The Tools of a Nutrition Therapist

The Tools of a Nutrition Therapist

Written by Jenn Burnell, CEDRD, Regional Director of Clinical Outreach for Carolina House

Every day, individuals seek professional nutritional help in implementing the “perfect diet” that is blowing up their social media feeds.  To make it even more confusing – and potentially dangerous – is that there are varying levels of nutrition experts marketing their services, and knowing who to trust can be just as daunting.  Nutritionist? Dietitian? Medical Nutrition Therapist? Nutrition Coach?  What does it all mean? It can mean everything and/or nothing at all – and if someone is seeking help for eating behaviors that have become life intrusive and are impacting their health, seeking a properly qualified professional is even more crucial.  So… just to make this even more murky, I’m going to add one title more to the mix: Nutrition Therapist.

First off, I must acknowledge that using Nutrition Therapist is not an accredited term nor a certified title- in fact it is not even 100% used among Certified Eating Disorder Registered Dietitians (CEDRDs), which are considered the most experienced practitioners in the eating disorders field.  “Nutrition Therapist” technically can be freely used by anyone, so it is be important to check that the provider also is a Registered Dietitian or Registered Dietitian Nutritionist (RD/RDN).


A nutrition therapist provides (want to guess?) nutrition therapy to clients seeking eating disorder recovery and help around chronic dieting patterns.  Nutrition therapy is different from the typical pictures of a dietitian in a lab coat telling a person what to and not to eat.  Instead of focusing on nutrition education and standardized meal plans, a nutrition therapist guides a client along on a self-discovery journey around their beliefs around food.   By dispelling myths with sound nutrition information, and providing a non-judgmental space for clients to discuss, explore, and challenge the “whys” of their thoughts and behaviors, the nutrition therapist helps move an individual towards a life enhancing relationship with food.  On top of this, a nutrition therapist also must provide clinical nutrition interventions to aid in the medical complications associated with eating disorders.

Sounds simple enough, right?  Actually, as many seasoned nutrition therapists will tell you, it takes a long time to hone in on these skills, which often means attending various trainings that are not typically provided in most didactic nutrition programs. Understanding counseling approaches such as motivational interviewing (MI) is integral to help guide clients through the resistance and ambivalence around their detrimental behaviors.

A nutrition therapist must also have a strong understanding of therapeutic modalities that mental health clinicians use when treating eating disorders, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), family-based therapy (FBT), and internal family systems (IFS) to name a few.  Incorporating the language and principles from these approaches not only help create cohesive messaging within one’s treatment team, but it also makes the nutrition therapist more effective in helping their clients.

What about specific nutrition-focused approaches that are best practices for nutrition therapists?  Effective nutrition therapists understand, embrace, and embody the principles of both Intuitive Eating (IE) and Health at Every Size (HAES), and discuss nutrition using a non-diet approach.

I first discovered the book Intuitive Eating back in 1997 at my first job out of grad school.  I credit that book, written by Evelyn Tribole and Elyse Resch, for changing my life both professionally and personally, and plotting the course that led to where I am today.   Their first edition shattered my world as a way to “Make Peace with Food”, and its Ten Principles around breaking the diet mentality served in working with all of my outpatient clients, especially those coming in for weight loss.

Where some aspects of the book may be challenged by staunch non-diet proponents, the overall message embraced by nutrition therapists around the IE model is that of body trust: that the vast majority of individuals have an innate ability to sense hunger, satiety and what food will best honor your needs in that moment.  However, as idyllic as it sounds, it is that simplicity and freedom that can make it seem inaccessible to eating disorder clients.  Also, it could leave individuals (especially those black-or-white thinkers) feeling like a “failure” if they ate when not hungry or past satiety, which are what we as humans and social beings all do from time to time.  Cue Ellyn Satter…

Ellyn Satter is another pioneer in creating guiding principles for nutrition therapists.  Her simple handout called “What is Normal Eating?”, which was penned in 1983, still resonates true today.    Where much of her work revolves around child feeding dynamics, her Eating Competence Model (also known as ecSatter) is based on two key elements: 1) the discipline of providing yourself with regular, reliable, and rewarding meals and snacks and paying attention while you eat and 2) the unconditional permission to eat what and as much as you want at those regular eating times.*  These principles require more structure around eating, which differs from IE, yet both can be important tools for eating disorder clients at different points in their journey.

