If you ask most people in the ED field, the ED RD does the meal plan, meal plan, meal plan.  If even our colleagues don't understand what we do, how can we expect patients to?

The ED RD is so much more than a meal planner.  In fact, besides weighing clients, giving a meal plan is the least favorite part of my job.  And ironically these are the 2 functions that most people think of when they think RD.  

What I want to scream from a mountaintop is that the ED RD is so much more!  We not only help evaluate, treat and monitor a person's nutritional health through dietary interventions, but we also provide a lot of counseling.  The way I explain it to clients is that I am here to help them find peace in their relationship with food and their body.  This not only means eating well but also includes having a relaxed attitude toward food and involves some 'mental gymnastics.'

Here is just a sampling of the tools I have in my toolbox:

• Medical Nutrition Therapy (MNT): "Nutritional diagnostic, therapy, and counseling services for the purpose of disease management which are furnished by a registered dietitian or nutrition professional…" (source Medicare MNT legislation, 2000).
• Anatomy and Physiology: Teaching clients about how their body works, how food is digested, the consequences of inadequate or unbalanced nutrition, and how food makes their body work properly.
• Biochemistry: Understanding how food is metabolized into nutrients.
• Food Science: The composition of food, the function of ingredients, how to prepare food, the science of cooking and baking.
• Culinary Arts: Planning and preparing meals that are appealing and tasty.
• Intuitive Eating: Based on work by Evelyn Tribole and Elyse Resch, both RD's, who teach the 10 Principles of Intuitive Eating, which basically means eating when you're hungry, choosing enjoyable food, stopping when full, dealing with emotions without using food.  
• Mindful Eating: Being present in the moment and eating with awareness.  Attunement with the body.
• Cognitive Behavioral Therapy (CBT): Changing thoughts, beliefs and behaviors surrounding food, exercise, weight, health.
• Acceptance and Commitment Therapy (ACT): Mindfulness, aligning with a person's values, dealing with painful thoughts and feelings without using the ED behaviors.
• Dialectical Behavior Therapy (DBT): Emotion regulation, distress tolerance, mindfulness skills.
• Motivational Interviewing (MI): Increasing motivation for change and recovery.
• Family Based Treatment (FBT): Coaching parents to take charge of nourishing their child back to health.  
• Internal Family Systems (IFS): When a client has worked with a therapist who uses this model I borrow the language about "parts" and how they impact the ED.
• Behavior Experiments: For example, eating a fear food with a client to help him/her see that s/he can handle it.
• Life Skills: Teaching clients how to budget for food, plan meals and grocery lists, make time to prepare and eat meals, eating out at restaurants, eating alone vs with others, setting boundaries, using their voice to express needs, self care, clothes shopping, making doctor's appointments, figuring out how to use their health insurance, communicating with their doctor, and a billion other random things that come up in our sessions!!

An eclectic mix of strategies is needed for working with this population since ED's are so challenging to treat, and what works for one person might not work for another.  The client and I have to find what works and what doesn't, creating a highly individualized approach.  So next time you think of the RD and just assume giving a meal plan is all we do, remember that it is so much more!