Tag: eatingdisorders

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“But What Do I Say?” A Clinician’s Guide to Navigating Conversations About Eating Disorders

Written by: Courtenay Vickers RD
Time to read: 6 minutes

For many healthcare providers, the thought of working with a client who has an eating disorder can be daunting. Questions like What if I say the wrong thing? or What if I make things worse? are common, and this uncertainty can make clinicians hesitate or feel stuck. With some practice and guidance, effective communication and building rapport can be life-changing for that client sitting across from you! 

This blog post offers some helpful strategies for having compassionate conversations with eating disorder clients, integrating self-reflection, examples of what to say and what to avoid, and actionable steps for clinicians to build their confidence in this area.

Before we dig in, an invitation to remain curious rather than judgemental about your current/past self! Wherever you are at on your learning journey, that is ok. And I’m so glad you stumbled upon this post today.

First, what’s the difference between an eating disorder and disordered eating?

It’s important to recognize that there is a difference between an eating disorder and disordered eating when working with clients:

  • Eating Disorders are diagnosable mental health conditions outlined in the DSM, including:
    • Anorexia Nervosa (AN)
    • Bulimia Nervosa (BN)
    • Binge Eating Disorder (BED)
    • Avoidant/Restrictive Food Intake Disorder (ARFID)
    • Other Specified Feeding and Eating Disorders (OSFED)
  • Disordered Eating refers to a broader range of harmful eating patterns or behaviours that don’t meet diagnostic criteria but can still significantly affect physical and emotional health. Disordered eating can be a precursor to an eating disorder. Sometimes disordered eating looks like someone going on a diet, actively pursuing weight loss through dietary restriction, or even being “watchful” of what they eat. It’s not something to ever brush past.

With nearly 2 million Canadians affected by eating disorders—and the second-highest mortality rate among mental health conditions—it’s critical for clinicians to be prepared to address these complex issues with care and sensitivity.

Self-Reflection: Starting with Yourself

Let’s take a moment to do a little self-reflection. You might want to pull out a pad of paper for these questions. Before we get started, it’s important to know that how you approach eating disorder clients can be influenced by your own relationship with food, body image, and assumptions about health. Now, take a moment to reflect on these key questions:

  1. How has your relationship with food and your body influenced how you view and work with clients as a healthcare provider?
  2. Have you ever made assumptions about a person’s health or behaviours based on their weight? How could this affect your care?
  3. How do you interact with patients in larger bodies? Do you notice any differences in how you approach patients in smaller or very thin bodies?

Self-awareness is vital. Recognizing and addressing personal biases is an important step toward creating an environment of trust and support for your clients.

Let’s explore some examples of what to say (and not to say)

Compassionate communication can make a significant difference in how clients feel about their care and recovery. Here are examples of what to avoid saying, along with alternatives that foster trust and understanding:

Instead of: “Just eat!”

Try: “It seems like eating is difficult for you. Tell me more about what challenges come up for you with eating.”

Instead of: “You don’t look like you have an eating disorder.”

Try: “Eating disorders can affect anyone, any age, any gender, any body size. Your experience is valid.”

Instead of: “You’re just going through a phase. Everyone feels insecure about their body sometimes.”

Try: “I imagine what you’re going through is incredibly difficult.”

Instead of: “Your vitals and blood work are fine; you don’t need to worry.”

Try: “Your body is working hard to keep things medically stable right now. I know other behaviours are going on, so let’s explore ways to better support you and reduce harm.”

Instead of: “I wish I had your self-control!”

Try: “The eating disorder is not your fault. It’s a complex brain-based illness, and you deserve to receive supportive care.”

Instead of: “You look healthy/better.”

Try: “How are you feeling about your recovery journey so far?”

Instead of: (silence)

Try: “I’m concerned about your eating. I’m wondering if we can explore your relationship with food a bit more together.”

Instead of: “Don’t worry, you’re not fat! You won’t get fat.”

Try: “I can imagine the idea of gaining weight feels scary for you. That makes sense, given how focused our society and healthcare system are on weight loss. Regardless of your body size, you are deserving and worthy of recovery.”

Instead of: “You have an eating disorder? Sorry, I can’t help you.”

Try: “It sounds like you’re having some real challenges with food and eating. You deserve proper care and support. Are you okay if we talk more about some options to help you?”

