New Dietitian

So, I have never had a super-great experience with a dietitian. I was forced to see one as a young teenager, and even if I had NOT been in complete denial and closed off to therapy (which I was), this person had never done EDs before and had no clue where to start. H. had one that worked with her practice, and I saw her a couple of times, and liked her approach, but in retrospect I didn't feel like I got much out of it because she seemed to treat my case as just generic ED instead of delving into specific disordered habits (although see a funny story about her here). I have spent the last ten years obsessed with food and nutrition, and have solid training in biology, so I felt like I was just being hammered with a lot of numbers and facts that were not news to me. I smiled, nodded, paid my $75 and went on with business as usual. I hate to convey a bad attitude, but that is the honest truth.

My needs are much different from 'classic' anorexia cases right now, because I actually eat a fairly normal amount of calories for someone my age and height. The superexcessive exercise makes my nutritional demands different, and getting proper nutrition while in the process of curbing those behaviors is what I really need to work on. The reason I only saw the dietitian from H's practice twice was because she really didn't seem interested in the exercise stuff, and did little more than add up exchanges for me.

But, I am really trying to be open-minded, and so I agreed to see the dietician at the ED clinic here. I went, albeit with trepidation, bracing myself for another lecture on exchanges and a session that amounted to just menu-mapping.

I was actually surprised at how it turned out, in a positive way. This dietitian seems to be much more focused on the relationship with the food than the food itself. This could be because at this point, although underweight, I'm not all that critical, so because there's no need for her to feel like she's doing a life-saving nutritional intervention, we can afford to get philosophical about things. She did ask me to outline a day of eating for her, but she seemed to focus more on the big picture and what is driving my patterns, rather than whacking me with disapproval for only getting X carbs per day.

I had worked with my new therapist (does she have a letter yet? I lose track. Let's call her C.). I had worked with C. to make a list of known bad habits that I have regarding food, although I don't really want to discuss them in detail here. So I brought those up during today's dietitian session, and she seemed really interested in what I was *thinking* that led to the behaviors, instead of just mapping out a plan for what I need to change. Not that I have anything against plans, but I am a "challenging patient" (or so I have been told by every professional I've ever seen) and don't have the best history of actually following them.

I don't feel like I'm doing a very good job of describing why I liked her. It was not that I felt she was letting me "get away" with any bad habits, I hope I am not sending that impression. I guess I just liked the fact that she recognized that I did not need a lecture on protein portion sizes, but I do need to change how I *feel* about consuming enough to meet my needs. I am the healthiest I've been in years, but am still fundamentally lacking balance. I try not to discuss behaviors and such, but even though I am eating enough to maintain right now, the composition and temporal distribution of my daily intake is really not optimal, and it's going to take a lot of work to kill those ingrained rituals, they feel so default at this point.

We talked about intuitive eating and tossing any diet behaviors, but right now my hunger/satiety factors are still extremely screwy. I basically measure what I 'should' eat, consume it til it's gone, and wait for the next appointed time to eat. I don't have reliable empty/full cues. The main goals we set were centered around bringing back some balance to normalize that. She understood that if I tried "intuitive eating" right now I would crash in terms of weight, because my appetite is nowhere near robust enough for the amount of food that I need just to maintain. Often the only way I know I am hungry is when I start to feel light-headed, not from any actual hunger pains. And even when I'm light-headed from not eating for X hours, my appetite is pretty blah. So, obviously that is something that needs some attention, and she was very encouraging without overwhelming me.

So, a positive experience, but it brings a frustrating conundrum. I had planned to see this dietitian once, maybe do a follow-up. But now I really like her. She thinks I need weekly sessions, or at the least bi-weekly, but that would effectively double the therapy bill that I already cannot pay. Such is life.

(EDIT: I don't mean to be down on traditional, "menu-mapping" dietitian sessions. Those are really helpful and necessary at many stages of recovery, I just get frustrated when the treatment doesn't go beyond that. Just wanted to make it clear; I was afraid it might come across that I thought meal plans were unnecessary or something to that effect).