What is seeing a dietician like?
September 4, 2019 12:25 PM   Subscribe

Next week, I’ll be meeting with a dietician for eating disorders for the first time. I have loads of anxiety about this, and it would help me manage that anxiety if I could hear from others who have worked with a dietician (especially for eating disorders) what I can reasonably expect this initial meeting and subsequent meetings to be like.

Some more info, if it’s useful:
- I have a therapist, and this RD comes STRONGLY recommended by my therapist, so I don’t actually have too much anxiety about the quality of care/familiarity with eating disorder issues
- I have been dealing with this ED for many years, but this is my first time seeking treatment of any kind
- My ED manifests as restriction, over exercise, and purging.

I’ve already talked to my therapist about my anxiety about this, and she has given me a general sense of what to expect, but I’d like to hear more of the nitty-gritty details about this process, as well as personal experiences. Obviously every dietician is different, but it would be very helpful for me to hear a range of experiences, in as much detail as possible: how was the meeting structured? What sort of questions were asked? What else did you talk about? Was your weight taken? Did you have to fill out some sort of food log? What happened in subsequent meetings? What kinds of tasks/goals were you given between meetings?
Did you only talk about practical food/eating stuff, or did you talk at all about emotional or psychological aspects? Who did most of the talking, you or the RD? Was it actually USEFUL??

Anything you can remember, I want to hear it! My anxiety thanks you!!
posted by anonymous to Health & Fitness (7 answers total) 6 users marked this as a favorite
Years ago, when my HIV meds were making me lose weight at a truly scary rate, I was assigned to a dietician to strategize about getting some weight put on me. She was very nice, and mostly wanted to know what my eating habits were (when, how much, what quantities), what allergies I had, what preferences I had, and then we went through plans on how I could add more calories to each meal in a way that wouldn't be too heavy on things that would either stuff me so much that my appetite was overly suppressed or make eating into a real chore.

Mostly, it was about education, planning, and asking lots of questions to me about how this would work best for me. Very non-judgmental, very low-stress, as far as medical appointments go. It felt more like an in-person tutoring session with an expert than a medical appointment, for me.

She did not take my weight, and though I was encouraged to record my food for general patterns, I wasn't required to keep a detailed log of exactly what I consumed.
posted by xingcat at 12:35 PM on September 4, 2019 [2 favorites]

My roommate saw a dietitian when she was dealing with an ED (with similar symptoms to yours), and she was emphatic that she found the dietitian was more helpful than her psychiatrist. The psychiatrist made her uncomfortable, I think she said "it feels like she's reading my mind and I don't like that".
She was much more comfortable with the dietitian, who focused on the physical symptoms and was very non-judgmental. If I recall correctly, there was a food log involved. Also some coping tactics like flipping a coin when she felt like purging?
posted by dotparker at 12:38 PM on September 4, 2019 [1 favorite]

I saw a dietician/nutritionist years ago as a teenager. I was not there for an ED but that was one of her specialities, so it might be pertinent to you. She was wonderful. She made it feel like she and I were working together on a food plan (and we were) rather than she was putting me on a diet. She defended me and told my parent to back off acting like the food police and let me be. She did not have me keep a food diary—instead, we made a meal plan for me for the upcoming month (not super detailed) and she went over some nutrition stuff with me without the usual side serving of judgment. The goals she set for me were trying to achieve certain things (like, more than 5 servings of veggies per day, more than X grams of protein per day) and no limits (she never suggested I needed to eat a certain number of calories). In making the meal plan she actually listened and incorporated my likes and dislikes (not “well, you can substitute carrot sticks for potato chips because they’re both crunchy!”). There was no weighing in, it was a more holistic approach. She had an office with a desk and a couch, no medical stuff. We talked about food but for some of it we were really talking about feelings (they are so tied together). She was almost like an angel to me at the time, given how confused I was about food and how much I needed to hear an adult who was not my parent validate and work through my feelings about eating. I hope you get someone just as good!
posted by sallybrown at 1:46 PM on September 4, 2019

I saw an RD for an eating disorder.

Most of the time, we would start by talking about how my eating had gone for the past week - she did ask me to keep a log of what I had eaten, but without quantities or calories (so an entry would be something like “oatmeal with blueberries”). She’d review it and we’d talk about both how I felt about it emotionally and whether what I was eating was meeting my needs physically.

At first, I didn’t let her weigh me - later, when I trusted her more and when I had stopped weighing myself, I did let her weigh me backwards.

She gave me suggestions for how to structure my eating - for example, she wanted me to have eaten at least half of my food for the day by after lunch. She also gave me suggestions for specific foods she though I would enjoy / be able to eat / just slightly push my comfort zone, but in a tolerable way.

We each probably talked for half the time - I think it was about half practical stuff and half more psychological aspects.

