anti-diet – The Aleo Collective

Written by: Courtenay Vickers RD

Time to read: 6 minutes

What comes up for you when thinking about working with a dietitian? Many people might say they feel anxious, or perhaps express fear that they’re going to be weighed, or maybe they’re worried about getting “lectured” to by the dietitian.

Navigating the journey of recovery from an eating disorder can be overwhelming, but understanding the role of an eating disorders dietitian (ED RD) can help illuminate the path forward. Let’s explore what a dietitian is, what you can expect when working with an ED RD, and practical steps to get connected with one. And, hopefully, leave you feeling less unsure and more confident about getting started with an ED RD.

What is a Registered Dietitian (RD)?

Registered Dietitians are healthcare professionals who provide evidence-based nutrition and food information to help individuals lead sustainable and enjoyable lives. To hold the professional title, a dietitian must:

Obtain a degree in nutrition from an accredited university.
Complete a one-year internship with rotations in clinical and community nutrition, and foodservice.
Pass a national registration exam.
Register with their provincial dietetic regulatory body.
Meet annual continuing education requirements.

Dietitians take a holistic approach, focusing on the overall well-being of their clients. In the context of eating disorders, this often involves specialized training and ongoing supervision to address the unique challenges of these conditions.

A note on “nutritionists”: In some provinces, the term nutritionist is a protected title that can only be used by Registered Dietitians. Currently, only applies to Alberta, Quebec, and Nova Scotia. Other titles, such as holistic nutritionist, nutrition coach, etc. can mean different things, but they are NOT the same as an RD. Educational background and ongoing education, level of competence, and regulations can vary drastically.

When an RD says they are eating disorder specialized, this means the RD has specialized training and supervision in addition to their required schooling. Unfortunately, most university nutrition programs have very little to no training on eating disorders, which means many eating disorder-specialized dietitians have gone on to complete many additional trainings and hours in supervision to build their competence and confidence to support those seeking recovery from an eating disorder.

ED RDs are a critical part of the professional care team for ED recovery, alongside a therapist & primary care provider. Many ED RDs have also adopted weight-inclusive, anti-diet, and HAES-aligned perspectives.

The Role of an Eating Disorders Dietitian

Eating disorders dietitians are a vital part of the recovery team, working alongside therapists and primary care providers. Their responsibilities include:

Conducting comprehensive nutrition assessments and regular follow-ups.
Developing personalized nutrition care plans.
Assisting with the implementation of these plans.
Addressing dysfunctional thoughts and emotions related to eating, food, or body image.
Collaborating with other healthcare providers and, when appropriate, family members.

What will come up in sessions with an ED RD?

Generally, the top nutrition priorities when working with a dietitian for recovery will be working towards nutritional adequacy and regularity with eating. Along the way there will likely be many other themes to explore and areas to work on, such as:

Exploration of weight stigma
Understanding set point theory, metabolism, and energy needs
Challenging diet culture and internal beliefs about food
Meal planning and grocery shopping
Pacing of meals
Fear foods / trigger foods
Body image
Intuitive and mindful eating practices
Managing gastrointestinal issues and nutrient deficiencies
…and many other things!

Most ED RDs will be bringing in tons of compassion and validation along the way, and an acknowledgment that the eating disorder is not your fault. Sessions generally should provide you with a supportive environment and a non-judgmental space to explore these complex issues, as you take these brave steps forward in your recovery.

What to Expect in Your Sessions

Initial Sessions

The first few sessions typically involve a nutrition assessment to understand your current nutritional status and recovery needs. This helps set the foundation for your personalized care plan.

Follow-Up Sessions

Subsequent sessions usually start with a check-in, where you can share your progress, challenges, and reflections. Together with your dietitian, you will work on breaking down the next steps toward your nutrition and recovery goals. Sessions can be conducted virtually or in person, depending on your dietitian’s practice setup.

Duration of Treatment

The length of time you will work with a dietitian varies based on individual needs, the availability of the RD, financial considerations, and accessibility. Many individuals see their RD every 1-2 weeks and continue until they can sustainably manage regular and adequate eating patterns, often spanning several months to a year or more.

How to Get Connected with a Dietitian

Free Options

Referral: Your primary care provider or specialist can refer you to a clinic with a dietitian on the team.
Family Health Teams, Primary Care Networks, and Community Health Centres: These often have dietitians available and offer free workshops, education programs, and counseling.
Home & Community Care Services and Hospitals: Ask your case manager or hospital staff about dietitian services.
Telehealth Services: Call 8-1-1 or visit the website to ask dietitians questions for free.