A component of both Intuitive Eating and the Eating Competence Model, and often discussed in nutrition therapy, is the concept of mindful eating (ME).  Some people may confuse Intuitive Eating and mindful eating on the surface, but they are quite different.  The idea of mindfulness is all about being present in the moment and fully aware of the experience (in this case the meal or snack).  Mindful eating does not suggest anything about your physical state (i.e., whether you are hungry or full) in order to do it, just the ability to notice all that is happening in that moment.  An objective and curious awareness is often the best approach in implementing ME in nutrition therapy work.  Some ideas include: Notice the color of the plate…What do you notice about the temperature of the food/how does the weight of the food feel on in your hand or on your utensil?… and one of my favorite questions: If I was an alien that came from outer space, how could you describe it to me?  If a client does or does not like a food (which is completely okay), a nutrition therapist might ask what is it about the food that objectively is not their preference – notice what specifically about the taste or texture is not appealing, or is one aware if a thought versus or past experience is making that decision.

Lastly, where not a nutrition specific strategy, I would be amiss if I didn’t discuss the importance of Health at Every Size® in nutrition therapy for eating disorders.  I was first introduced to this platform at the Binge Eating Disorder Association (BEDA) conference in 2012, where it created this landing space for the things that inherently made sense from my experiences in weight management and eating disorder work, and shared solid and pivotal research to support it all.  At that time, the take-home messages I assimilated were that 1) one cannot determine anything about one’s health based on a person’s body size, 2) the shame and stigma our society creates around larger bodies is the true health crisis and 3) weight cycling and chronic dieting are the culprits related to poor health versus size or weight.   What I have grown to truly understand over the years is that HAES is really a social justice movement advocating for safety and inclusion of bodies of all sizes (and colors and gender identities and abilities).  In order for a nutrition therapist to be effective in their work, they must truly embody size diversity acceptance, and have done a thorough assessment of their own weight biases.  This can be hard and uncomfortable work, especially because dietetic education provides so many guidelines around weight management.

If you are looking to work with a nutrition professional on eating disorder or chronic dieting struggles, do not be afraid to ask them about their qualifications and approaches to working with clients.  Are you a registered dietitian?  What do you know about Intuitive Eating or Health at Every Size?  What is your approach to weight management?   If you are an RDN hoping to learn more on how to effectively work with clients seeking the above help, there are several resources listed below.  Also – seek out the support and supervision of the many amazing CEDRDs and Nutrition Therapists that are available to mentor and share their vast knowledge with you, and help our world break free from the frivolous search for the perfect diet.

Online Resources:

Where to find a qualified nutrition professional (CEDRD/ Nutrition Therapist)


Jenn Burnell is a regional Director of Clinical Outreach for Carolina House, an eating disorder program in Raleigh/Durham, NC.  She is a Certified Eating Disorder Registered Dietitian Supervisor, and owns CEDRD Nutrition, where she helps RDNs in becoming Nutrition Therapists.

Is it Binge Eating Disorder (BED) or are you stuck in a vicious cycle?

Is it Binge Eating Disorder (BED) or are you stuck in a vicious cycle?

Written by Graduate Clinical Intern and Clinical Support Specialist, Meagan Mullen

Binge eating disorder is an eating disorder characterized by episodes of uncontrollable eating, typically not followed by compensatory behaviors. People often get confused and believe that if they are engaging in a binge, they automatically meet criteria for a BED diagnosis, but that’s not always the case!

Let’s break it down by taking a look at Binge Eating Disorder, Bulimia Nervosa, and the binge-restrict cycle.

As previously stated, BED is characterized by episodes of binge eating that are usually not followed by compensatory behaviors such as vomiting, laxative abuse, fasting, or excessive exercise. Bulimia Nervosa, however, differs from BED in the sense that people with this disorder do engage in these modes of compensation. People often believe that Bulimia Nervosa strictly refers to self-induced vomiting after eating, but purging can refer to many different kinds of unhealthy compensation.

Despite the fact that these two diagnoses exist, many people engage in binge eating but do not meet criteria for BED or Bulimia. Instead, they find themselves stuck in a cycle of bingeing and restricting, often unsure of how to stop the cycle and get the help they deserve.

People can find themselves in this cycle for a variety of reasons, but let’s take a look at two of the most common ways people get stuck in this pattern.