Actionable Steps for Clinicians

Working with eating disorder clients doesn’t mean you have to know everything, but there are clear steps you can take to provide meaningful support:

  1. Learn About Eating Disorders
    Expand your knowledge by reading books like Sick Enough by Dr. Jennifer Gaudiani, Life Without Ed by Jenni Schaefer, and The Body Is Not an Apology by Sonya Renee Taylor. Food Psych by Christy Harrison is a wonderful podcast to learn more from. A great Canadian website about eating disorders that we often recommend is the National Eating Disorders Information Centre (NEDIC).
  2. Practice Active Listening
    Listening without judgment or a need to immediately “fix” can be a powerful tool. Validating a client’s feelings and experience can make them feel seen and understood.
  3. Collaborate with a Care Team
    Eating disorder treatment is often multidisciplinary. Work with dietitians, therapists, and medical professionals to ensure comprehensive care. If a client doesn’t have a team, help build a team or consult with other professionals on behalf of your client.
  4. Refer When Necessary
    Know the options for higher levels of care and how to connect clients. If waitlists are long, continue supporting your client with compassion and harm-reduction strategies while they wait.
  5. Advocate for your clients
    Advocacy can make a huge difference, whether it’s within the healthcare system, with family members, or through education about eating disorders in your community.

Building Confidence Through Practice

Feeling confident in conversations about eating disorders takes practice and support. If you want further guidance, consider joining Confident and Competent: Eating Disorder Clinician Consultation Group, starting in February 2025. This program offers group calls, practical skills, and a supportive community to deepen your expertise. Email us at thealeocollective@gmail.com to learn more and get on the waitlist.

Remember, you don’t have to be perfect or have all the answers to make a positive impact. By showing up with compassion, humility, and a willingness to learn, you can help clients feel supported and valued on their recovery journey.

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What to Expect When Working with an Eating Disorder Dietitian

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 💕

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New Year New View: A Dietitian’s Take on Challenging Diet Culture

Posted by: Courtenay Vickers RD
Time to read: 8 minutes

What is diet culture anyway?

Diet culture can be defined in many ways. I’ve been an RD (short for Registered Dietitian) for the past 10 years, and adopted a weight-inclusive lens with my practice about 6 years ago. I’ll preface this blog (as I did in my recent webinar) that I am constantly learning more about what diet culture is, how it shows up, and what to do instead.

When asked this question (re: what is diet culture anyway) I often reply by saying something to the effect of: diet culture is the harmful belief that certain body shapes and sizes are better than others, and there’s a “right” way of eating. To which I typically get the follow up question of “but you’re a dietitian, isn’t there a right way of eating?”. My response from here can get quite nuanced, depending on the audience – in short, there is no one-size-fits-all way of eating, because bodies are meant to be incredibly diverse and different! Not to mention everyone’s unique relationship with food, cultural connections and traditions with food, access to food, etc.

One definition of diet culture that I keep coming back to is by Christy Harrison:

“Diet culture is a system of beliefs that:

  • – Worships thinness and equates it to health and moral virtue, which means you can spend your whole life thinking you’re irreparably broken just because you don’t look like the impossibly thin “ideal.”
  • – Promotes weight loss as a means of attaining higher status, which means you feel compelled to spend a massive amount of time, energy, and money trying to shrink your body, even though the research is very clear that almost no one can sustain intentional weight loss for more than a few years.
  • – Demonizes certain ways of eating while elevating others, which means you’re forced to be hyper-vigilant about your eating, ashamed of making certain food choices, and distracted from your pleasure, your purpose, and your power.
  • – Oppresses people who don’t match up with its supposed picture of “health,” which disproportionately harms women, femmes, trans folks, people in larger bodies, people of color, and people with disabilities, damaging both their mental and physical health.”
https://christyharrison.com/blog/what-is-diet-culture

Diet culture in the new year

So, now that we have a bit more of an idea of what diet culture is, here’s a short list of various ways I’m seeing diet culture show up so far in 2024:

  • Overemphasis on getting “strong”
  • Influx of “clean eating”
  • Overambitious fitness goals
  • Bigger emphasis on dietary supplements
  • More orthorexic tendencies
  • Orthorexia = an unhealthy obsession with healthy eating
  • Sudden removal of entire food groups
  • Increased use of calorie-tracking apps + smart watches
  • Health washing + green washing on food labels
  • X # of day challenges related to food and/or fitness
  • “Watching” what you eat
  • More labelling of foods as good/bad, healthy/unhealthy
  • Lifestyle changes and wellness journeys

Here’s an interesting fact to highlight diet culture’s prevalence: according to Forbes, the top New Year’s resolutions in 2024 include improved fitness, losing weight, and improved diet.

I think it’s important to note that while there’s nothing inherently “wrong” with these resolutions, I find they are often fueled by diet culture and can perpetuate, worsen, or ignite eating disorder behaviours.

Why I’m concerned as a weight-inclusive dietitian in the eating disorder space

I’m concerned because diet culture can often be a precursor to eating disorders, and can perpetuate disordered eating behaviours. I think it’s important to mention that many factors can spur a full-blown eating disorder, such as genetics, food insecurity, trauma, and more (this is probably a topic for another blog post). And, diet culture is, unfortunately, a common piece that shows up along the way either in the development or recovery from an eating disorder. 

