Eating disorders are complex illnesses that benefit from a multifaceted approach. As an eating disorder therapist, I often collaborate with dietitians. I interviewed my lovely colleague, Alex Raymond, RDN, CEDRD, of Courage to Nourish Nutrition to learn more about her role with patients, challenges, rewards of the work, and what it’s important for clinicians to remember when it comes to treating eating disorders.
Jennifer: Tell me a little bit about yourself and what fueled your interest in helping people to recover from eating disorders?
Alex: I’m a dietitian in private practice in Maryland. I work exclusively with eating disorders and those who are looking to find peace in their relationship with food and body.
Outside of counseling patients, I enjoy speaking to large and small groups on eating disorder awareness, body image, and intuitive eating. I absolutely love my job and my clients are some of the courageous people I know. I live in DC, but have family all over the country, which is super exciting because I get to visit them in fun places like Nashville, Southern California and Arizona.
Like most people who study nutrition, I got into the field for the “wrong reasons.” Meaning, it was fueled by my own disordered eating habits and wanting to learn more about “healthy” eating.
Plus, in high school, I always had an interest in psychology, but never wanted to become a therapist. When applying to schools, I didn’t know nutrition was something I could study, until I went to accepted student’s day at University of Maryland.
There, I listened to the dietetics advisor talk about the major and becoming a dietitian; it sounded like a good fit to me. Due to my own disordered eating, I’m not sure if majoring in nutrition was something that I needed for my own self-care, however I’m so, so happy it was the path I chose.
I started interning for a practice that specialized in eating disorder recovery where I learned more about healing relationships with food, cultivating a positive body image, and intuitive eating.
I think it clicked with me because I wanted to support others find peace with food, which at the time, was something that felt foreign to me. I think my own experience truly helps me to relate to my clients and better understand their journeys.
Jennifer: What is your approach when it comes to helping your clients who are struggling with eating disorders?
Alex: Listening, listening and listening some more. Each of my clients has a hugely important and different story to tell. I can’t possibly gain any understanding how they feel about food and how they feel in their bodies unless I ask plenty of questions.
As a dietitian, it may surprise many people that my job actually isn’t to tell my clients what and how much to eat–except for maybe in the early stages of recovery when clients need more information about how to fuel their bodies.
But, it’s important to make it clear to my clients that if I give them any sort of meal plan, they know it’s a minimum and also super flexible. Because if it feels too rigid, it will play into their eating disorder brain. My job is actually to support my patients in learning how to trust their bodies’ natural hunger, fullness, and appetite cues.
In session, we might talk about different ways food feels in their bodies and how different cravings feel. It’s so important for me to normalize cravings, eating more or less sometimes, eating meals that aren’t satisfying, weight fluctuations, and eating food just because it tastes good–all things in our culture that are often demonized. And, it can feel super confusing for someone who is healing from an eating disorder.
Jennifer: Do you utilize a health at every size approach?
Alex: Absolutely! Treating eating disorder recovery without HAES © is unethical. Of course, eating disorders don’t always begin with body image concerns or the desire to lose weight. But, many of them do, so it’s important as clinicians we don’t perpetuate fatphobia and body hatred. We need to teach our clients worth does not depend on body size (or how our bodies look), and health and weight are not correlated.
Jennifer: What would you say are some common misconceptions when it comes to eating disorders?
Alex: There are a ton. I love the nine truths of eating disorders and often reference them with families and other clinicians. I think one of the most harmful misconceptions is one can only struggle with anorexia and restricting if they live in a smaller body as well as one can only struggle with bingeing if they live in a larger body.
This prevents health care providers from asking the appropriate screening questions. For example, a person in a larger body could be struggling with anorexia and malnutrition but be praised for weight loss by their doctor. This prevents so many people from getting the eating disorder treatment they deserve.
Jennifer: What are your biggest pet peeves about diet culture?
Alex: Is all of them an acceptable answer? The one that’s on my mind at this moment is the belief we have to track calories (or macros or serving sizes…etc.). The truth is, we don’t have to track our food at all. Our bodies were born to digest and metabolize food to use it for energy. We don’t try to micromanage any other bodily function.
For example, we blink when we need to moisten our eyes. Our heart beats without us reminding it. Our kidneys process water and minerals. Digestion is the same way. We were born with internal cues to let us know when it’s time to eat, how much, and when to stop. Diet culture gets in the way of us believing this. And instead, we have so much shame and guilt in honoring our bodies.
Jennifer: What would you say are some of the biggest challenges and most rewarding aspects of your job?
Alex: I think the biggest challenge and frustration is the denial that comes with the disease. Actually, I’m not sure if I would call it denial, but perhaps shame and fear. I think shame and fear, aside from access to care, are two top things to prevent people from reaching out for support.
The most rewarding aspect is seeing my clients face that fear and choose to challenge their eating disorder voice.
Jennifer: What is important for clinicians to remember when it comes to treating clients with eating disorders?
Alex: Treating eating disorders can bring up a lot of stuff about our own relationships with food. It can bring up our insecurities as clinicians and sometimes make us feel like we’re not cut out for this work. And that’s totally normal.
We are human beings and have our own emotions and biases and blind spots to deal with. That being said, lots of supervision and self-care is essential. We have to remember to take care of ourselves so we can take care of our clients.