Dear Dietitian

Before we even begin, please know that while you may have studied and earned a degree in nutrition, most of us with eating disorders have a damn good knowledge of food too, so the first question I will ask is: what extra can you bring to aid in our treatment and recovery? If the knowledge of what type of foods to eat, and at what amount, was enough we wouldn’t be here, so your services have got to provide more than this if progress is to be made.

Patients with eating disorders are veeerrrrry different to the clients you typically see in your profession; dealing with us is not something that you can just “wing” and hope for the best. If you can, do a bit of research onto understanding the functions of eating disorders – you will be better prepared when you encounter someone with, or may be, suffering from an eating disorder. And on that note – don’t ever base your opinion of what a person needs from your services upon what you see. Anorexia, bulimia, binge eating – these are not disorders that only effect the extremely underweight or overweight, they do not discriminate against size. For all you know, you could be telling a heavily-restricting overweight client to just restrict even more just because you assumed that they are not struggling with an eating disorder. Tread with caution.

When it comes to getting a plan in place for us and our eating, prescribing a set meal plan with exchanges or calories or specific foods with exact timings may look good on paper, but this is not recovery-friendly for eating disorder sufferers. Like a dog with a bone, the illness can take these numbers and rules and make them law – further exacerbating the eating disorder’s control and making recovery even harder. We need to learn that food enables life, not that food is life. While we are on the topic of rules and our head playing games, most of us are aware of this (whether we care to admit that or not is another thing) and recognise the irrational fear and understand that our behaviours don’t make a lot of sense – but it does not make our feelings or struggles any less valid. What you’ll need to help us with is recognising these thoughts and feelings – but eating anyways.

You may be able to help us with all of our issues around food, do not feel unsuccessful if you cannot help with all issues. While recovery cannot happen without food, recovery goes far beyond normalising food and weight restoration and into intense therapy which is beyond the scope of your skills. So, don’t get caught up in one small thing you can’t help us change – as time passes by, recovery progresses and so too can the issue you weren’t able to tackle. Additionally, remember that we may also be receive other forms of therapy and support for our recovery. If you can, liaise with other professional involved in our treatment to ensure that you are all giving us the same message. From experience, an occupational therapist, anxiety psychologist, eating disorder psychologist, and a dietitian can all have different advice about our recovery – including what, when, or how to eat.

If you happen to encounter young clients who live at home with their parents – don’t for get this when thinking of how to treat your client. Use their family and their knowledge of what the sufferer ate before the disorder took over – as much as we want help, sometimes our disorders can be sneaky and cause us to deviate from the truth. The family may not like eating Italian, or fish, so putting such types of foods on the meal plan or forcing the patient to eat these foods may be a waste of time.

For those of us who have slowed down our metabolism due to restrictive behaviours, know that when we start increasing the amount of food and energy we consume it is very possible for us to need a lot of food – easily exceeding 5,000 calories and may be required for a prolonged period of time. Be prepared – getting enough energy in can be very uncomfortable for us for a non-extreme amount, so keep that in mind if we end up needing extra nutrition.

You are in for a hell of a ride, and we apologize if we – or should I say the eating disorder – react badly to your advice, we truly appreciate the work you are trying to do. Eating disorders are hard work for us, and just as hard for you, take a deep breathe, put your game face on, and be relentless – we may take some time but you are undoing potentially years-worth of entrenched behaviours.

Your friend,

Rawing Meg

xx