Jennifer Lewis, RD has spent the past decade working as a dietitian, specializing in eating disorders
and weight management, including helping those that struggle with compulsive overeating
. But Lewis’s role is only one part of what she referred to as the “treatment triangle” that patients with eating disorders must have for success.
“There are three main components to treating eating disorders and all are equally important,” said Lewis, who joined Eating Recovery Center in Dallas last summer. “Everyone who comes here meets with a psychiatrist, a clinician and a dietitian. When they arrive, we meet with them as a team to understand their food-related issues and, specifically, why they have decided to seek treatment.”
Lewis, who is also a Certified Intuitive Eating Professional refers to the dietary aspect of treatment as “nutritional rehabilitation,” and said that without proper nutrition, the brain cannot function effectively.
“For medications to work properly and talk therapy to be optimal, patients need to be nourished physically,” she said.
Lewis said when she first meets with a patient one-on-one, she does a nutrition assessment, asking questions and gathering details about their current eating behaviors, eating habits, food preferences, foods he or she avoids, food allergies, vitamins or supplements regimen, coffee intake, and alcohol habits.
Weight is not discussed directly with the patients, and to prevent additional anxiety she charts the patient’s weight without sharing it with them. Lewis then determines their appropriate daily caloric intake and creates a meal plan based on their personal needs and preferences.
“I challenge them throughout each week in treatment to include foods they might be avoiding or foods that are triggering to them,” she said. “Cake, a candy bar, a bag of chips… I want them to try those foods here — in a safe setting. It’s portioned. It’s a moderated amount.”
Dietary treatment consists of “experiential practice” with food, in other words, eating meals and snacks while talking about their thoughts, urges and feelings.
“When I meet with the patients for their weekly nutrition sessions, I will ask questions like, ‘What are you feeling when you are eating a particular meal or snack? What thoughts do you experience while eating? How are you managing unhelpful thoughts? What urges related to your eating disorder are you experiencing? Are you able to enjoy the foods? What did you feel success with? What was a challenge? What did you learn from that meal experience?’” Lewis said. “The goal is to help them with their distress tolerance. Over time we aim to neutralize food judgments and work towards helping them accept that food is food and it doesn’t make you a good or a bad person. We are supporting them in getting control back versus the food having control over them.”
Lewis said she teaches patients four basic nutrition principles to live by:
- Balance: It is important to eat from all the food groups every day.
- Variety: To get as many different nutrients as possible, eat a variety of foods in each food group.
- Moderation: It is OK to eat any kind of food, as long as portions are controlled. That includes everything from fruits and vegetables to desserts and bread.
- Flexibility: Be prepared to improvise. Vacations, holidays and restaurants might disrupt what you typically eat. Learn that you can eat healthy wherever you are.
Family is invited to join in during some of the meals, not only for nutritional education, but to learn how to support the patient.
Additionally, dietary therapy includes education and discussions on different topics, such as “Understanding carbohydrates,” “How to overcome fear foods” and “Learning how to portion appropriately using your eyes instead of measuring cups.”
“The biggest goal of dietary treatment in eating disorder patients is normalizing eating behaviors,” Lewis said. “Food is so much more than just food for these patients. It’s their coping mechanism for stress, anxiety or depression. They need new skills on how to deal with their emotions such as fear, guilt and shame. They need to learn that the number on the scale or what they did or did not eat doesn’t need to be how they determine their self-worth. These new skills that they learn while in treatment here in turn help them maintain healthier food-related habits throughout the rest of their life.”
Jennifer Lewis is a Registered Dietitian with Eating Recovery Center.
Written by Jackie Pilossoph for Eating Recovery Center and ERC Insight.