Working with a Registered Dietitian for Eating Disorders

Caring for people struggling with eating disorders or disordered eating patterns is core to our work at Culina Health. There are specific RDs on our team who specialize in working with patients who are struggling with eating disorders—and they all have advanced training and extensive experience in supporting the unique needs of this patient population. We recently spoke with one of these specialists, Culina Health RD Quin Kelly, BS, RDN, who worked at the Renfrew Center for Eating Disorders before joining the Culina team. Read on to hear more about Quin’s approach to ED care as well as how Culina Health supports patients with nutrition care for eating disorders.

About Quin Kelly, BS, RDN

How did you come to the RD profession, and eating disorder care in particular?

I was drawn to nutrition due to my own health issues, finding out I had an autoimmune condition one week before heading into my freshman year of college. During that time, I realized how common eating disorder behavior was amongst my friends, roommates, and peers—even myself! I became interested in pursuing a career in the ED field as a dietitian to provide proper nutrition education and help those struggling with their relationship with food and body 

What to Expect From Eating Disorder Treatment at Culina Health

What are the most common EDs you treat?

Atypical anorexia (where someone struggles with anorexia but is not technically underweight), anorexia nervosa, binge eating disorder, and ARFID (avoidant/restrictive food intake disorder) are the most common EDs I see. 

What is the role of an RD in supporting a patient with an eating disorder?

The role of an RD in supporting someone with an ED is so multifaceted. Some of the things it includes are:

• Educating a patient around proper nutrition practices and eating habits (what a balanced plate looks like, what types of macronutrients our bodies need to survive), and often myth-busting harmful nutrition beliefs that are pervasive and normal in our society (“carbs are bad,” and “you shouldn’t eat dinner past 7pm” are misconceptions I hear alot!).
• Helping patients rebuild their relationship with ALL foods—not just “healthy” ones.
• Creating a toolkit with easy meal/snack ideas and grocery lists to remove the stress from feeding oneself and creating reminders of what a balanced eating pattern can look like.
• Supporting creation of a meal plan to follow as a blueprint.
• Strategizing with patients to develop coping skills that keep them resilient and on the path to healing, even when stressors or triggers arise.

What can an eating disorder patient expect from their first few nutrition therapy sessions?

In nutrition counseling, I like to get to know the patients that I work with as a whole person, not just their symptoms or struggles. It’s important to me that I know things about their day-to-day routine, as well as any food rules or food judgements they may have, so we can work on starting to break some of these habits or disordered ways of thinking about food. I also work to get an understanding of a patient’s historic relationship with food in the first few sessions. I try my best to make people feel as comfortable as possible when talking about something that is as vulnerable and often kept to themselves as eating behavior. And I always take a gentle and non-judgmental approach to ensure these patients feel safe. 

During the first few follow up sessions I always tell patients there isn’t a direct roadmap to follow, or a defined “path” or “destination.” After our intake session, we will often cover the basics of nutrition education to ensure the patient has science-backed foundational knowledge of healthy eating and how to build a balanced meal.

How might you collaborate with an eating disorder patient’s other providers to support them in light of the other care they are receiving?

I often collaborate care with a patient’s primary care provider, as well as their therapist if they have one—if they don’t I try to encourage them to work with a therapist, as they are absolutely vital to the treatment of ED. Having coordination amongst all members of a patient’s care team allows for everyone to be on the same page and aligned in supporting a patient’s health and recovery. For example, I find it helpful to discuss with a therapist that we may be working on a challenge food and encourage them to help review coping skills in their upcoming session. This collaboration with other providers also makes sure nothing falls through the cracks that might be shared with one provider but not another, as well  as ensure medical stability, especially being in the outpatient setting where the patient has a lot of time on their own.

Strategies and Challenges in Treating Eating Disorders

Can you talk about HAES and how you incorporate this framework into your work with ED patients?

