Nutrition counseling

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What is nutrition counseling?

Nutrition counseling is a form of eating disorder treatment that is part of a comprehensive, multidisciplinary treatment plan that can also include medical interventions, talking therapies, family therapy, and other treatment methods. A dietician who specializes in treating eating disorders can deliver nutrition counseling to achieve positive outcomes in patients by improving relationships with and attitudes toward food and eating. (1)

During nutrition counseling sessions, the dietician or nutritionist will discuss the various nutrients the body needs, as well as how much food someone of a specific age, body type, and gender generally requires to adequately nourish the body and remain healthy. The dietician will also teach Individuals how to recognize the cues of hunger and satiety (absence of hunger), as well as how metabolism works.

Nutrition counseling is an important step in the recovery process for an eating disorder, as it provides valuable information and accountability. (2)

How to treat eating disorders with nutrition counseling

Nutrition counselors are essential members of a multidisciplinary clinical team treating people with eating disorders, including therapists, nurses, and care partners.A dietician in this role has the advanced training needed to effectively treat people with eating disorders and understands the psychological, physiological, and neurobiological aspects of eating disorders. (8) Nutrition counseling for eating disorders will focus on the person as a whole. It includes repairing the relationship with food, as well as working on body image, addressing emotional dysregulation, weight restoration, body-weight maintenance, and development of neutrality toward food.

A good nutritionist will tailor eating disorder treatment to an individual’s specific needs, taking into account unique fears, food attitudes, medical history, and any co-occurring disorders. The nutritionist will offer emotional support, as well as providing correct nutrition education and addressing nutrition misinformation and eating disorder beliefs.

Nutrition therapy is usually done in conjunction with other forms of counseling, including cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). This helps individuals understand why they might engage in certain eating behaviors and learn to replace harmful ones. (3)

A nutrition counselor can also create a personalized meal plan, designed to meet specific goals. This plan can help patients reconnect with food, and nutrition in a healthy, harmonious way. 

Types of nutrition counseling

The type of eating disorder dictates the goals of nutrition therapy. (4) In most types of eating disorders, one of the primary goals is to develop neutrality toward food by re-learning to recognize feelings of hunger, fullness, and satiety.

Goals of nutrition counseling

Anorexia Nervosa (AN)

  • Restore and maintain body weight
  • Regulate blood phosphate levels
  • Increase food intake gradually through an individualized meal plan
  • Acknowledge and accept that gaining fat (along with other tissue types) is part of weight restoration

Binge Eating Disorder (BED)

  • Regulate blood sugar levels via portion redistribution
  • Improve food-related behaviors through an individualized meal plan
  • Introduce variety into the diet if nutritional deficiencies exist
  • Explore triggers of binging episodes and learn to replace these maladaptive coping mechanisms

Bulimia Nervosa (BN)

  • Decrease binging and compensation cycles, which may help stabilize weight
  • Establish consistent eating patterns
  • Regulate blood sugar levels through portion redistribution
  • Restore and maintain blood potassium levels

What to expect in nutrition counseling

The nutrition counselor will work closely with each individual, listen to concerns and provide support when facing new challenges and food fears.

The primary goal is to help restore a healthy relationship with food and improve eating behaviors. They may also make recommendations for dietary supplements if certain nutrients are deficient.

The nutritionist will create a personalized plan to help individuals learn:

  • What foods and drinks are needed to consume to maintain good overall health
  • How the body uses nutrients and essential vitamins and minerals, and why they are important
  • How to prepare appropriate snacks and meals
  • How to recognize food fears, how even ‘feared’ foods are good for your body, and how to gradually tackle phobias
  • How eating behaviors are linked to emotions

Evaluating nutrition counseling as an effective eating disorder treatment

What are the benefits of nutrition counseling?

Improved digestion and gut health

Nutrition counseling can result in improved digestion and nutrient absorption in patients with eating disorders by promoting healthier eating habits. Healthier eating habits can improve overall gut health and address nutritional imbalances common for people with eating disorders.

Gut health is a key factor in maintaining a healthy immune system, and improving the gut through a better diet boosts immune response. 

Reduced fatigue and increased energy levels

Addressing nutrient deficiencies, particularly vitamin B12, sometimes seen in patients with eating disorders can help reduce feelings of chronic tiredness. Plus, adopting a balanced diet allows the body to stabilize blood sugar levels, which can increase energy levels.

Lasting healthy habits

The nutrition counselor teaches skills and tools to last for the long term. With solid knowledge of  proper nutrition and how to challenge negative food behaviors, individuals can help their bodies stay healthy for a lifetime. 

Efficacy of nutrition counseling in healing eating disorders

When treating eating disorders, nutrition therapy is essential for the patient to regain normal eating habits and restore a more appropriate body weight. (5)

Intensive nutrition therapy, along with an initially high energy nutrient intake, results in significant weight gain, increased fat and muscle mass, and reduced food-related anxiety in people with anorexia nervosa (AN). (6)

A combination of nutrition and cognitive therapy have been shown to result in significant decreases in binge/purge behaviors, as well as an increase in self-control and improvement in dysfunctional attitudes in people with bulimia nervosa (BN). (7)

Nutritional counseling at Within Health

In traditional treatment programs, nutrition counseling will only involve meal planning for the week. At Within Health, we decide the meals for our patients as a part of their exposure. So our nutrition counselors will get into the patient’s food beliefs, working to debunk myths they may perceive as truth (e.g. myth: “sugar is the devil”). Within Health offers nutrition counseling to our patients on a daily basis, as well as in weekly nutrition groups. If you would like to learn more about what nutritional counseling Within Health offers, or are interested in starting treatment at our virtual care program, please call our clinical care team now.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Reiter, C.S., Graves, L. (2010, April 25). Nutrition therapy for eating disorders. Nutr Clin Pract, (2):122-36. 
  2. Susan Cowden, M.S. (2019, July 28). A dietitian can make treatment plans for eating disorder recovery. Verywell Mind.
  3. Mind. Dialectical Behavior Therapy (DBT).
  4. An introduction to nutritional therapy. National Eating Disorders Association. (2018, February 21).
  5. Nikolic, M., Pavlovic, M., Vojinovic, M.M. (2009). Medical Nutrition Therapy in Management of Eating Disorders. Acta Medica Medianae, (48):50-55.
  6. Pettersson C., Tubic, B., Svedlund, A., Magnusson, P., Ellegård, L., Swolin-Eide, D., Bertéus Forslund, H. (2016). Description of an intensive nutrition therapy in hospitalized adolescents with anorexia nervosa. Eating Behaviors, (21):172-178
  7. Hsu, L., Rand, W., Sullivan, S., Liu, D., Mulliken, B., McDonagh, B., & Kaye, W. (2001). Cognitive therapy, nutritional therapy and their combination in the treatment of bulimia nervosa. Psychological Medicine, 31(5), 871-879. 
  8. Ozier A.D, Henry B.W. (2011, August). American Dietetic Association. Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders.J Am Diet Association, 111(8):1236-41.

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