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Nutrition Therapy for Eating Disorders in the COVID-19 World

Regional Outreach Manager, Mid-South Territory
Monte Nido & Affiliates

Regardless of our situation prior to the COVID-19 pandemic, we all have experienced a shift in our connection and access to food.  Brunch with friends or a quick pop into the grocery store after work seem like events of the distant past or far off future.  While a yearning for the simple pleasures of life exists for many of us, the daunting reality of our current normal impacts us all.

For the millions of individuals struggling with an eating disorder, these basic food related events already incite overwhelming and intrusive anxiety.  Add a life-altering disruption to the mix, and one’s recovery journey becomes even more challenging- to say the least.

Registered dietitians that work in the eating disorder field are used to discussing the psychological challenges around food.   Eating disorder specialized dietitians, often called ‘Nutrition Therapists’, have continued to provide these essential services during this time, primarily in a virtual format.  These changes have created unique opportunities for both dietitians and their clients – some that pose new obstacles to one’s recovery, while others that create an unforeseen space for growth.

The necessary, yet sudden shift to the virtual world has impacted the delivery of eating disorder treatment.  In day treatment programs, clients typically spend 3-8 hours per day in therapeutic groups and meals. These programs, by design, are available to provide intensive supervised meal support for those unable to do so on their own.  Clients who come to treatment because it is too difficult to meet their nutritional needs at home are now being asked to prepare and eat all of their meals in this potentially triggering environment.

While supporting clients virtually during meal times is much harder when not physically together, many clients have seized this opportunity to push themselves out of their comfort zone in the spirit of recovery.  “Some clients are really thriving on the virtual programming” noted Janessa Slatky, East Coast Director of Nutrition for Monte Nido & Affiliates.  Having clients be in their home during sessions also provides an invaluable perspective on their lives.  Janessa shared how RDs are getting tours of their clients’ kitchens and pantries, which helps with meal planning and flexibility in the moment.

Clients are also encouraged to be creative in the kitchen.  Monte Nido has been providing to-go boxes containing staple items along with directions for meal creativity and basic food preparation.  These packages are available several days per week to those near the facilities, and these themes are subsequently explored during nutrition sessions.

Along with these topics, new issues are also emerging in nutrition sessions – ones that may not have occurred otherwise.  Food scarcity, whether actual or perceived, has been a prominent concern for those working on recovery.  Long lines, empty shelves and uncertainty of what foods are available are anxiety provoking, even if you do not struggle with an eating disorder.  Add fears of not finding your ‘safe’ foods, or the overwhelming choices that come from online shopping, and it can be paralyzing.  Hayley Miller and Michelle Pillepich, who are both licensed dietitians and therapists working in Manhattan, help clients manage these crises in the pandemic’s epicenter.  “It can be difficult to feel the need to shop for food well in advance and somewhat ‘stockpile’ shelf stable goods.  That message is triggering of a scarcity mindset which is not focused towards more flexible and calm eating,” said Pillepich.  Miller added, “It is difficult at times to stay focused on the session given the uncertainty of the situation especially in NYC where it is the worst. Clients need a lot more grounding because of all the uncertainty.”

Valery Kallen, a registered dietitian also practicing in New York City, has noticed some changes in clients’ demeanor.  “Clients have reported feeling that their privacy is now limited, as there may be several family members residing in close proximity.”   Sara Gonet, a certified eating disorders registered dietitian in Raleigh NC, shared a similar sentiment, noting privacy concerns “make them feel uncomfortable opening up as much due to fear someone is listening to our session.”

Yet for others, these situations have led to breakthroughs, as many dietitians can attest. “Some RDs have noticed improved conversations regarding behaviors and urges to use behaviors,” Slatky noted.

Erin Schulberg, an RD in the metro-Atlanta area, has also witnessed the brave choices that may not have happened otherwise.  “I have a few clients who have actually made really healthy decisions for their recovery despite significant discomfort” she noted. “It has been beautiful to watch as many of the individuals I work with find the bright side of being stuck at home.”  Gonet added, “Many clients have caught me by surprise in their ability to us all their skills and tools they have learned to make recovery a #1 priority, during a time of change and increased fear in the world, when it would otherwise make sense for their eating disorder behaviors to occur.”  Kallen agreed: “Clients are learning to handle situations that are ‘out of their control’ and they are actually surprising themselves with how well they are able to take care of themselves during such as difficult time… this situation has been helping clients to align with their values.  It’s always incredible to see how resilient clients are when faced with hardship – they are always impressing me!”