What to Expect When You Work with an Eating Disorder Dietitian


Seeking professional help is crucial for eating disorder recovery. It’s also super overwhelming — and it can be intimidating! Choosing to work with an eating disorder dietitian means opening up to a total stranger and trusting that their guidance can help you. At Ruby Oak Nutrition, we don’t take it lightly when people choose to work with us. We consider it a huge honor when clients share their stories with us, and let us support them on their recovery journey.

If you’ve been on the fence about seeking out a dietitian to help you recover from an eating disorder and/or work on improving your relationship with food, we get it. (Especially if you’ve had bad a bad experience with a dietitian in the past.) Here are some things you should know about what it’s like to work with an eating disorder dietitian.

Dietitians are a key part of your eating disorder treatment team.

At the very least, your eating disorder treatment team should include a mental health therapist, a primary care provider, and a dietitian. You might also work with a psychiatrist for medication management. Some people have other providers as well, like a physical therapist to make sure you’re able to move properly in your body, or an occupational therapist to support you in being able to get through everyday tasks.

We’re based in North Carolina and work primarily with clients who live here, too. We do see clients in several other states via telehealth.

For the first few sessions, your dietitian will spend time assessing where you’re at and what you need.

When you start working together, your dietitian will spend several sessions asking questions in order to assess your eating habits, thoughts and feelings about food, body image concerns, and any medical complications related to your eating disorder. We always tell our clients that they shouldn’t expect to walk out of the first session with a full treatment plan, because it takes a few weeks to figure out what each person needs.

We also understand that it can be hard to open up to your dietitian when you’ve only just met them. We make our sessions as conversational and collaborative as possible.

After a few weeks, you and your dietitian will agree on a treatment plan that will guide your work together moving forward. It’ll include your long-term goals, as well as an overview of the smaller things you’ll be working on to achieve those big goals.

When you work with an eating disorder dietitian, you’ll be working towards some big goals.

Eating disorder dietitians are specialized professionals trained to address the unique nutritional challenges faced by individuals struggling with eating disorders. In almost every case, the primary goal of your work with an eating disorder dietitian will be to eat an adequate amount of food for your needs, at regular intervals, without purging.

Other big goals we often work towards with our clients are:

  • Increasing the variety of foods that you eat
  • Eating without calorie counting or measuring food
  • Ending binge eating
  • Eating at least 3 meals per day
  • Building meals that contain a mix of different food groups
  • Learning how to meal plan/meal prep with flexibility
  • Accepting your body and no longer trying to lose weight
  • Not weighing yourself anymore
  • Learning to eat intuitively

You’ll also have small goals — we love setting SMART goals — to work towards each week.

The big (often scary) goals of eating disorder recovery are important, but they aren’t necessarily what you’ll talk about every week with your dietitian. Those big goals get broken down into lots of smaller, more manageable goals along the way.

These smaller goals, which we call SMART goals are particularly important because they give you realistic, manageable things to work towards every week with your eating. The acronym SMART stands for Specific, Measurable, Achievable, Relevant, and Time-Bound, and it provides a structured framework for setting goals that make the recovery process sustainable.

Let’s break down each component of SMART goals in the context of working with an eating disorder dietitian:

  1. Specific: The goal should be clear and well-defined, addressing a particular aspect of the individual’s eating disorder and recovery journey. Specific goals help focus the efforts and energy of the individual, making it easier to work towards a clear target.

Example: “Instead of skipping breakfast, I will eat three meals every day for the next seven days.”

  1. Measurable: It’s helpful when your goals are quantifiable so that progress can be objectively tracked and monitored. This helps you and your dietitian assess your progress and your challenges.

Example: “I will eat at least 2 slices of Domino’s pizza (a fear food) one time this week.”

  1. Achievable: Your SMART goals will be realistic and attainable each week. Unrealistic goals leave you feeling inadequate and frustrated. Achievable goals promote a sense of accomplishment and motivation.

Example: “I will add 1 slice of cheese to my sandwiches 4 times this week, instead of skipping it.”

  1. Relevant: Your SMART goals will all be in service of your bigger recovery goals. Each of them should address specific challenges and concerns that are standing in the way of your recovery.

