Why Does My Teen Need a Registered Dietitian for Eating Disorder Recovery?

Written by Cristina Luibil MS, RD, LDN with support from Sabrina Stadelman

For a teen recovering from an eating disorder, working with a treatment team to determine the best recovery plan for their specific needs and goals is very important. As a parent or caregiver, you may be wondering how to get your teen the best care. It will be important to understand which qualifications and experts are needed on your teen’s treatment team, including the importance of working with a registered dietitian, as well as what you should expect from a nutrition counseling session. Your teen’s treatment team should work with them and with you as a parent or caregiver to determine the best plan for your teen to have a successful recovery. 

What is the Difference Between a Dietitian and a Nutritionist in Eating Disorder Care?

Registered dietitians are required to complete a Master’s degree in nutrition, an accredited dietetic internship, a national board exam, 75 hours of continuing education every 5 years, and be licensed in all states they practice in. In contrast, the nutritionist title isn’t regulated. Anyone can call themselves a “nutritionist” without proper education, training, or continuing education. 

The main difference between registered dietitians and nutritionists is that in order to use the title, a registered dietitian must complete specific, advanced coursework in biochemistry, anatomy, physiology, and nutrition science, including courses in medical nutrition therapy. Medical nutrition therapy (MNT) is a specialized nutrition service used to treat or prevent nutrition-related medical conditions, including eating disorders. Registered dietitians are recognized nationwide as qualified providers of MNT. Registered dietitians must also complete at least 1000 hours of an accredited dietetic internship to gain experience before sitting for a national board exam and becoming registered through the Commission on Dietetic Registration. RD credentials also must be renewed every 5 years by completing at least 75 hours of continuing education.

The education and training that registered dietitians complete make them experts in nutrition, specifically in medical nutrition therapies, for treating nutrition-related medical conditions. These conditions include eating disorders. Since the title of nutritionist is not regulated, anyone can call themselves a nutritionist, and the level of education and training completed can vary widely. Someone may call themself a nutritionist without completing any of the training or educational requirements that all registered dietitians must complete. 

Why Does This Difference Matter for Eating Disorder Care?

Registered dietitians are qualified to treat illnesses like eating disorders, whereas nutritionists might not have the experience and education to adequately care for someone with an eating disorder without unintentionally doing more harm to the patient. Additionally, registered dietitians are qualified to provide medical nutrition therapy, as well as a range of clinical nutritional interventions for individualized treatment plans, including meal plans and intravenous feedings or tube feedings if necessary.

While both registered dietitians and nutritionists can provide nutrition education and coaching, a nutritionist may not have the education, training, or qualifications to provide individualized nutrition counseling or eating disorder recommendations, nor will they be qualified to provide medical nutrition therapy or clinical interventions that will be necessary for eating disorder treatment. Essentially, this means that nutritionists may lack the specific qualifications necessary for treating a patient with an eating disorder, as eating disorder treatment and nutrition counseling are very different from providing generalized nutrition education or coaching. 

Registered dietitians also receive training that will allow them to be more familiar with working in a hospital setting and with other medical professionals as part of a treatment team. Registered dietitians’ skills and knowledge are necessary for refeeding, weight restoration, meal planning, and nutrition education necessary in eating disorder recovery. 

Who Should Be On My Teen’s Care Team in Eating Disorder Recovery?

In eating disorder recovery, a care team should include a primary care provider(such as a pediatrician or another medical doctor), a registered dietitian, a therapist, and a psychiatrist. Each member of your teen’s care team plays an important role in monitoring their recovery, and the expertise of an entire treatment team is important to achieving the best recovery outcomes. 

Registered Dietitian

A registered dietitian’s main role is to stabilize nutrition status, monitor weight regain, and correct any deficiencies. Registered dietitians will provide a recovery nutrition plan that is unique to your teen and their individual needs. The recovery meal plan will be designed to correct nutrient deficiencies, meet energy and nutritional needs, and create a sustainable eating pattern. Registered dietitians will also work with teens to build a healthier relationship with food and reduce fear around food and eating. 

Primary Care Physician

The role of a primary care physician is to assess your teen’s physical conditions. This is an ongoing step in the process of treatment, and a primary care physician will continue to be a part of the treatment team and monitor your teen throughout recovery. 

