuretics, diet pills, exercise etc)
 Relationship Between Food & Mood

18. +
Nutrition Education
 Assist clients in planning menus to meet needs
 How to Grocery Shop
 How to Cook

19. +
Medical Nutrition Therapy
 Establish Goal Weight Range
 Laboratory Data
 Weight History
 Family Weight History
 Body Composition
 Monitor weight changes & educate accordingly
 Fluid Shifts
 Refeeding Effects
 Natural Weight Cycles

20. +
Medical Nutrition Therapy
 Monitor Nutrition-Related Labs & Medical Complications
 Ongoing communication & coordination of care with
physician
 Prescribe Healthy Exercise
 Prescribe Meal Plan
 Optimize Resting Metabolic Rate

21. +
Collaboration Between RD &
Psychotherapist
 Itis not the role of the dietitian to do
psychotherapy
 Patients attempting to discuss therapy in nutrition
sessions are distracting from the real issues
 Itis not the role of the psychotherapist to do nutrition
therapy
 Patients attempting to discuss food in therapy
sessions are distracting from the real issues
Eating Disorders: Nutrition Therapy in the Recovery Process; Reiff & Reiff

22. +
Collaboration Between RD &
Psychotherapist
Do’s Don’ts
 Defer all food issues to RD  Work on food issues in therapy
 Keep an open mind regarding  Discuss your own food beliefs
nutrition science/media with clients

23. Collaboration Between RD & Pyschotherapist
Therapist Dietitian
 Psychological  Teaches ways to
aspects of treatment  Model communication change food,
w/team & reinforce exercise & wt –
 Determines purpose of team related behaviors
appropriate therapy
 Reveal how food, wt &  Educates on
 Informs team of body image behaviors
normal &
mirror life
progress in therapy abnormal eating,
 Help pt develop sense of hunger, metabolic
 Explain pt issues that trust and connectedness rate
may influence how in people & self
they work with team  Increase
awareness of
body

24. Collaboration Between RD & Pyschotherapist
Therapist Dietitian
 Helps pt connect  Assists pt in
underlying issues to  Help pt identify needs understanding
ED behaviors connection
 Help pt develop alternative between emotion &
 Educates, ways to deal and cope food behavior
discusses &
prepares pt for  Support & encourage
working with team  Teaches pt how to
change in Ed behaviors &
highlight development & develop healthy
 Helps pt & family growth relationship with
understand food
purpose of ED and
explores pt  Update team
willingness to get regarding food,
better exercise & weight

25. +
References
 American Academy of Pediatrics, Committee on Adolescence. (2003). Identifying and treating
eating disorders. Journal of Pediatrics , 111, 204-211.
 American Psychiatric Association. (2006, July). Treatment of patients with eating disorders.
Retrieved May 5, 2012, from Psychiatryonline:
http://psychiatryonline.org/content.aspx?bookid=28&sectionid=1671334
 Ashley, M., & Crino, N. (2010). A novel approach to treating eating disorders in a day-hospital
treatment program. Nutrition and Dietetics , 67, 155-159.
 Beumont, P. J., O'Connor, M., Touyz, S. W., & Williams, H. (1988). Handbook of Eating Disorders,
Part 1. Amsterdam: Elsevier Science.
 Cockfield, A., & Philpot, U. (2009). Symposium 8: feeding size 0: the challenges of anorexia,
managing anorexia from a dietitian's perspective. Proceedings of the Nutrition Society , 68, 281-
288.

26. +
References
 Cordery, H., & Waller, G. (2006). Nutritional knowledge of health care professionals
working in the eating disorders. European Eating Disorders Review , 14, 462-467.
 Costin, C. (2007). The Eating Disorder Sourcebook (3rd ed.). New York, New York:
McGraw Hill.
 Escobar-Koch, T., Banker, J., Crow, S., Cullis, J., Ringwood, S., Smith, G., et al. (2010).
Service user's views of eating disorder services: an international perspective. International
Journal of Eating Disorders , 43, 549-559.
 Hart, S., Russell, J., & Abraham, S. (2011). Nutrition management and dietetic practice in
eating disorder management. Journal of Human Nutrition and Dietetics , 24, 144-153.
 Hay, P., Bacaltchuk, J., Byrnes, R. T., Claudino, A., Ben-Tovim, D., & Yong, P. Y. (2003).
Individual pyschotherapy in the outpatient treatment of adults with anorexia nervosa.
Cochrane Database System Review .
 Laessle, R. G., Beumont, P. J., Butow, P., Lennerts, W., O'Conner, M., Pirke, K. M., et al.
(1991). A comparison of nutritional management with stress management in the treatment
of bulimia nervosa. British Journal of Psychiatry , 159, 250-261.

27. +
References
 Mehler, P. S., Winkelman, A. B., Anderson, D. M., & Gaudiani, J. L. (2010).
Nutritional rehabilitation: Practical guidelines for refeeding the anorectic patient .
Journal of Nutrition and Metabolism , 10, 1-7.
 Ozier, A. D., & Henry, B. W. (2011). Position of the academy of nutrition and
dietetics: Nutrition intervention in the treatment of eating disorders. Journal of the
American Dietetic Association , 111, 1236-1241.
 Rock, C. L., & Curran-Celentano, J. (1996). Nutritional management of eating
disorders. Psychiatric Clinics of North America , 19 (4), 702-713.
 Van Son, G. E., Van Hoeken, D., Van Furth, E. F., Donker, G. A., & Hoek, H. W.
(2010). Course and outcome of eating disorders in a primary care-based cohort.
International Journal of Eating Disorders , 43, 130-138I.
 Waterhous, T., & Jacob, M. A. (2011). Nutrition interventions in eating disorders.
Academy of Nutrition and Dietetics.