I am quite sad to say that when I was studying to become a dietitian I learned next to nothing about eating disorders. I recall perhaps a few slides during a lecture about the various definitions of eating disorders and that was it. I am even more sad to say that at that time it didn’t phase me at all because I had no interest in working in the eating disorder population, so I really didn’t think I needed to have an understanding of that world – I was wrong.
Fast forward to my first job working as a clinical dietitian where I would experience working with a handful of people affected by an eating disorder and those I encountered where arguably the sickest of the sick. A young women - let’s call her "Sarah" - was admitted to my unit because she was so malnourished she was not safe to be at home in the community. It was my job to help boost her weight up to a safe level which we did with a temporary feeding tube so that she could go home and wait to be accepted into a hospital based eating disorders program. My experience working with Sarah was both eye opening and awful. Awful to see someone so sick and to hear of how she fell through the cracks and even then at her lowest point there was no where for her to go – she had to wait. Her family desperately wanted her to get help but she had to wait as she waited she suffered. Sarah wasn’t the only patient with an eating disoder that I worked with in the hospital – but she was the one I worked with the most as she would return to the hospital multiple times during the time I worked there – each time for the purpose of restoring her weight so she could go home and wait for a bed to open in an eating disorders treatment program.
A few years went by and I left working as a clinical dietitian and started working as a retail dietitian in a grocery store. If you’d asked me when I started out in this role if I’d encounter anyone with an eating disorder most likely would have said no but again I’d be wrong. The grocery store I worked at was in very close proximity to a large gym facility. I started to notice a girl who appeared to be in her 20s come to the grocery store in her gym clothes, presumably after a work out. She’d find a quiet corner in the sitting area where most people stopped for lunch or a quick coffee and she’d eat an entire package of bakery prepared muffins all in one sitting – I mean muffins the size of large cupcakes many of which came with a layer of icing so thick they might as well have been cupcakes. Her body language and mannerisms gave it away to me that there was some version of disordered eating going on – she looked uncomfortable, on the lookout for who might see her. She picked at the muffins eating them quickly but only via the tiniest bites I’d ever seen. She’d finish the box, look around nervously and then disappear to the washroom. She'd do this same pattern on what seemed like a weekly basis.
In private practice I was also naïve – I’ve had a number of people reach out looking for support for a friend or family member related to an eating disorder and when this happened I would let these people know it’s not my are of expertise and I’d refer to someone else to support them - after all my niche is working with clients with digestive health concerns so it made sense to me then to redirect clients. I thought this was a solid plan - sending these clients to someone who might be a better fit and removing myself from what can be uncomfortable counselling sessions. I had a solid plan but little did I know there would be a number of clients who didn’t call and up front tell me they wanted support for an eating disorder - it isn't always apparent on the surface. There have been occasions where I've been working with a new client for digestive health concerns and I’d start to pick up on red flags of disordered eating behaviours. The first time it happened I felt sort of trapped - too late for me to redirect this client to someone else. I’d have to deal with it myself and it made me uncomfortable. I felt I really needed to be careful what I said or how I said it so as not to make a mistake. I worried that I might lose a client if my words were hurtful.
I feel ashamed to admit how unprepared or even scared I was to help these patients but I also realized in more recent years of practice that while I may not be an ‘expert’ in this field, I am equipped to be a support to someone in need – I am empathetic. I am a listener. I can have tough conversations. And if and when needed, I can connect my clients to additional resources - I don't have to be the only person on their support team. but I can be a person on their support team - at times I am the first they open up to and that's ok. I’ve been blessed in recent months to do some continuing education learning from a dietitian who specializes in eating disorders in her practice and I have grown because of it and want to continue growing - there is such a need.
So here we are years later, and I think about Sarah from time to time. I wonder if she made it. I also wonder if there had been more support for her early on would her eating disorder have been able to invade her world and turn it as upside down as it did. In the years since I met Sarah, I grew as a dietitian and hope I can/of have already made a difference for someone else at an earlier stage of the game than when my and Sarah's paths crossed.
February 1-7, 2018 is Eating Disorder Awareness week. For more information click here