Readers and Friends,
After a bit of a hiatus, I bring you a gem — an interview with eating disorder specialist and licensed dietician, Kristin Williams, RDN. In her very gentle approach, Kristin shares with us a wealth of information concerning Symptoms, Early Intervention, and Treatment of Eating Disorders. Conversations about mental illnesses are at an all-time high, and patients meeting criteria on the DSM 5 for such illnesses as Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Orthorexia need help! I sincerely hope this interview guides us into more fact based conversations that equip women to see themselves as God ‘s beautiful children – valuable, powerful, and completely lovely.
Juleeta: Hi, Kristin. Thank you for taking time to meet with me today. Readers, Kristin just gave a birth to a beautiful baby boy, Kipton, just over two months ago! Besides being a mom, she is also a licensed dietician who works part-time in her own practice and part-time in a local eating disorder treatment facility. Kristin, thanks for finding time to meet here.
Kristin Williams: Of course. I’m honored to answer some of the questions your readers have about body image and disordered eating. Ask me anything, and I’ll answer as best I can.
J: So, here it goes. My first question is about how it looks when parents approach you if they are concerned about eating disorders in their children. For example, when parents are concerned about the weight of their child, what steps do you take in guiding them?
KW: When parents approach me with weight concerns about their child, I first offer them a listening ear and validate their concerns. A lot of parents of children with eating disorders are overwhelmed with feelings of guilt and shame, believing that they have somehow caused the problem.
It is so very important for parents to feel heard, for professionals to show compassion, and for the parents to be encouraged by learning of the positive role they can play in their loved one’s recovery. Usually a patient’s medical, mental and weight history is discussed with parents along with their current eating patterns and disordered behaviors (restricting, binging, purging, etc). An individualized meal plan is created for each patient and parents are educated in regards to appropriate portion sizes and mealtime conversations. Parents are also educated on how to help their children manage and control urges at home in order to decrease the frequency of engaging in disordered behaviors.
For a lot of my parents, I use the Ellyn Satter’s Division of Responsibility approach; it teaches parents about appropriately feeding their children following recovery from an eating disorder.
J: I’m going to focus some of our time on female patients as adolescent girls and young women appear to be the largest group struggling with disordered eating and negative body image. Considering your female patients, what age/range do you most commonly hear concerns (from them) about weight?
KW: At the eating disorder treatment facility that I work at, I have seen females as young as 10 years old to women in their 60s.
We have a large adolescent population as well as a large adult population. With this large age range, you can see that unfortunately, no one is immune from weight concerns. However, when weight concerns/disordered eating in an adolescent female are detected and treated early, that patient will hopefully have a better outcome in regards to recovery. Early intervention is key!
J: Do you have any measures or scientific-based guidelines you use to assess healthy weight for your female patients? Why do you use these?
KW: For adult women, most medical professionals use the Ideal Body Weight charts to determine an appropriate weight. This chart starts with 100 lbs per 5 ft and allows for an additional 5 lbs per inch over 5 ft. The challenge with this method is that it only takes into account a person’s height and whether or not they are male or female.
For adolescent females, ideal body weight is determined using a growth chart and looking at the relationship between body mass index (BMI) at the 50th percentile and the person’s height. So many other variables should be accounted for when determining an appropriate weight for a female such as her previous weight history, muscle mass, bone structure, menstrual cycle, etc. I tell all of my patients that a healthy weight is one at which they are not having to under eat or over exercise in order to maintain.
J: Is your approach different when the parents are concerned about obesity vs. when the parents are concerned about their daughter being underweight?
KW: For the most part, my approach is very similar whether a parent is concerned about obesity or their daughter being underweight. With both scenarios, I practice a non-diet approach where all foods can fit. I teach parents and their daughters about how, though not all food is nutritionally equal, it is vital that all food is emotionally equal meaning that it does not elicit feelings of guilt and shame. We discuss the importance of making peace with food and patients are taught how to recognize internal hunger and fullness cues. All patients, whether medically obese or underweight, are taught how to recognize emotional triggers that keep them engaged in their eating disorder. Patients work toward learning distress tolerance and emotional regulation which, in turn, helps to normalize their eating behaviors.
- With underweight patients, meal plans are increased regularly for a goal of weight restoration.
- However, with both populations, weights are not shared directly with the patients, and the focus is not on the scale. Patients are blindly weighed, meaning that they step onto the scale backwards and staff monitor weight trends.
- I do share with parents the negative outcome of trying to control their child’s food intake whether the child is obese or underweight. A parent who is force feeding or restricting their child’s intake is likely to observe the exact opposite effect of what they are trying to achieve.
- For example, the parent who is restricting the dietary intake of their obese daughter is likely to find that their daughter is now actually overeating or eating in secrecy in an act of rebellion or in fear that they will not get enough to eat. Whether a child is overweight or underweight, I work with parents to better provide meal support at home in a way that promotes recovery from disordered eating.
J: What are some of the main factors you consider as you recommend different levels of treatment?
KW: Some of the main factors to consider when recommending different levels of treatment would be whether or not the person is medically stable and whether or not they are able to appropriately manage urges and behaviors at home. These are just a couple of things that would be considered when identifying an appropriate level of care. The American Psychiatric Association has a helpful set of guidelines to review when determining an appropriate level of care for a patient. The different levels of care are as follows: outpatient, intensive outpatient, partial hospitalization, residential and inpatient.
J: How involved is each patient’s family in their treatment once she returns home?
KW: Ideally, each patient’s family would be very involved once she returns home from treatment. Families have a huge role to play in the recovery from an eating disorder by offering meal support during meals and by helping their loved one to manage and control urges and behaviors at home. Families also can play a role in providing a non-diet environment in the home and by providing a safe place for their loved one to express their emotions. Many treatment facilities offer ample opportunities for families to learn about eating disorders and how to better support their loved one at home. Many treatment centers offer weekly education for families, provide family therapy sessions and offer family meals on the unit in order to prepare for mealtime at home.
Each day that a patient is in treatment for an eating disorder, they are increasing their understanding of causes, triggers, appropriate coping skills, behavior change, emotional regulation, etc. Because of this, it is vital for parents to constantly be learning as well so that they are able to support their child when their child comes home from treatment.
J: Thank you for your guidance and experience here, Kristin! Readers and Friends, thank you for taking the time to digest all that Kristin has shared. I am grateful to her, my friend, for her time and expertise. Kristin loves the Lord with her heart, soul, mind, and strength, and she desires for suffering individuals to seek God’s healing over our hiding.
You are invited to join Kristin at her blog about all things, good and nutritious. Her writing is honest, insightful, and a delight to read.