When working with eating disorder patients, it can be difficult for RDs to understand what their clients are going through. Often, these clients haven’t yet received an official diagnosis when they see you for nutrition counseling and may be skeptical that they have a disorder at all. Since eating disorders are complex and serious, RDs might need to rely on a treatment team that includes eating disorder specialists; knowing which specialists to refer patients is critical for proper treatment.
In completing dietary recall with a new patient, RDs should look out for patterns of restriction, excessive or compulsive exercise, and/or fear of certain foods, or food or macronutrient groups, each of which can signify an eating disorder. Other red flags include underweight status, considerable weight loss in a short period of time, social isolation, and fear of gaining weight. The patient may complain of weight gain, an inability to lose weight, hunger, unmanageable cravings, and uncontrollable snacking as well. Sometimes, the patient may come in due to their family’s concern. If any of these signs emerge, it’s imperative that the RD assess the patient for an eating disorder.
If an eating disorder is suspected, the first thing the RD should do is evaluate the patient’s risk. Available online, the SCOFF Questionnaire and the EAT-26 (Eating Attitudes Test) can help RDs determine whether the patient is at risk for an eating disorder. This can initiate the conversation about further assessment and referrals to a treatment team.
In addition to the RD, the treatment team should include a doctor and a therapist. A psychiatrist may also join the effort. RDs cannot specialize in every diagnosis; as such, it’s appropriate to tell the patient that although they don’t specialize in eating disorders, they can refer to someone who does.
RDs can find eating disorder professionals through many outlets. The International Federation of Eating Disorder Dietitians (www.eddietitians.com) provides information about practicing RDs who specialize in eating disorders by address or ZIP code.
After the RD makes the referral to a specialist, the RD should obtain the patient’s consent to follow up with the patient’s primary care physician to provide feedback about the suspected eating disorder. Eating disorders have the highest mortality rate in the mental health disease category and, if left untreated, can be fatal.
It’s important to be empathetic but transparent and explain the risks of an eating disorder as well as the importance of the specialty team. Once the RD has made the referral, a follow up in a week with the primary care physician and patient is recommended to ensure the treatment plan is correct.
By utilizing available resources, RDs can provide patients with best possible help and steer them on the path to recovery.
— Amy Goldsmith, RDN, LDN, is owner of Kindred Nutrition, a private nutrition practice in Frederick, Maryland. Amy has 18 years of experience working in many realms of medical nutrition therapy and now specializes in eating disorders and sports nutrition. Amy founded the HOPE Consortium to help patients with eating disorders. As a sports dietitian, Amy assists the client attain peak performance by incorporating optimal nutrition before, during training, race time, and recovery.