Therapist

The role of a therapist is to focus on eating disorder symptoms, behaviors, and the underlying emotional issues that contribute to an eating disorder. A therapist will help your teen to work through thoughts and feelings that lead to disordered eating behaviors, as well as to develop coping skills and stress management techniques so they know what to do if the eating disorder voice gets loud. 

Psychiatrist

A psychiatrist can prescribe medications, if needed, for a variety of mental health needs, including but not limited to: improving mood disturbances such as depression and anxiety, or to help reduce obsessive behaviors surrounding food. 

What Kind of Treatment Methods are Common in Eating Disorder Recovery?

There are different treatment methods commonly used when navigating eating disorder recovery, including Family-Based Treatment, Cognitive Behavioral Therapy, and nutritional rehabilitation and counseling, just to name a few. Family-Based Treatment is considered a top choice for adolescents, as it involves parents being part of the treatment team, with the goal of teens eventually regaining autonomy over their own treatment, nutrition, and recovery.  

Family-Based Treatment

Family-Based Treatment (FBT) is considered a top choice, especially for teens struggling with anorexia nervosa and ARFID. With FBT, parents or caregivers have the responsibility to ensure that their teen is eating their meals and following their recovery meal plan, as well as to have open conversations and communication with their teen and their teen’s treatment team. Parents and caregivers are part of the treatment team involved in ensuring their teen regains weight (if needed), minimizes eating disorder behaviors, and eats enough food regularly. Parents will gradually become less involved as more responsibility is placed on the teen as they progress through recovery and gain more autonomy over their treatment and eating habits. Still, one of the most important responsibilities for parents and caregivers during FBT is supporting their teen, and that support is needed throughout all stages of recovery. 

Cognitive Behavioral Therapy

This treatment modality is considered especially helpful for treating eating disorders.  It is targeted towards helping individuals recognize how their thoughts and behaviors related to food and body image affect their relationship with food and lead to eating disorder behaviors. These eating disorder behaviors can also be brought on by more than just struggles with body image, as food/eating can sometimes be used as a coping mechanism. Cognitive behavioral therapy helps individuals to recognize and change these unhelpful behaviors by teaching healthy coping strategies. 

Nutritional Rehabilitation and Counseling

Nutritional rehabilitation and counseling consist of a registered dietitian helping to restore optimal eating patterns and adequate nutrition. This is done through both medical nutrition therapy (MNT) and nutrition education. With MNT, the dietitian will focus on the nutrition-related medical complexities of the disease and ensure the teen is meeting their energy, protein, fluids, and other macro and micronutrient needs. During education and counseling, the dietitian will help the teen dig a little deeper into their motivation and confidence to change behaviors as they relate to the eating disorder, including but not limited to helping to reduce fears surrounding food, eating, and body changes. Registered dietitians help patients to understand the importance of adequate nutrition and consuming enough food to support overall health and well-being. 

Other treatment and counseling methods might be used in your teen’s treatment, as it really is an individualized approach to care.

How Do I Know Which Treatment Method is Best for My Teen?

There is no “best” approach to eating disorder treatment. All of the treatment methods described above can be effective, and treatment methods are typically combined because they each focus on treatment of a specific part of the disordered behavior. The best treatment option for your teen depends on many factors, such as diagnosis, age and developmental stage, family involvement, personality, temperament, mental health conditions, level of motivation and insight, and medical and nutritional status. 

Family-based treatment (FBT) is often recommended, especially for younger teens and teens who have been diagnosed with anorexia nervosa or ARFID. Some young adults may even benefit from an FBT approach. Family-based treatment can be beneficial in allowing teens to remain in a familiar environment, empowering parents and caregivers as part of the treatment team, and it doesn’t require long-term hospitalization in most cases. However, family-based therapy can require significant time and energy from parents and can be very emotional in the beginning. It’s okay if this treatment modality isn’t what works best for your teen and your family, and other treatment modalities can be equally effective. 

To determine what is best for your teen, it is important to have open and honest communication with your teen and their treatment team to understand your teen’s specific challenges, personality, and environment. Your treatment team can help to determine which approach may be best for your teen, and skilled clinicians may even blend elements of different modalities depending on their needs. 