Challenging diet culture

Depending on where you are at with your journey to healing, you may have already started to challenge diet culture! I’ve compiled below a short list of ways I commonly find helpful to challenge diet culture (whether you’re starting this for the first time, or perhaps you are further along):

  • Learning more about the harms of diet culture
  • Setting boundaries (with yourself and/or others)
  • Stop labelling foods in binaries such as good/bad, or healthy/unhealthy
  • Take time to check in with yourself
  • Practice self-compassion
  • Get curious about a non-diet approach (or similar)

Here’s a short list of some keywords you may find helpful to guide your own reading and research as you start to learn more and challenge diet culture:

  • Anti-diet
  • Intuitive Eating
  • Body Liberation
  • Non-diet
  • Weight-inclusive
  • Health At Every Size®
  • Fat Positive

What to do next

A big (non-exhaustive) list of specific things you may or may not want to try instead of participating in diet culture this new year:

  • Eat regularly throughout the day. For some, this might look like multiple meals and snacks throughout the day. This might mean seeking help from a trusted support person, or a professional such as a dietitian. 
  • Integrate challenge foods, if you find there are foods in your life that are holding some sort of power over you. This might be foods that you are fearful of, foods you avoid completely, or foods that you often feel ‘out of control’ around. Integrating challenge foods is something that I typically only recommend once we are getting enough food in regularly first, and then slowly integrating the challenge foods one at a time in a structured way. 
  • Play with movement in a way that feels good for you and your body (only if this is medically appropriate and accessible for you).
  • Work on staying appropriately hydrated. What this might mean is ensuring you are drinking adequate fluids (or high fluid food sources) throughout the day. Watch out for overdoing it with caffeine as this can cause dehydration. 
  • Prioritize rest! And not just sleeping enough at night, but allowing space to rest during your waking hours. For some this might mean taking a nap, allowing yourself to ‘do nothing’ for an afternoon, or perhaps it’s pausing what you are doing for a few minutes periodically throughout the day to slow down and check-in with yourself.
  • Take time to explore your relationship with food and body. This might mean journaling, talking about this in therapy or with a dietitian, or reflecting on your own. 
  • Cultivate self-compassion ❤️ I truly believe we can’t talk about nutrition without talking about self-compassion. Nourishing ourselves and challenging diet culture is not always an easy thing to do. And at times, it can feel like a struggle. Can we work towards being kind and gentle with ourselves as we navigate all the sticky murky bits?
  • Challenge your food rules – especially if you find there are specific rules/patterns/or behaviours related to your eating getting in the way of recovery.
  • Re-evaluate your use of the scale and set limits around this. Many find it helpful to hide the scale, reduce the frequency of how often you use it, or get rid of it entirely. If it’s absolutely medically necessary to be weighed, consider these limits or have it done blindly at a clinic.
  • Put away diet apps and/or fitness trackers/watches. As a dietitian, I rarely find these pieces of tech actually helpful, and, if anything, they often cause an unnecessary focus and obsession with food/movement.
  • Curate your social media to better support your pro-recovery and anti-diet goals
  • Pick up a workbook or book related to ED recovery and/or an anti-diet approach
  • Improve your sleep hygiene. For some this might mean developing a bedtime routine, sticking to a sleeping schedule, or reducing caffeine intake.
  • Try a support group geared towards eating disorder recovery, body image, or intuitive eating (depending on where you are at and what fits best). 
  • Get professional help from an eating disorder registered dietitian, therapist, social worker, nurse practitioner, family doctor, or psychiatrist. 

I hope that by the time you are done reading this, something has stood out to you. Whether it’s a small takeaway, a new learning to ponder, or a new perspective on a familiar theme, I hope this has resonated with those reading. 

For anyone wanting to dig a little bit deeper, I’ll end with a few reflective prompts below.

Reflective prompts to help you challenge diet culture:

Whether or not journaling in a pen-and-paper way is your thing, these reflective prompts may be helpful as you work on challenging diet culture and healing your relationship with food and body:

  • How has diet culture shown up for you in your life?
  • What would it be like to step away from diet culture?
  • What’s the scariest part of challenging diet culture for you?
  • Who or what might be helpful to you during this process?
  • What’s one small thing you can do this month to challenge diet culture in your life?
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Postpartum body image tips: from an ED therapist with ED lived experience

Posted by: Raquel Griffin

Time to read: 5 minutes

Originally appeared on: NEDIC.ca

At first, I thought I was successful in combating ED thoughts and the diet mentality that followed the birth of my child. Sure, my ear would initially be tickled with ED whisperings of fatphobia and diet culture. But just as quickly as they appeared, self-compassionate and comforting hums would replace them. But as time passed, I began to feel more stress about my new body shape and size. I had a number of friends and acquaintances who gave birth very close to when I did, and I really began to struggle with body comparison. Why was my body larger than theirs? Why did it seem like they were restored to their pre-pregnancy body sizes when I wasn’t? These fatphobic thoughts and expectations hung like a cloud as I squeezed my body into my too-small clothes.

