I asked women (no men happened to respond) with eating disorders/in recovery what they wanted future dietitians to know about working with clients with eating disorders. The following list is also helpful for nurses, doctors, therapists, teachers, fitness instructors, health/life coaches, and anyone else who will ever work with clients/individuals with eating disorders. Of course, always make referrals if you truly do not feel comfortable working with eating disorders.
1. Every person with an eating disorder (ED) is different. Although their reasons for some of the behaviors may be similar, the disorders are multi-factorial and you cannot assume that what works for one person will work for another person, even if they both present with the same symptoms.
2. An eating disorder can be very serious no matter what a person’s weight or BMI. A patient who is not underweight may experience great difficulty getting help because she feels that she does not deserve help until she loses weight. Additionally, a very underweight patient may still deny that she is sick enough to deserve help. She may often go to great lengths to appear to be doing well.
3. It is helpful to reassure clients that eating is okay and necessary and weight fluctuations are normal and the uncomfortable physical symptoms of weight restoration will eventually go away. Remind the client that eating keeps her metabolism going and is fuel for the body. Validate all of her fears.
4. Challenge the patient’s cognitions about certain foods or myths she may have heard and back it up with solid scientific facts because she will often cling dearly to the facts once she begins to believe them.
5. Do not label foods “good” or “bad”. Try to avoid labeling things as “healthy” as well because this can play into obsessive eating patterns. Do not reprimand anyone for eating anything “unhealthy” or too many of these foods because clients are already likely beating themselves up for it.
6. Many patients with EDs know how to eat healthy already, but they have taken it too far. It can be boring if an RD lectures the patient about how to eat healthy.
7. A patient needs help feeling empowered to make decisions for herself. She often may know what a healthy eating pattern looks like, but may not be able to take the steps to get there. Breaking things into small goals can be more helpful than trying to tackle everything at once.
8. Recovery meal plans can feel restrictive for some people because it can feel like being put on a diet. A meal plan can also be difficult for a person with obsessive compulsive tendencies because she will be eager to get the exchanges exactly right and will not be able to be flexible.
9. Comments about a patient’s appearance are often more harmful than helpful, even if the person is taking steps in a healthier direction. Instead of commenting on her appearance, a comment on how her mood or mannerisms are would be more helpful. You can say that she seems more energetic rather than that she is looking healthier or that her weight has gone up if she needs to gain weight.
10. Even if the client has restored her weight to a healthy range, that does not mean she is in full recovery. Recovery takes into consideration so much more than just weight.
11. Avoid making comments about your own weight loss/gain/diet/eating disorder until you are sure that it is beneficial in some way to the client and will not trigger her.
12. Malnutrition or certain symptoms of an ED may cause a person to have trouble thinking clearly. She may lash out or say things that she wouldn’t otherwise and these things shouldn’t be taken personally. Additionally, when she says she can’t remember something, she may not be avoiding the answer, but she literally cannot remember anything because her brain is starving.
13. Do not base your treatment of a person exclusively on her weight and be wary of the accuracy of a person’s weight. Some patients with EDs are good at manipulating their weights through tricks like water loading or stuffing their pockets with heavy items at weigh-ins.
14. Although certainly not everyone with an ED will do this, many will lie about their intake, so know when not to completely trust a person’s food journal. Remind the patient to write down her feelings surrounding each meal on her food journals, as that is often more helpful than knowing what was actually eaten.
15. Stating the health impacts of an ED may not help and attempting to scare a person into health won’t work because she often doesn’t care about the consequences of her symptoms.
16. Weight needs to be talked about on a very case by case basis. Some people can handle knowing their weight and for others it can be very triggering or upsetting.
17. Teaching a person how to have a healthy relationship with exercise and use it for more than just weight loss is extremely helpful. It is very difficult to recover from an ED without incorporating healthy movement.
18. There are times when you have to realize when you are talking to the client and when you are talking to the client’s ED and counsel accordingly. Do not negotiate with the person’s ED.
19. Communicate with other members of the client’s health care team if possible. The team can have more insight into trouble areas which will give you a better idea of what’s going on with your client.
20. Recovery can be a lifelong process for some. It is very difficult and there will be many road blocks. Giving up on a person can cause her even more harm because she needs to know that there are people who will be there for her.