Finding an Eating Disorder Specialized Dietitian

National Eating Disorder Information Center (NEDIC) – Find A Provider
Dietitians of Canada – Find A Dietitian
EDforRDs – Find A Dietitian
Association for Size Diversity and Health (ASDAH) – Healthcare Provider Listing
International Association for Eating Disorder Professionals (IAEDP) – Member Search
Intuitive Eating Counselor Directory

Tips for accessing and picking your RD

Note – if you are part of a hospital-based program, you generally won’t get a say in who your dietitian is.

Consider your options based on where you live and financially: In-person vs virtual, Private practice vs a free option, sliding scale and/or direct billing to insurance providers, etc.
RDs with eating disorder knowledge may or may not highlight the extent of their expertise online, so ask about their knowledge and comfort level of working with EDs
Some ED RDs will specialize more specifically with a certain type of ED (ex, ARFID or BED). Consider your symptoms and ask the RD if they have additional training/experience with what you’re struggling with.
Consider what values the dietitian has, and if they are in alignment with yours
Ask if you can meet with the RD for a free initial call to see if you’re a good fit
It’s okay to say if you’re nervous!

Working with an eating disorders dietitian can be a transformative step in your recovery journey. By understanding what to expect and how to get connected with the right professional, you can take proactive steps towards a healthier relationship with food and your body. For those living in Nova Scotia, New Brunswick, or Ontario, virtual nutrition counseling options are available through the Aleo Collective.

For more information or to schedule a free discovery call with the dietitian at The Aleo Collective, visit courtenayvickersrd.com and follow on social media at @courtenayvickersrd.

Remember: you are worthy of reaching out for help 💕

An Introduction to Intuitive Eating: Rejecting the Diet Mentality

Posted by: Raquel Griffin

Time to read: 5 minutes

“I just want to eat normally”. In my experience teasing this statement out with folks, I typically learn that what they mean is they don’t want to feel so preoccupied with food, or worried, or scared. They are tired from being at war with food and with their bodies. Many of them want Intuitive Eating, but it feels far off, out-of-reach, out of their capacity.

But, what if I invited you to consider that we’re born Intuitive Eaters? Of course, there are always going to be exceptions to most things, but generally speaking we come out of the womb with much of our intuition (evolutionary and survival responses) when it comes to eating. However, what happens often is that internal wisdom becomes polluted by external factors like diet culture. We learn to disconnect from our bodies and deny our needs and wants. Intuitive Eating is about reclaiming our birthright by shifting focus away from external factors rooted in diet culture and rebuilding trust with our internal wisdom and intuition.

This blogpost is the first entry of a series, an Introduction to Intuitive Eating. To summarize, Intuitive Eating:

Its philosophy is rooted in an anti-diet positioning and is aligned with the concepts of Health At Every Size and weight inclusivity.
It is comprised of 10 principles that are dynamic in nature (not sequential steps, though the positions of #1 and #10 are intentional)
Interoception is the foundational skill of reference; it is the ability to perceive physical sensations that originate from inside the body.
It has a solid footing in research in numerous ways:
(a) evidence for the ineffectiveness and damage of diets or intentional weight loss
(b) is an evidence based approach that demonstrates the benefits of intuitive eaters (220+ studies and counting)
(c) has a validated assessment tool.

In this post, I want to focus on explaining the anti-diet positioning of Intuitive Eating, which is related to the first principle of Intuitive Eating, and I’ll pull in some research pieces to corroborate that stance.

The first principle is the most important, Reject the Diet Mentality, where right away things get real specific on why an anti-diet approach can be a helpful cornerstone in your relationship with food repair. Diets do not work, and by this I mean weight loss that can be experienced from dieting is not long lasting. On top of that, the ineffectiveness of dieting is not a neutral quality: diets can cause a lot of harm and damage on our health in a variety of ways.

Dieting and intentional weight loss have been have showing their hand in research for a while now. You can see a non-exhaustive list of some of this research at the end of this post. Way back in 2007 a team of researchers came together to conduct a meta-analysis of all the long term weight loss studies they could find to assess whether long-term weight loss was actually a thing. The results from this meta-analysis, and other research studies since, report a 5-year maximum window where approximately 95% of people will not only regain the weight they did lose from dieting initially, but up to 2/3 of people will actually regain MORE weight than they lost. Let’s recognize for a moment what that means: dieting is more likely to make you fatter in the long-run. Now, this is not meant to demonstrate colluding with diet culture, but instead to point out the ridiculousness of a product that worsens the very “issue” it claims to resolve. Imagine purchasing a water bottle that not only is ineffective in quenching your thirst, but instead actually makes you thirstier. Pretty ineffective product, eh?