What Can You Expect From a Nutrition Counseling Session?

In a nutrition counseling session for an eating disorder, a registered dietitian will work with teens and their parents or caregivers to improve energy and nutrient intake to meet recovery goals and to rebuild an improved relationship with food. At Aterra Nutrition, nutrition counseling sessions are collaborative, personalized conversations with your registered dietitian designed to meet your teen’s unique needs. 

In a nutrition counseling session, you can expect your registered dietitian to discuss:

• A thorough health and medical history, including a review of recent lab work and any medications or supplements your teen is taking 

• A comprehensive nutrition assessment, which includes a review of your teen’s daily routine and eating patterns

• A recovery meal plan tailored to and adjusted to the treatment goals

• Realistic, sustainable nutrition goals tailored to your teen’s life

• Adjustment of goals based on personal wins and challenges

• Coordination of care with your teen’s therapist, physician, family, and full treatment team

• Between-session check-ins with the RD (called concierge nutrition care) for questions and ongoing support before the next 1:1 appointment

Nutrition counseling sessions may look slightly different depending on diagnosis, severity of the eating disorder, and individual goals, needs, and challenges. However, the goal of nutrition counseling sessions for a teen with an eating disorder should always be to help caregivers ensure their teen is eating enough and helping teens to build a better relationship with food, with the goal that they will eventually resume responsibility for their own nutrition and be able to nourish themselves in a healthy and sustainable way. 

What Happens in Eating Disorder Nutrition Counseling Sessions at Aterra Nutrition?

At Aterra Nutrition, our registered dietitians will discuss all aspects of nutrition-related care, including a thorough nutritional and medical history, a comprehensive nutrition assessment, coordination of care, and realistic, sustainable, and personalized goals for eating disorder recovery. Aterra Nutrition’s eating disorder nutrition counseling is designed to help teens across all diagnoses and include parents and caregivers in the process. We also offer support to families, parents, and caregivers who want help navigating mealtimes and family nutrition dynamics during your teen’s recovery. 

Our nutrition counseling appointments are held virtually through a secure client portal, Healthie, making it easy to access and allowing you and your teen to attend sessions from the comfort of your own home. Additionally, we also offer food and feelings journaling through Healthie when desired and helpful for eating disorder recovery. Our nutrition counseling sessions are designed to meet your teen where they are in recovery and help them to build realistic and sustainable long-term eating habits and an improved relationship with food. 

A registered dietitian is an essential part of an eating disorder treatment team. Your teen’s treatment team will help determine the best treatment plan for your teen’s life, needs, and goals. As a parent or caregiver, you will also play an important role in supporting your teen every step of the way. With your support and the guidance of a qualified treatment team and the expertise of a registered dietitian, your teen can experience great success in eating disorder recovery. 

If you’re looking for support for a teen struggling with an eating disorder, Aterra Nutrition offers virtual nutrition counseling and support for eating disorder recovery with a registered dietitian. We offer one-on-one nutrition counseling for those in DC, Maryland, Virginia, New Jersey, and Michigan. Learn more about the eating disorder services Aterra Nutrition offers on our website at aterranutrition.com.

About the Author

Cristina Luibil, MS, RD, LDN specializes in eating disorder recovery and Intuitive Eating for teens and adults. Aterra Nutrition provides virtual nutrition counseling for those in DC, Maryland, Virginia, New Jersey, and Michigan. This post was researched and written in conjunction with Sabrina Stadelman, dietetics student and nutrition assistant at Aterra Nutrition. Learn more about the whole team at aterranutrition.com/about.

Disclaimer: The information shared in this blog is for general educational and informational purposes only. It may not be tailored to your specific health needs as it is written here. This content is not intended to replace personalized medical advice, nutrition counseling, or medical nutrition therapy. Any recipes or suggestions provided are meant to inspire and should be used at your discretion. Always consult with your own registered dietitian, physician, or healthcare provider before making changes to your nutrition, lifestyle, or treatment plan. If you choose,

If you have other nutrition and Intuitive Eating goals for you or the entire family, our sister company, Radica Family Nutrition, would love to help.