dear dietitian

Podcast: Dear Dietitian … what we want you to know about Anorexia


In this podcast we hear from adults with Anorexia, parents of people with Anorexia, and dietitians treating adults and children with Anorexia about their experiences with dietitians in the field of eating disorders. This podcast is a mixture of Tabitha Farrar reading out notes sent in from listeners, and audio files from listeners that have been sent in.

Transcripts of some of the written Dear Dietician posts belowdear dietitian


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“Dear Dietitian – I want you to like me, to trust me; and I desperately need to trust you. But, my ED will lie to you or exaggerate / manipulate the truth, even when – maybe especially when – I really admire you and want you to think well of me. And, my eating disorder will use and abuse that rapport, that trust, to try and preserve itself and hurt me, right beneath your eyes. I need you to be vigilant, to trust but verify, to encourage and affirm, and, at the same time, hold me accountable and give me limits, even if I fight against them. EXPECT that I will be well. Thank you.”

 

Dear Dietician, I don’t need to hear about what YOU eat.. or YOUR diet.. I need to know what will save MY life and I need you not to compare that to anyone else. My ED will abuse that and use it as a stick to beat me with. I know you have studied to be an expert in your field, but I am an expert in my illness.. I need you to understand that I WILL need more calories than many would deem necessary to allow for my compensatory behaviours (that I WILL certainly lie about, at least at first) and to allow my body to heal. I will need to go over my 100% to allow for a buffer.. I will also need you to try discussing numbers to a minimum, because that will be hard for me. It will become a benchmark as a maximum, rather than minimum and my ED will abuse that. I need you to be firm with me and tell me being vegan/veggie is not helpful for me in early recovery, and will likely be a sure fire way to allow my illness back in. I need you to know what I used to enjoy eating, and challenge me to get back to that. I need to believe you believe in me, so I may trust you. I need to know food is not scary. I need you to understand not everyone is the same, and this is going to be hard for you to understand too, because sometimes, this illness will force you to disregard everything you “know” about nutrition and health in order to treat me.”

 

Dear Dietician. I need you to help my daughter to recover from her AN. Which means I need you to understand that a balanced, healthy diet is something to aspire to, but whilst she’s terrified of food, and whilst her body is screaming for fats more than anything else, please do not tell her that it’s okay not to eat a food group. Or to be careful eating fats. I need you to throw out the book when it comes to what ‘good nutrition’ is, and to realise that fat is good. That she will need way more calories than a ‘normal’ person for a solid recovery. I need you to help her not to be scared of food. I need you to help her to get up to and even over her target weight. And then, when she gets there and may continue to put weight on, please do NOT tell her to be careful and cut out some foods! Do not tell her that she may risk becoming obese! Never, ever tell anyone recovering from a restrictive ED that he/she needs to be cut back on their calories whilst their bodies are still adjusting to being a higher weight, because their brains seem to be the last organ to recover, and may take a long time – a year or more – before their torturous ED voice/thoughts quieten down. Thank you. Yours, a desperate mother.

 

Dear dietician, please justify your existence. I’m fairly knowledgeable about all things food and nutrition. I’m “woke” about fat (have read or am at least familiar with the work of Gary Taubes, Nina Teicholz, Phiney & Volek). If I’m not gaining weight, it’s not due to a lack of information, or even “bad” information, per se. I’m even aware that I’m underweight and would look and feel better if I gained a bit (though we may argue on that point)…. That said, what can YOU bring to the table, so to speak?

 

Dear Dietician,

When you treat a child with anorexia, a young child ( let’s say a ten year old), you need to fully understand the fact that his/her metabolism has slowed to keep her organs alive. When refeeding starts and the body is no longer in starvation mode, her body will rev up that metabolism and her caloric needs and specifically needs for FATS will skyrocket. The caloric needs will very likely keep rising for years because BAM, puberty will hit like a ton of bricks and it will take even more food to keep weight stable and climbing. Do not be shocked or surprised that anywhere from 4000-6000 calories a day for several years will be essential to full recovery from anorexia.

