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Nutrition Therapy in the Treatment of Eating Disorders
By Meghan Vivo
Eating disorders often have very little to do with food, yet they are acted out with food. Whether an eating disorder is caused by past trauma, family conflict, genetics, low self-esteem, underlying emotional issues, or any number of other reasons, one thing all eating disorders have in common is that they are played out through issues surrounding food.
Like the alcoholic who turns to substances to avoid coping with underlying emotional or physiological issues, the individual with an eating disorder acts out through food. And just as treatment for alcoholism involves addressing the underlying issues that caused the addiction and abstaining from further alcohol use, treatment for an eating disorder requires developing a new set of coping skills and a new relationship with food.
Although eating disorders are not necessarily caused by issues with food, learning about nutrition is an essential component of eating disorder treatment. The American Psychiatric Association guidelines recommend nutritional rehabilitation as a first goal in the treatment of anorexia and bulimia.
Kelly Hinds, a registered dietician who has worked in eating disorder treatment for eight years at all levels of care, believes individuals with eating disorders benefit from a comprehensive nutrition program that encourages a healthy relationship with food. As a full-time dietician at Montecatini, a well-known eating disorder treatment program for adolescent and adult women near San Diego, Calif., Ms. Hinds knows firsthand the importance of not only treating the underlying issues surrounding eating disorders but also providing women with a new model for healthy living.
The nutrition program Ms. Hinds administers at Montecatini is multi-faceted, consisting of restaurant and grocery store outings, nutrition education classes, therapy and processing groups around food issues, and family coached meals.
Understanding the Body and Its Nutritional Needs
Part of treating an eating disorder is teaching patients how the body works and how it is affected by the eating disorder. Because there is a great deal of misinformation about what a healthy diet looks like, as well as negative messages from the media, the women at Montecatini receive nutrition education courses each week about food groups, portion sizes, and other helpful subjects.
“Our nutrition philosophy at Montecatini is that there are no good or bad foods – all types of food are part of a healthy meal plan,” explains Ms. Hinds. “The key is moderation and variety.”
Every patient at Montecatini has her own structured meal plan that includes a grain, vegetable, protein, and fat at each meal. She also has the flexibility to create menus each week so that she has choices about what she eats. Over time, the staff introduces meals that may be less structured, but that mimic real-life scenarios patients may confront outside treatment, such as a cocktail party with only appetizers, a potluck at work, or a pasta bar. In this way, patients learn to accept challenges, try new things, take risks, and maintain flexibility in their thinking.
Getting Comfortable Around Food
Individuals with eating disorders often have mental distortions and intense feelings of fear around certain foods, particularly fats and carbohydrates. For example, a young woman may believe that eating a donut will result in massive weight gain or destroy her body or her health.
At Montecatini, women are encouraged to sample “fear foods” each week in a supervised, safe environment where they can discuss their concerns with caring staff and peers.
“Because food is essential for survival, individuals with eating disorders will be faced with their fears several times a day for the rest of their lives,” says Ms. Hinds. “They can’t just walk away from it, so we help them develop the skills to cope in healthy ways.”
Once a week, patients at Montecatini venture out on restaurant and grocery store outings to practice ordering food without knowing its exact ingredients and choosing foods at the supermarket that will fit into a balanced meal plan. These “exposure outings” gradually accustom patients to coping with their fears rather than engaging in eating disorder behaviors.
“By exposing patients in a safe environment to foods, meals, or situations that trigger disordered eating habits, they gradually begin to realize they can overcome the feelings of stress, guilt, or anxiety,” says ms. Hinds. “Instead of becoming terrified or breaking down emotionally, they gain confidence in their ability to not only survive but actually confront their fears head-on.”
Learning the basics of cooking is another important component of eating disorder treatment. Patients at Montecatini work with a full-time chef, who helps them adapt to touching and preparing food and getting comfortable in the kitchen. In order to remind the women of the natural source of their food, the program features a garden with in-season produce. All of these pieces combined help patients develop a healthy connection with their food.
Support for Families through Family Coached Meals
For many families, meals are a time of bonding and togetherness. But when disordered eating habits are brought to the table, mealtime can be stressful and emotionally charged for both parents and the individual with an eating disorder. For this reason, parents often need guidance on how to support their daughter through these especially difficult times.
At least once while in treatment at Montecatini, adolescent patients sit down with their parents, therapist, and dietician for a “family coached meal” – a meal that allows parents to look at their child’s eating behaviors, and the patient to look at her parents’ eating behaviors.
“Family coached meals are an opportunity for patients and their families, in a supervised, therapeutic environment, to discuss their feelings around their own disordered eating habits as well as any unhealthy mindsets present at home,” says Ms. Hinds. “By openly discussing those habits, we can help identify behaviors that need to change in order to create a healthy environment when the patient returns home.”
The staff of eating disorder specialists also use family coached meals to teach parents about Montecatini’s nutrition program and offer guidance and support in preparation for their child’s return home after treatment. The goal of the staff is to model healthy, balanced eating habits for the entire family and discuss how to address common issues that arise around mealtime.
Family involvement is an integral part of adolescent eating disorder treatment. In addition to family coached meals, patients at Montecatini participate in family therapy at least once a week, address relationship issues on an ongoing basis, and begin preparing for the transition home early on in treatment.
“Parents often feel overwhelmed when their daughter returns home from treatment,” says Ms. Hinds. “Understandably, they are unsure how to act and what to say in order to best support their child, so we give them a lot of practice and guidance both during and after treatment.”
Eating disorders involve a complex inter-relationship between society’s ideals of beauty, past psychological trauma, genetics, and family dynamics. As such, they require holistic, multidisciplinary treatment that incorporates medical management, psychiatric care, individual, group, and family therapy, and nutrition counseling. Though nutritional therapy is just one aspect of treatment, it is essential for individuals with eating disorders to learn how to treat their bodies well.
