How Nutrition Supports Eating Disorder Recovery
Misconceptions about food are prevalent in society and can lead to disordered eating behaviors. Two of our Eating Recovery Center (ERC) nutrition experts explain how nutrition plays a fundamental role in eating disorder treatment and recovery.
Previously working together as co-managers for dietitians at ERC Dallas, Kathryn Johnson, RD, LD, CEDRD-S, MA and Jennifer Lewis RD, LD, CEDRD-S both recently began roles as nutrition directors for Eating Recovery Center’s (ERC) East and South regions, respectively. They answer questions about ERC’s nutrition approach; how their teams work with patients, families and care teams; and nutrition myths, including unrealistic body image perceptions.
Meal planning in eating disorder recovery
Kathryn Johnson: All foods fit. There are no good foods or bad foods. I always tell the patients and families that if they think a food they like does not fit their meal plan, sit down with me and we’ll make it happen. We look at everything through balance, variety and moderation. We make a plan for the day so that the patient does not feel out of control, stressed that they may restrict or overeat and then engage in some sort of compensatory behavior. We want patients to feel comfortable and safe with the dietitian and meal plan.
Jennifer Lewis: It is about learning how to balance your food intake, understanding what appropriate portion sizes look like and learning how to be flexible with a wide variety of foods. Food is our patients’ number one medication; without appropriate nutrition, their brains and bodies cannot heal from the devastation of the eating disorder. If their food intake does not meet their body’s needs, they don’t stand a chance at getting better. Getting adequate nutrition is vital to their recovery.
Support for families in eating disorder recovery
Kathryn Johnson: With patients, we're challenging their thoughts, beliefs and feelings around food and nutrition, so there is a lot of talking. I may ask, ‘I wonder why you think that? Let's kind of figure it out—is that real?’ We work with families a lot too by providing education, and ensuring they understand the meal plan and the importance of incorporating these foods.
Jennifer Lewis: The dietitians work with patients individually, although sometimes a patient needs extra support. That’s when nutrition leadership gets involved and provides a second layer of dietary support. We use a family-based treatment approach, so whoever the main support people are for a patient, we need them to be involved and have the education and skills to support the patient long-term. We want to get patients back on the right track and set them up for success: this means preparing for a successful home and support environment for when they leave treatment.
Effective eating disorder treatment
Kathryn Johnson: It is really a benefit of working at this higher level of care and having so many people involved — psychiatrists, therapists, physicians and nurses. We can discuss how the patient is doing: if they are having troubles or experiencing victories. It helps us come up with a more realistic plan of working towards recovery.
Jennifer Lewis: Collaboration is kind of what I call our secret sauce: what makes ERC so good. We have all these different clinicians on-site working together. Our dietitians are in frequent communication with our therapists, psychiatrists, nurses, dietary assistants, program therapists and behavioral health counselors. We can also easily set up team sessions with the patient or family as needed. If the patient is not closely monitored, they could be at risk for cardiac failure and other dangerous medical complications, so it really takes a team of clinicians keeping a close eye on them. Collaboration takes place every single day.
How can nutrition support body image?
Kathryn Johnson: When people come into treatment, it's often a bit of ‘me versus my body’ and asking, ‘why won't my body just do exactly what I want it to do?’ But the body is trying to take care of itself. A lot of patients respond well to having that conversation about how they can work together with their bodies — being kind to their bodies by eating more consistently, drinking water, sleeping — as opposed to working against their bodies.
Jennifer Lewis: We all have genetically wired body sizes that are different from one another. While one person may have a certain body frame, another person may have a totally different body frame — but both body frames may be healthy. We try to help our patients learn how to accept the body they were born with; to not spend so much time listening to societal standards, but rather to accept their body. Oftentimes, rigid thinking comes along with eating disorders, so we must find that middle road of helping our patients understand what's going on. We explain the basics of how our bodies use food because we want them to understand why their bodies need it, and then we try to help them learn flexibility with food and acceptance that there is no such thing as perfect eating.
Common eating and food myths
Kathryn Johnson: It is important to recognize when nutrition gets twisted into disordered eating under the guise of wellness, which is very common in our diet culture society. I often hear that water is bad and will make you gain weight, but water is so essential to our lives. I think the patients I see who struggle with drinking water are often some of the same ones who struggle the most in treatment. Without water, you aren’t thinking clearly, and your organs are not functioning well. We work to help these patients get nourished so that we can actively start fighting some of these beliefs.
Jennifer Lewis: Some patients will come in and say that sugar is bad, or that they can’t eat what their friends and family are eating. Lots of “shoulds” and “shouldn’t” judgments tend to be related to food, especially around holidays such as “I shouldn't have any Valentine’s candy” or “I should only have a little to eat for lunch because I know I’ll be eating a holiday meal later.” Holidays can be very difficult times for people with eating disorders because of the emphasis on food. We educate our patients that there is no need for rigid food rules since our bodies know how to – for example – digest sugar, just like it does any other type of carbohydrate. Our patients tend to think in all or nothing terms, so we try to help them understand that dessert is okay from time to time. We show them appropriate portion sizes and use a meal plan to create a sense of structure and safety.
The nutrition philosophy at Eating Recovery Center emphasizes helping patients overcome their fear of food and eating by providing support and structure during meals, education on a balanced pattern of nutrition and collaborative care to achieve a healthy weight for optimal recovery.
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