Also push for fast weight gain. 2 pounds or more a week is completely doable. Push to challenge fear foods. Don’t give into the eating disorders desires to limit food groups. Don’t be afraid of the eating disorder. Support the parents fully. Help them to know that FOOD IS MEDICINE and adding creams,butter, oils to cooking is medicine for their child’s very life.

There’s not much room for salad and apple slices when needing high calories and please understand that what you have been educated to teach as ” healthy” for the masses is NOT HEALTHY for a kid trying to recover from an ED.

Thank you,

A mother ( who had to become her daughters own dietician, therapist, chef, researcher, advocate) of a daughter diagnosed at ten who is now 17 and in full recovery.

 

Dear Dietician, not all food exclusions are motivated by the restrictive nature of anorexic tendencies. In addition to general dislikes and preferences, some people have feeding aversions due to sensory processing issues to include: taste, smell, and texture!

WHEN A “BEHAVIOR” WAS PRESENT LONG BEFORE THE EATING DISORDER STARTED, please do not blame it on the eating disorder.

Some of us slid under gender biased diagnostic radars and have autism spectrum disorders and had misunderstood ARFID bc the label didn’t yet exist, which then morphed into a full blown eating disorder.

In my case, this switch flipped when I was immersed into ED culture: hospitals, treatment centers, etc, where I didn’t quite fit in and yet was desperate for help and understanding.

Having a competitive trait, common among those with ED’s, I had to learn how to have the right ED to access help. Obviously, I was hard to help because my root issues were buried in effort to be good enough at dying to have that support and nurturance I was seeking by reaching out for “help” for so long.

I also want you to know I WANT to follow your advice. Something deep within me longs for permission to do what you are asking. Please be patient and know I wish I could eat and enjoy all the nourishment you are encouraging

 

 

Dear Dietician,
Please remember my daughter had Anorexia and is now in good recovery as her brain has healed from NOT using the Canada Food Guide! It was by using evidence based treatment from the amazing educated team in the ED program at Sickkids Hospital in Toronto Ontario. The dietary guidelines were to eat a variety with nooooo restictions and no vegetarian menu . Approx 3,000 – 4,000 calories a day and please blind weigh your clients to reduce their anxiety. Remember this is a biological brain based illness a disease of the brain so please speak to the professionals in the ED field and add some of their research and professional teams to your Professional Development Days.

 

Please Dieticians let’s be inclusive and include careers in your appointments. No one should do this alone and
Iike any other Mental Illness it takes a village so don’t try to rely on some of your patients to adhere to your daily meal planning, request family, friends etc to help your client.

 