Many people begin a diet in hopes of controlling their weight or shape, but after time, they’re physically and psychologically depleted. Dieting can lead to obsessive thoughts about food and feelings of extreme hunger. When people experience extreme hunger paired with an increase in thoughts about food and eating, they’re more likely to binge. Dieting (which is a form of restricting), often denies the body of necessary nutrients. This will lead to hunger that sometimes results in bingeing.

After a binge, however, people are overwhelmed by feelings of shame. They often believe that they lack the willpower to “successfully” diet. They’re shamed by the media and by diet culture and ultimately recommit to a restricting their intake. And as we know, restriction leads to physical and psychological depletion, which can ultimately lead to a binge. Thus creating the cycle of bingeing and restricting.

An alternative way that people find themselves stuck in this cycle is when the binge eating occurs first. If someone is struggling with binge-eating and is using food as a way to cope with uncomfortable emotions, they might result to restricting their intake due to the shame they feel about engaging in these behaviors. Oftentimes, people will restrict the day after a binge, eating small amounts of food at breakfast and lunch, or throughout the day entirely.

However, after making it through most of the day on an insufficient amount of food, people experience hunger at the end of the day. The combination of a lack of food and exhaustion can also lead to another binge. This evening binge can lead to more feelings of shame, therein restarting the cycle.

This pattern of bingeing and restricting can lead to health problems, such as cardiac issues, metabolic issues, and various emotional and mood disturbances. While someone engaging in this cycle might not be diagnosed with BED or bulimia, they may be given a diagnosis of OSFED or Unspecified Feeding or Eating Disorder. Both of these diagnoses are serious and deserve proper treatment and attention.

If you or someone you know is engaging in this cyclical pattern of eating, recovery is possible. Many people who struggle with eating disorders or disordered eating receive the help they need through therapy, nutrition therapy, and other group and individual supports.

If you or someone you know is struggling with an eating disorder, or if you feel like you might be stuck in the binge-restrict cycle, MEDA is here to help, and fully recovery is possible!

How Parents Can Spot an Eating Disorder in Their Child

How Parents Can Spot an Eating Disorder in Their Child

Written by: Caroline Rudnick, MD | Family Medicine Physician, McCallum Place

Early Signs and Symptoms of an Eating Disorder in Your Child or Adolescent​

Our culture and media spend a lot of time thinking, talking, blogging and watching videos about dieting, food choice, weight loss, and exercise. Amid this wave of information, our children can get caught up in information that is misleading, misinformed or simply harmful. Combined with the stresses of childhood, this focus on food, appearance, and exercise can contribute to some children and adolescents developing disordered eating behaviors or fully diagnosable eating disorders.

Sometimes these disorders go unrecognized for a period of time, and a child may lose a substantial amount of weight or suffer other medical effects. Because early detection of an eating disorder improves the chances of recovery it is important for parents to know the signs and symptoms of anorexia, bulimia, binge eating disorder, and other disordered eating behaviors.

Signs and Symptoms of an Eating Disorder in Your Child or Adolescent

We often see kids skipping meals, wanting to prepare their own meals, eating alone, avoiding whole groups of foods, counting calories, grams of fats or carbohydrates, or being very picky about food. Sometimes kids will be overly concerned about the nutritional value of food and spend a lot of time reading, thinking and researching food, calories, and diet choices.

Other Signs that Should be Noticed by Attentive Parents

Children spending a lot of time in the bathroom after meals may be an indication that purging is occurring. Binge eating is often discovered when food is suddenly missing from the household supply. Children or teens who are obsessively exercising or secretively exercising are likely struggling with body image distress and concern about weight, size, and shape. Of course, noticing weight loss or sudden weight change is important as these can indicate an eating disorder or another medical issue which would merit the attention of a physician.

Finally, a child’s appearance can offer clues to health concerns or disordered eating behaviors. Kids with eating disorders will often appear pale and withdrawn. Their clothes may no longer fit or they may begin wearing baggy clothes or out-of-season winter clothes to hide their appearance.

Seek Professional Help for Your Child or Teen

If you notice any of these things in your child, please seek medical attention for the possibility of an eating disorder or another medical problem. Your first appointment should be with a medical professional who is confident and educated on the symptoms of an eating disorder. Your doctor may also recommend working with a licensed therapist or a registered dietitian. To find resources in your area or to have a free assessment completed by an eating disorder professional contact McCallum Place at (314) 957-5042.

This blog was originally published at on December 10, 2018 and is republished here with permission.