So, the diet is the problem itself, yet we are convinced by diet culture that WE are the problem. We are somehow at fault. When the weight inevitably comes back we blame ourselves and try the next diet or “lifestyle change”, and the next, and the next. This often results in weight-cycling: the pattern of weight loss and regain that occurs with chronic dieting. Weight cycling is seldom controlled for in many large studies that associate weight with health issues; this is a major oversight because weight cycling itself is an independent risk factor for many health conditions including: cardiovascular disease, inflammation, high blood pressure, and insulin resistance. And what do you know, these health issues often are blamed on one’s weight or fatness, resulting in various prescriptions of the very thing that could be contributing to these health issues = intentional weight loss via dieting and exercise.

In future posts for this series on an introduction to Intuitive Eating, I’ll share more on how the concepts of Health at Every Size and Weight Inclusivity have overlaps with an an-diet approach, some of the benefits of Intuitive Eating that research has shown, Interoception, and more. For now, my hope is maybe reading this has helped you begin to consider a different perspective toward the normalized attempts to shrink our bodies via some rendition of eating less. If you’re feeling exhausted from the never ending pursuit of weight loss, or feeling obsessed with food or eating, know that exploring Intuitive Eating could bring more peace and ease to your food and body relationship. It has the potential to reconnect (or introduce) you to your birthright.

Research references (for dieting being ineffective), a non-exhaustive list:

Bacon, L., & Aphramor, L. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, (10) 9. DOI: 10.1186/1475-2891-10-9

Dulloo, A. G., Jacquet, J., & Montani, J. (2011). How dieting makes some fatter: from a perspective of human body composition autoregulation. Proceedings of the Nutrition Society, 71, 379–389. doi:10.1017/S0029665112000225

Field, A. E., Austin, S. B., Taylor, C. B., Malspeis, S., Rosner, B., Rockett, H. R., et. al. (2003). Relation between dieting and weight change among preadolescents and adolescents. Pediatrics, 112, 900– 906.

Fothergill, E., Guo, J., Howard, L., Kerns, J. C., Knuth, N. D., Brychta, R., et. al. (2016). Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity biology and integrated physiology. doi:10.1002/oby.21538

Mann, T., Tomiyama, A. J., Westling, E., Lew, A., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, The American Psychological Association, 62(3), 220-233. doi: 10.1037/0003-066X.62.3.220

Montani, J., Schutz, Y., & Dulloo, A. G. (2015). Dieting and weight cycling as risk factors for cardiometabolic diseases: Who is really at risk? World Obesity, (1), 7–18. doi: 10.1111/obr.12251

Neumark-Sztainer,D., Wall, M., Larson, N. I., Eisenberg, M. E., Loth, K. (2011). Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a

10-year longitudinal study. Journal of the American Dietetic Association. doi: 10.1016/j.jada.2011.04.012

O’Hara, L., & Taylor, J. (2018). What’s wrong with the ‘war on obesity?’: A narrative review of the weight-centered health paradigm and development of the 3C framework to build critical competency for a paradigm shift. SAGE open, 1–28. DOI://1d0o.i.1o1rg7/71/02.1157872/241450812484707128878728888

Richmond, T.K., Thurston, I.B., Sonneville, K. R. (2020). Weight-focused public health interventions: No benefit, some harm. JAMA Paediatrics.

Ross, R., Blair, S., de Lannoy, L., Després, J., Lavie, C. J. (2015). Changing the endpoints for determining effective obesity management. Progress in Cardiovascular diseases, 57, 330–336. http://dx.doi.org/10.1016/j.pcad.2014.10.002

Tribole, E., & Resch, E. (2020). Intuitive eating: A Revolutionary Anti-Diet Approach, 4th ed. St Martin’s Publishing Group: New York.

Tribole, E., & Resch, E. (2017). The intuitive eating workbook: ten principles for nourishing a healthy relationship with food. New Harbinger Publications: Oakland.

Pietiläinen, K. H., Saarni, S. E., Kapiro, J., & Rissanen, A. (2011). Does dieting make you fat? A twin study. International Journal of Obesity. doi:10.1038/ijo.2011.160- online publication, 9 August 2011

Wing, R. R., Bolin, P., Brancati, F. L., Bray, G. A., Clark, J. M., Coday, M., et al. (2013). Cardiovascular effects of intensive lifestyle intervention in Type 2 diabetes. The New England Journal of Medicine, 369, 145-54. DOI: 10.1056/NEJMoa1212914

Tag: anti-diet

What to Expect When Working with an Eating Disorder Dietitian