At 4 months postpartum, I was horrified to come across a post in my social media feed from my local hospital’s pregnancy unit for an upcoming Q&A on C-sections. The post included a naked, very thin, flat-tummied, stretchmark-free, White person, from the navel down to the thighs. Laying on top of this body was a newborn baby, peaceful in slumber, blocking the birthing person’s labia but also positioned low enough down to wonder how this person had no pubic hair. It was a completely unrealistic picture of any body, let alone a postpartum body. I was so upset that a reproductive-focused medical facility was perpetuating such a harmful body standard (not to mention a weirdly sexualized one). I felt  shame about my postpartum body and at times bought into this diet-culture idea that my body should be getting smaller the further away I got from  my child’s birth date.

Pregnant people are often highly encouraged to try nursing at any cost (a whole separate conversation) and one of the “benefits” often included is weight loss. I hate to admit it… but when feeding/nursing was going well with my baby I was partially relieved, because in the back of my mind, I thought it would help prevent me from needing to adjust to a drastically new and different body. But, I was wrong. I was experiencing shame that my postpartum body was “too large” or differently-shaped. And, then I had shame about my fatphobia-induced shame, as that was not aligned with my values.

It’s a strange thing to hold reverence for the body that withstood such a major medical event and brought my treasured child into the world, while also resenting the bodily evidence left behind. To admire the softness and smoothness from stretched skin where my child was held in their first home, then to shortly thereafter hold disgust for new skin/fat folds and stretch mark scribblings. The good news is, with a lot of work, over time my relationship to my new body as a result of pregnancy and childbirth is becoming easier. If I’m being honest, I’m not yet at a place where I like my postpartum body and I’m willing to accept that maybe I will never be. But, I am at a place where my feelings toward my body are much more neutral and compassionate. My body has been and is capable of great things. My body is worthy. 

These are some of the things that have been helping me move toward body acceptance:

Remind yourself that eating is especially important during this time
Our bodies need energy in the form of food. Providing consistent and adequate nourishment following labour and delivery is extremely important—especially for postpartum bodies. The last thing your body needs right now is to have its starvation response triggered.

Whether your birth was vaginal or Caesarean, your body needs to recover and it needs food to do that. You will need the energy from food to help you combat the sleep deprivation you’ll be experiencing. I was able to have several family members and friends provide food and meals in the weeks after my birth so that I didn’t have to worry about cooking. This was an absolute life-saver. I also made sure I had Ensure and meal supplements on hand to quickly consume nutrients with little time/effort. Eating enough consistently and regularly will also help your milk production if you are nursing.

Respect your body by dressing in clothes that fit and are comfortable
Stop trying to squeeze into your old clothes. Wearing clothes that are too tight does not feel good. 

Pregnancy/maternity clothes are meant to accommodate a changing body. Your body may keep changing postpartum so just because you’re no longer pregnant doesn’t mean you should stop wearing pregnancy clothes if they are comfortable and fit. If it helps you feel better, stay away from the items that accentuate a “bump”.

If you find that your new body shape does not fit in any of the sizes provided in a store, consider buying a size that is too big and then taking to a tailor or a family member who has some sewing skills. Get familiar with thrift stores. I have bought some items new, but I have found most of my success with thrift stores. I’ve even bought a couple items with the tags still on.

Engage in re-embodying activities
With pregnancy, labour, child-birth, and nursing, there is a long period of time where you may feel like your body isn’t fully your own anymore. And, if you have a history of disordered eating and disembodiment, these feelings could be exacerbated. Where possible, engage in pleasurable activities that help you reconnect with your body in positive ways. For me, that was prioritizing walking, getting back to choir rehearsals and singing, and maintaining sexual intimacy with my partner. 

Reject the Diet Mentality
Shortly after giving birth, I completed my Intuitive Eating Counselling Certification. Immersing myself in anti-diet values, principles, and scientific research really helped me to reject the diet mentality and ED thoughts as they arose. 

There is no research to indicate that long-term weight loss is a realistic endeavour.
Speak out against harmful diet culture when you see it. For example, that Instagram post I mentioned— I commented something along the lines of “I’m really happy to see this event on C-sections will be taking place but I am very disappointed you chose to use a promotional image that perpetuates an unrealistic body standard”. Many other commenters followed suit and the account ended up removing that promotional image.
Consume weight-inclusive content, media, and literature that aligns with anti-diet values, fat-liberation, and Health at Every Size. Some of my favourites are:

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