Mindful & Intuitive Eating for BED Recovery

Mindful & Intuitive Eating for BED Recovery

Written by MEDA undergraduate intern, Stephanie Wall 

Binge Eating Disorder (BED) is the most common eating disorder in the United States (NEDA, 2018). About 3.5% of American women, 2% of American men, and 1.6% of American adolescents currently suffer from BED (ED Referral, 2018). It is characterized by recurrent episodes of eating large quantities of food, often very quickly and to the point of discomfort. Those who suffer from BED tend to feel a loss of control during the binge and experience shame, distress, or guilt afterwards. Further, compensatory measures, such as using laxatives or forcing oneself to vomit, are not enacted to counter the binge. In addition to typical therapy for eating disorders, such as Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT), using both intuitive and mindful eating techniques can be quite powerful in helping those struggling with BED.

A common symptom of BED is engaging in any new practice with food or fad diets. This contributes to body dissatisfaction, food and body preoccupation, and weight stigmatization (Tribole, 2017). The fallout from this mindset is mandating what and when one eats, regardless of one’s biological needs. In those with BED, this rigidity can lead to a binge, and thus feelings of a loss of control. This is known as the binge/restrict cycle.

Intuitive eating can be helpful in breaking this cycle. Intuitive eating is a personal process of honoring your health by responding to your body’s biological signals (Tribole, 2017). Here at MEDA, the EmbodiED Group focuses on self-compassion in their sessions, emphasizing this idea. Because a major idea in intuitive eating is listening to oneself and meeting one’s needs, the individual undergoing this change must be ready for it. This is a key factor for therapy to work, which is why intuitive eating works best for those who have the internal motivation to recover.

One major component of intuitive eating is “legalizing all food” (Hirschmann, 158). This means viewing all food in the same way, in order to remove the idea of “good” vs. “bad” calories. Because namely “junk food” is consumed during a binge, removing the negative connotation associated with that food may help alleviate some of the guilt felt after a binge. This also destroys the idea of “trigger foods” because all food is seen as the same. Many individuals who suffer from BED believe that even the slightest consumption of a certain kind of food will automatically invoke a binge session. According to Dr. Sandra Aamodt, a neuroscientist, hunger and energy use are controlled by the brain, mostly without one’s awareness. Thus, if we truly listen to our bodies and eat without guilt, the more we will naturally crave nutritious food.

Moreover, the idea of the “clean the plate club” has to be disregarded for intuitive eating to work. Being sure that everything on a plate is eaten disconnects us from our bodies and our feelings of fullness (Tribole, 2017). The basis of intuitive eating is to eat when hunger strikes. By legalizing all food as well as ending adherence to rigid rules, intuitive eating can be achieved.

Often those with BED eat when they are overwhelmed and stressed. To eat both intuitively and mindfully, we must ask ourselves how we are feeling and thus why we are eating. As a therapy, having the patience to sit with their feelings instead of eating to quell them is very effective (Tribole, 169). This coincides with mindful eating, based on concepts in the Buddhist faith, which involves being fully aware of what is happening within and around you in the moment. In addition to learning how to eat intuitively, learning how to eat mindfully is important.

Staying present and mindful while eating “allows you to feel the direct experience of your body and the many sensations of eating” (Tribole, 137). Someone who eats mindfully acknowledges that there is no right or wrong way to eat, varies their degree of awareness surrounding the experience of food, accepts that their eating experiences are unique, directs their attention to eating on a moment-by-moment basis, and gains awareness of how they can make choices that support health and wellbeing (The Center for Mindful Eating, 2013). A common method for eating mindfully is eating with one’s non-dominant hand. In one study, participants were instructed to eat popcorn while watching a movie. Unknown to them, the popcorn was a mix of fresh and stale. Those who ate with their non-dominant hand recognized the stale popcorn, and ate less of both the stale and fresh popcorn. Their counterparts didn’t recognize the stale popcorn and ate more (Tribole, 2017).

Experts suggest starting gradually with mindful eating by eating one meal a day or week in a slower, more attentive, manner. Thinking about the flavor, texture, temperature, and aromas of what you want to eat before you settle down to eat will help you eat in a mindful manner (Tribole, 135).

Intuitive and mindful eating are quite useful for re-establishing one’s relationship with food, however these concepts will not address all components of the eating disorder. Typical forms of therapy proven to work include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and interpersonal psychotherapy. By working on both the physiological and psychological aspects of Binge Eating Disorder, recovery can be achieved.


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