RD Career Path: Nutrition Therapist in Disordered Eating and Eating Disorders
Treating disordered eating (DE) and eating disorders (EDs) can be both a challenging and rewarding specialty for dietitians. If you are interested in pursuing a career in this area, the following suggestions are offered to assist you in this endeavor.
Evaluate your personal interest:
If you have been attracted to the field of dietetics as a result of a personal struggle with DE or an ED, your experience can aid your understanding and contribute to your compassion; however it can also impair your judgment, especially if you have not fully resolved your own eating issues. Moreover, personal experience cannot substitute for education and credentialing. Be certain that you have addressed and resolved your own food issues and eating beliefs to a point where they will not affect your ability to be objective and client-focused prior to working with this population of clients/patients.
Pursue additional education and experience:
When specializing in DE and ED, you may find that traditional training in the field of dietetics is not adequate preparation. Where your past experience may have been geared more toward providing education (re: eating and nutrition), ED work will require additional education in the areas of psychology and counseling. Seek out related continuing education, and if you choose to make this your specialty, consider taking additional classes in psychology which will better equip you when working with personality disorders and the family systems component.
Be prepared to be part of an ED treatment team:
The management of DE and ED involves a multi-disciplinary team including physicians, psychiatrist, and therapists. If you chose to specialize in this area you will need to be a ‘team player’. In fact, it is considered unethical for a dietitian to be the only health professional treating a patient with the clinical EDs anorexia or bulimia nervosa. Being a part of a treatment team allows each practitioner to be more effective in their particular role. Frequent communication with team members regarding mutual patients is vital. This enhances treatment success and reduces the occurrence of triangulation and splitting that can occur when treating this population. Be aware that family members and possibly coaches or trainers are often part of the treatment team especially when working with children and adolescents.
DO YOUR RESEARCH
Understand diagnoses thoroughly:
Understand the diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS), but be cautious when discussing the diagnostic criteria with your clients. Realize that DE and ED occur along a spectrum of severity and the patient will likely move along that spectrum and demonstrate a varying range of DE/ED behaviors throughout the treatment process.
Treat the person, not the disorder:
Always treat the individual … not just the eating disorder. Never assume the diagnosis is the person!
Become familiar with psychiatric terms and medications.
Become familiar with the Ancel Keys Starvation Study:
Ancel Keys University of Minnesota study done in the 1940’s regarding the effects of semi starvation on behavior and brain functioning. This study underscores the contribution dietary restriction makes to the development of DE & EDs. (You will never look at dieting the same!)
Read, read, read:
Read a variety of newsletters, journals and books to further your education in the field of EDs.
Network with all health professionals:
Begin networking with non-dietetic professionals in your area who have experience treating eating disorders. Psychologists, licensed clinical social workers (LCSW) and physicians can broaden your scope of knowledge and become great referral sources.
Join professional associations and attend conferences:
Join professional organizations such as The Academy for Eating Disorders (AED), National Eating Disorders Association (NEDA) or The International Association for Eating Disorders Professionals (IAEDP). This will provide you with additional networking and educational opportunities. Membership in The AED includes a subscription to the International Journal of Eating Disorders. In addition to joining SCAN and attending SCAN Symposium, consider joining Behavioral Health Nutrition DPG for additional resources including issues of addiction.
Strongly consider receiving supervision from an expert in the field for at least the first year or two of working with clients struggling with DE & EDs. This can be from a master’s level dietitian specializing in DE & EDs work or other mental health professionals. This is generally a fee for service arrangement. If you are in private practice, this is tax deductible. If you are not in private practice, and your employer will not pay for supervision, it is deductible if you itemize as non-reimbursed employee expense.
Reba Sloan, MPH, RD, FAED, Nutrition Therapist, Nashville, TN
Christina Scribner, MS, RD, CSSD
Katherine Beals, PhD, RD, CSSD, FACSM
Leslie Schilling, MA, RD, CSSD
Karen Wetherall, MS, RD, LDN
Updated July 2011