HAES (Health at Every Size) is a healthcare approach that utilizes a weight-inclusive model that takes the focus off of body weight as the main determinant of health. I incorporate HAES principles into my work to help patients towards body acceptance/neutrality, as well as engaging in movement that is joyful, and intuitive eating. Weight bias is unfortunately very common in the health system and can often impact patients in not feeling they deserve ED support due to their body size. This is something I have seen very often and emphasizes why HAES matters and why it’s so important to acknowledge that weight is not an indicator of health status.

What are some misconceptions or common questions you receive from potential patients about nutrition care and eating disorders?

A common misconception is that the registered dietitian nutritionist is just going to create a meal plan and that following it is the only goal or way to measure progress. But when working with a patient through their recovery, there are so many different ways to measure progress that are not always as quantifiable as meal planning (even though that is also helpful!). Some non-numerical victories include trying a fear food or feeling comfortable routinely incorporating previously-restricted foods in their home.

What are some common strategies you employ to support patients with EDs?

• Science! I love to use science to explain the WHY behind our need for different food groups and certain nutrients. I’ve found that a lot of my patients resonate with the science behind needing a good balance of the macronutrients in being able to break some of the fears or judgements they may have previously held around certain foods or food groups.
• Learning how to cope with emotions without food. We are human beings with emotions so there is some level of emotional eating that is normal, but it’s important to develop other coping skills to manage emotions such as stress, anxiety, anger, sadness, etc., especially as someone in treatment or in recovery from an ED.
• Discussing short term comfort vs. long term consequences. A lot of my patients struggle with knowing the behaviors they are engaging in are harmful in the long term, but still experience the urge to act on the behavior for that “short term” comfort. I like to emphasize the idea of short term discomfort of NOT acting on an ED urge (ex: not restricting, not purging, not exercising compulsively) in service of the long-term comfort of having a better relationship with food and exercise.

What is a recent patient story where you found success?

I had a patient come in with ARFID (avoidant/restrictive food intake disorder) wanting to “expand her palate and be able to eat something at any restaurant she goes to.” She was really struggling with feeling limited when going out to eat with friends and family, and it was causing feelings of isolation and shame in what she felt was a childish food palate.

First, we worked on food exposures to expand her comfort to try new foods. We started this process by going through a comprehensive list of challenging foods and categorizing them as red (does not like/fears/avoids), yellow (could be okay with eating), and green (likes/enjoys/actively eats). We started with trying different versions of green foods or doing repeat exposures of yellow foods. For example, crispy chicken was a green food, so we tried grilled chicken. We set goals for her to try 1-2 new foods between our sessions when first working together. 

A year later, she is actively trying new foods almost every week and feels much more comfortable going out to eat even when unsure of what the menu has on it, or trying a food even when it arrives different than how she’d ordered it. 

How does lifestyle play a role in eating disorder recovery?

Someone’s lifestyle definitely plays a role in their ED. For example, if I’m working with someone who compulsively exercises for multiple hours a day, but this has been part of their routine for years, we will talk about how there are pros to exercise but try to work on reducing the time spent exercising per day, and working on feeling more flexible to miss a workout to create a better relationship overall with the activity. We’ll also get more into sports nutrition and discuss proper hydration and energy intake for anyone who exercises, play sports, etc. If someone spends time around people who are active in diet culture, we may talk about trying to spend less time around these friends or create boundaries when around them to avoid triggering conversations. We may even talk through who they might follow on social media and try unfollowing triggering accounts.

Get Support for an Eating Disorder

What’s one thing you want to say to someone who may be struggling with an ED?

You are not alone! Unfortunately, so many people struggle with their relationship with food—even if they do not have a formally diagnosed ED. Disordered eating is extremely common. But you do not need to live this way! There are resources and support out there to help support you on the road to recovery. But it’s really important to be mindful of who you take nutrition advice from . In the age of social media and misinformation, there is constant confusion around food which often results in people feeling they need to be more restrictive than they should be. So make sure you are going to vetted and licensed experts for help!

Work with a Registered Dietitian at Culina Health

If you are looking for personalized help in working through an eating disorder, or if you want to improve your relationship with food and your body, the team of Registered Dietitians at Culina Health is here for you! We are in-network with most major insurance companies, and the majority of our patients get coverage for their sessions. Get matched with an RD today to begin your nutrition care journey.