I was extremely resistant to the idea of seeing an RD when my therapist first suggested it - my eating disorder led to excess research on every aspect of food and nutrition, so I thought that she wouldn’t be able to help me. I was basically like, “I know how to eat in a balanced way, I just don’t do it, why should I talk to an RD?” I was totally wrong, she was really really helpful. She was totally non-judgmental. It also allowed me to focus more on the emotional/psychological aspects of the ED with my therapists - prior to seeing the RD, my therapist was regularly checking in with me about food intake. I signed consent forms so they could talk to each other about me - I think they had a bunch of patients in common and spoke regularly.

I’m so glad you’re seeking treatment for your eating disorder. Treatment was absolutely life-changing for me; I didn’t really believe that I could ever recover, and I will probably always have some eating disordered thoughts, but I haven’t engaged in ED behaviors or even been particularly tempted to for years now. Best of luck - it’s really hard and a lot of work to change, but it’s possible and you can do it.
posted by insectosaurus at 2:10 PM on September 4, 2019 [1 favorite]

So I just went to a dietician for the first time last month. I'm not going to go into the details, except to say that my physician wanted me to, and I thought it would be a complete waste of time. What could a dietician tell me that I didn't already know?

What I discovered was SO MUCH MORE HELPFUL than I ever could have imagined. Possibly the most effective time I've ever spent with any medical or medical-related practitioner of my entire life. The woman was an excellent communicator, extremely warm and gentle, very nonjudgemental, and through the entire thing I got the feeling that she was working hard to meet me where I am, and perceive me as an individual, not just one in a long line of clients. I'm scheduled to see her again next week and I am actively looking forward to it.

My appointment was in a hospital (which I hated; I had to get a wristband, blerg), but she met me in the waiting area and walked me to her office. She did take my weight (which I was not prepared for). We made one set of smallish goals to carry me through about 6 weeks, at which point we are going to meet again. We discussed food and also feelings; at one point I cried, so I'd say this felt much like an informational therapy session. It lasted two hours, though I think we were only originally allocated for 90 minutes.

Best of luck to you.
posted by BlahLaLa at 2:27 PM on September 4, 2019

I saw a dietician for about six months for some disordered eating patterns and it was so, so helpful. In my experience, I did most of the talking. In fact, I felt like my appointments were closer to a therapy session than a doctor's appointment. It's been awhile so I can't remember things in as much detail as I wish I did, but the intake appointment started with a questionnaire about my eating behaviors and beliefs. We talked a lot about my relationship with food as it related to my family growing up and then moved on to my grown-up eating habits.

Mine was a non-diet dietician which I think is extremely important, especially for anyone with atypical anorexia. Having a dietician who understands the external pressures of diet culture and the influences on disordered eating was helpful for me because we spent a long time breaking those influences down. We spent a lot of time challenging my beliefs of what I was allowed to eat and what was "clean" vs what science actually tells us about nutrition, and after a few sessions we worked up to eating forbidden foods together. It was like relearning how to eat and it was very helpful to have someone there with me encouraging me to notice all the sensations that came up. It gave me a lot of tools that I carry with me to this day.

A few words of caution: be very careful about seeing a dietician who recommends a food log and weighs you unless you are severely undernourished and under clinical supervision — otherwise, those tools are not helpful. Be very careful of any dietician who would treat disordered eating at a lower weight as a problem but at a higher weight as a cure. I really like NEDA (National Eating Disorders Association) as a resource, I've linked to their page about what to expect treatment to look like and think it gives a good breakdown of questions to ask treatment providers. If your dietician doesn't click — because it can be a very intimate relationship, even if you like their philosophy, a different in personality can disrupt progress — it's totally okay to look for another one, and NEDA has a good database.
posted by the thorn bushes have roses at 2:58 PM on September 4, 2019 [2 favorites]

I saw a dietician a few times because of disordered eating (similar to you: restriction, purging, over exercise). I was only able to a few times because of cost/insurance refusing to cover it (oh the continued joys of US healthcare), but she was very nice and helpful, and I would have continued going longer if I could.

This was a number of years ago, but she didn't weigh me, and I didn't have to do a food log. She did give me a rough food plan (after we had a discussion of the kinds of foods I liked, was able to access easily, etc). I found the structure and the tips she gave to be super helpful. I was still kind of resistant to treatment at the time, so we started off with her giving me a plan that would help me maintain weight rather than gain weight.

At the follow up, we did discuss what worked and didn't work on the plan, what I was able to stick to and what I wasn't, but it was all verbal as I can remember. (I think for me, having to do a food log would have been actively unhelpful, as I was already obsessively tracking what I ate as a manifestation of my disorder.)

Good luck!
posted by litera scripta manet at 9:32 PM on September 4, 2019

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