Dear dietician – we are not stupid. By the time we come to you, we know almost as much as you do about nutrition – we just have latched onto the wrong things and twisted a few things because ED. Please don’t treat us like we are silly and don’t know what you’re talking about.
Please don’t tell us it’s ED speaking when we express food preferences or tell you something doesn’t agree with us. ED does manipulate, but we are human beings and we DO have foods we love and foods we absolutely can’t stand. We DO have foods that make us sick. Help us work around those preferences. We also do genuinely like to eat things in ways you might not think ‘normal’ sometimes. I always loved vegemite with banana on a sandwhich but that wasn’t allowed because it must be ED behaviour. It wasn’t.
Be so, so careful when you go to caution us about how much we are eating. I love fruit, and when I was gaining weight, I might eat more than 2 serves per day. So the dietician told me I was eating ‘too much’ fruit. When someone’s gaining weight, does it really matter if they have fruit with every meal, if they genuinely love it and aren’t eating it instead of another food group they need? I went away from that feeling ashamed, a big fat pig. That fed into ED.
It really helps to know what all the different foods you want me to eat are doing to help my body grow. Carbs for the brain (because otherwise they just scare me). What do fats do that I need them for? What about meat? Help me understand how food is my medicine. Don’t just dictate ‘this is what you should eat’. Work WITH me.
Please, don’t ever tell a new client who you see for anorexia to go away and eat more, or give them a list of high calorie milkshakes to make, for example. That’s what the first ED dietician I ever saw did. ED laughed and laughed – I came to you because I am struggling losing weight and struggling to eat and you just say go away, make this out of cream and ice cream and drink it? You’re dreaming.
And if you’re going to work with people with EDs, please make sure you’re within the healthy weight range yourself. 
Dear Dietician,
Please know that we anorexia possessed sufferers do lie to you about what we eat! The illness is a cunning rat that will manipulate the truth! The scales do not lie though! So if I am not gaining weight, or in fact, am losing weight, please tell me that I need to eat!
Don’t be afraid to use scare tactics! And please, please, please reassure us that we can eat, and we can eat as much and whatever we want and crave! No guilt should surround any particular food or any quantity of food! Food is our medicine as much as chemotherapy is for a cancer patient!
Dear dietitian, I am glad you are trying to help individuals with eating disorders, I know you’ve trained under certain paradigms and influences, I am going to ask you to change your paradigms and open your mind to a new view. Please forget all what they taught you about diets, fat fobia and classifications about ‘bad’ and ‘good’ foods. Once you face someone with an eating disorder you need to change your own views, please don’t fear weight increase, don’t fear foods, don’t you ever think that if a person under weight is increasing weight, that the higher weight is going to back fire. Encourage all food types, encourage higher weight, embrace the curves. Remember it is about state and not weight. All food is good. Don’t mention measuring. Don’t mention counting. And always listen to the carer´s instinct and gut. Always share information with them. Thank you!
Liebe Diätassistenten, immer und immer wieder wurde mir im Laufe meiner Ansätze, die ich hatte gesagt, ich solle zu Diätassistenten gehen, damit sie mir sagen, was ich essen soll. Ich habe zweimal die Erfahrung gemacht dorthin zu gehen. Leider machte ich die Erfahrung, dass mir gesagt wurde, dass ich mich gesünder ernähren müsste, zu viel Süßes esse und auch teilweise zu große Portionen. Was macht das mit jemandem der gerade versucht die ED zu zerstören? Alles wird in Frage gestellt, die Stimme der ED wird gestärkt. Ich war nach den Terminen so zweifelnd an dem was ich tue. Die Worte begleiten mich nun und haben nicht einen nicht ganz unwesentlichen Teil daran, dass ich soviele Schleifen gedreht habe, bis ich nun weiß, für mich, durch die Wissenschaftlichen Erkenntnisse, durch Tabitha, ich habe damals das Richtige getan. Mein Körper hätte diese Dinge gebraucht und es spricht ja nichts dagegen trotzdem noch Gemüse und Obst zu essen. Bitte, liebe Diätassistenten, legt uns nicht Regeln auf zum Essen und wertet es nicht in “gut” und “schlecht”. So etwas darf es nach jahrelangem Hungern nicht mehr geben. Bitte stärkt uns und stützt nicht die ED. Wir gehen doch zu euch um Unterstützung von euch zu bekommen um die ED zu zerstören.
Ich wünschte, ich hätte mich nicht so sehr von euren Worten abhängig gemacht. Ihr habt ganz viel Einfluss auf unsere Genesung. Positiv wie negative. Bitte vergesst das nicht.
Dear Dietician, Please understand how important it is that my loved one overshoot their pre-eating disorder weight in order to have their recovery firmly rooted in success. Don’t let them subsist on minimal daily caloric intakes and engage in eating disorder behaviors. And please, please, please…don’t tell them to “stick to your eating plan!” Listen to my parental concerns and work with me to form an alliance that will force the ED out from the shadows to being acknowledged and dismantled in the true light of day. Please do your research and try to accept the fact that most folks in recovery from EDs may need more calories per day than you are comfortable with. While this may fly in the face of your academic learning, please understand that this particular method of nutritional rehabilitation can restore my loved one to their pre-eating disorder state of wellness and health. Whatever you may consider as caloric overcompensation will do no great harm in the long run as eventually things will equalize; however your interference and misguided comments may do irreparable harm in the short term and usher my loved one right back into severely compromised wellness. Remember this illness has skewed my loved one’s metabolism and it may take some time but please support them to trust their bodies to auto-correct to their natural set point. Remember: we are all “fearfully and wonderfully made,” please give my loved one the support and guidance to believe that.
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About Tabitha Farrar

I work as Head of Marketing for a software startup in Boulder. As a recovered Anorexia sufferer, I advocate for proper understanding of eating disorders in my spare time. On that note, I wrote a book about my own journey into eating again called Love Fat.

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