Example: “I will sit at the dinner table with my parents for at least 30 minutes after I finish eating dinner every day, in order to stop purging.”

  1. Time-Bound: Setting a specific time frame for achieving the goal creates accountability. Of course, it’s sometimes impossible to predict exactly when and how quickly you’ll be able to achieve your goals, but including timelines helps both you and your dietitian measure your progress.

Example: “In order to stay in outpatient treatment, I will gain X pounds per week. If I gain less then X pounds per week over the next 2 months, I will seek out residential treatment.” (Note that the amount of weight gain recommended varies from person to person, and not everyone with an eating disorder needs to gain weight as part of their recovery.)

Nutrition counseling sessions aren’t lectures, but your dietitian will offer some nutrition education along the way.

As eating disorder dietitians, we’re equipped to provide evidence-based nutrition education. That means helping you understand how much food you need, why different foods are important for your body, and the consequences of under-eating. We’ll probably also dispel loads of myths about food and diets — like the myth that diets work, or the myth that your body needs to be a certain size in order to be healthy.

Your dietitian might give you some kind of meal plan. We like ours to be as flexible as possible.

We don’t like to give strict, detailed meal plans to our eating disorder clients, because we find that they sometimes make obsessive thinking about food even worse.

That said, having some kind of meal plan to guide your recovery is important. We’ll explain your meal plan to you at the start of treatment, and we’ll be there every week to help you implement it. The type of meal plan we use most often is the plate-by-plate approach, which is a visual approach to plating meals that doesn’t call for any measuring or counting.

Your meal plan will probably change over the course of your recovery. We typically don’t expect you to drastically change the way you eat in a single week. Instead, we’ll work with you to gradually increase the amount of food and variety of foods that you’re eating.

Your meal plan might also include exposure therapy, which means gradually reintroducing fear foods or challenging eating disorder-driven restrictions to promote flexibility and reduce anxiety around specific foods.

Your eating disorder dietitian will collaborate with your other providers, to make sure everyone is on the same page.

Working with an eating disorder dietitian is just one part of the treatment process. These professionals collaborate closely with other members of the treatment team to ensure a holistic approach to recovery. Some key aspects of this collaboration include:

  1. Therapists and Counselors

Dietitians work closely with therapists and counselors who provide psychological support to individuals with eating disorders. This collaboration helps address the emotional and behavioral aspects of disordered eating while promoting a positive body image.

  1. Physicians and Medical Team

The dietitian is in regular contact with your primary care provider to monitor your physical health and address any medical complications resulting from your eating disorder. Your dietitian may also touch base with your psychiatrist, if you have one.

Working with an eating disorder dietitian is a crucial step in the journey towards recovery from disordered eating.

Eating disorder dietitians offer individualized treatment plans, nutritional guidance, and a holistic approach to recovery that supports the development of healthier relationships with food and body image. We help you make food choices that that addresses the physical, emotional, and psychological aspects of eating disorders.

If you or someone you know is struggling with an eating disorder, seeking the expertise of an eating disorder dietitian can be a pivotal step towards a healthier and happier life.

If you’re struggling with an eating disorder or disordered eating, we can help! We’re a group of dietitians who takes an anti-diet, body-positive, identity-affirming approach to recovery and healing your relationship with food. Learn more about nutrition counseling for adults and teenagers, in-network with Blue Cross Blue Shield insurance plans and offered virtually to clients in North Carolina and over a dozen other states. Not ready to commit to counseling but want more information about the anti-diet approach? Subscribe to our weekly newsletter.

You might also like:

What Is Family-Based Treatment for Eating Disorders?

What Is Anorexia Nervosa? How Can a Dietitian Help?

What is Bulimia Nervosa? How Can a Dietitian Help?

What Is Disordered Eating, Exactly?

Free Intuitive Eating Course

Looking for a free intuitive eating course? Whether you’re new to the anti-diet approach or you’ve been trying to work towards intuitive eating for a while, our 5-Day Intuitive Eating Starter Course is a great start for anyone who’s tired of obsessing over “wellness” and constantly struggling with food and body acceptance.


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