KELLY WALKER, RD LD

CASTLEWOOD TREATMENT CENTER

Understanding Our Nutrition Philosophy

Our focus today

Castlewood’s philosophyThe role of a DietitianNutrition Therapy and Intuitive Eating Exercise philosophy

Castlewood’s philosophy

Our goal is to provide education, support, and nurturing guidance as our clients let go of their eating disorder behaviors and distorted thoughts regarding food and weight Abstinence from eating disorder behaviors Recognize how it got to this point Understand the internal core belief system Facilitate autonomy around eating

Our Nutrition Approach

Internally-driven“All foods fit”Nutritionally Balanced according to the ADA’s

guidelines and recommendationsUnderstanding food’s role and functionGoal is Intuitive/normalized eating

Three Phases of Intuitive Eating in Eating Disorder Treatment

Nutrition Rehabilitation Phase I: Intuitive Eating is Contra-Indicated.

Phase II- Identifying, Normalizing, and Responding to Satiety Cues.

Phase III- Indicators of Readiness for Intuitive Eating

(Tribole & Resch, 2004)

Ten Principles of Intuitive Eating

1- Reject the Diet Mentality2- Honor your Hunger3- Make Peace with Food4- Challenge the Food Police5- Feel your Fullness6- Discover the Satisfaction Factor7- Cope with your Emotions without using Food8- Respect your Body9- Exercise- Feel the Difference10- Honor your Health- Gentle Nutrition

(Tribole & Resch, 2004)

The Role of a Dietitian

Gaining the client’s trust- First Session is KeyUnderstanding the client as a whole

Therapy Nutrition intake Body image

Part of the therapy process

The Role of a Dietitian

Manage the clients food and fluid intake Meal Planning and Portioning Variety Moderation Consistency

Achieve healthy weight and weight stabilizationAddress medical concerns and provide nutritional

managementTeach the Role of Food in the body

The Role of a Dietitian

Challenge the Diet MentalityDiscuss appropriate exercise plansTeach mindful and respectful eatingWork to understand hunger and fullness

Emotional and Physical

The keys to meeting our goals

Understanding the function Connect the dots Process along the wayDecrease shameAid in compassion

Food Rituals

Work to eliminate from beginningUnderstand the functionFacilitate client’s desire to changeVary differences depending on diagnosis

Where do food rituals come from?

Control: “If you’re going to make me eat…”Fear of not getting enoughFear of getting too muchNever enough and always too muchDeny food as foodA way to further disconnect from the food

How do we work on trauma foods?

GOAL: to detach the association between trauma and food and to eventually eliminate fear response with exposure.

Not encouraged until therapist indicates and/or trauma has been processed

Work gradually to decrease association between food and trauma

Continue processing with client during and after eating

Encourage client to be patient

Eating disorder fear foods

Introduce from beginningConsistently increase variety and reinforce by

educating the importance Help them maintain variety as autonomy increases

Fluids

RestrictionFluid loadingBingeing on fluidsUnderstand what’s behind the behaviorFluid protocol/role in refeeding

We model a realistic structure for normalized eating by incorporating:

Artificial SweetenersSodaCaffeineMeal outingsVegetarianismGrocery ShoppingCooking

Meal Experience

Self portioningModelingMindful Meals vs. Distraction MealsDiscussion After EatingHow to support struggles at the tableSupplementing

De-coding “I’m terrified of gaining weight.”

Getting to know themselves/core beliefsNeeds going unmetBeing UnlovedUnpredictability

Relapse Prevention

How food effects mood and can set one up for behaviors

Urge CardsTeaching how to create meal-structure in “the real

world.”Behavioral Chain Analysis

Our Exercise Philosophy

IndividualizedLearning moderation and re-learning what it feels

like to enjoy exerciseA privilege – the food comes firstFocus on How it FeelsDisassociate Exercise from Weight Loss

A Way to Take Care of Yourself The mind, body connection

Yoga, Walks, Mindful Walks, Nia, Community Activities, Strength Building

(Tribole, 2010)

Recovery process

An ongoing processConstant challenging of fear foods, trauma foods,

food ritualsMaintaining “stabilization weight”Utilize support from others

Eliminating the “I can do this myself” mentality

Identifying “Red Flags” before they turn into a laspe and/or a relapse.

Questions?

References

Tribole, E. (2010). Intuitive eating in the treatment of eating disoders: The journey of attunement. Perspectives, 11-14.

Tribole, E., & Resch, E. (2004). Intuitive eating, a revolutionary program that works. (2 ed.). St. Martin's Griffin.