Eating disorder nutrition counselling in Canada

An eating disorder is considered a 'mental' or psychiatric disorder with potentially severe physical consequences. The optimal treatment for eating disordered individuals is multi-disciplinary and multi-dimensional. Nutrition counseling is an integral part of the eating disorder treatment process, but the actual practice of nutrition counseling has yet to be defined. American eating disorder dietetic manuals describe nutrition therapist as the optimal way to support this client group. A nutrition therapist would delve into process-oriented strategies whereas; a nutrition educator would work strictly with didactic and content oriented strategies. Given the absence of information on Canadian eating disorder dietetic practice and how dietitians are being prepared to work in this area, this study aims to rectify these gaps in knowledge. The goals of this study were to ascertain the counseling practices and explore the educational needs of dietitians in Canada who worked with eating disordered individuals in order to optimize the treatment for this population group. The literature for nutrition counseling was reviewed and a list of 50 counseling strategies was compiled. Surveys based on these 50 strategies were developed and mailed to 138 Canadian dietitians who worked with eating disordered individuals. The types of strategies explored in this study comprised of assessment, rapport building and behavioural change categories. Within the behavioural change group, strategies can be further divided into instructional, behavioural, cognitive behavioural or motivational strategies. Strategies may also be categorized with respect to being strictly content-oriented or being process oriented. Dietitians were asked to complete the dietitian survey and to pass the therapist survey on to the appropriate member of their eating disorder team. The dietitian survey had a return rate of 56% while the therapist survey had a return rate of 34%. Assessment and rapport building strategies were used frequently by Canadian dietitians. The most frequently used behavioural, change strategies tended to be content-oriented. Dietitians used strategies they were familiar with, strategies they considered useful and strategies within their perceived professional role boundaries. Therapists had a similar view as dietitians on which strategies were useful and which ones were appropriate. The four highest ranked strategies for usage and usefulness were the same. They were: using small increments in goal-setting, involving clients in decision-making, discussing barriers for behavioural change and reflective listening strategies. The strategy usage of Canadian dietitians seem to indicate that they worked in more of a nutrition educator role as opposed to a nutrition therapist role. Overall, the most frequently used route for learning eating disorder nutrition counseling skills was reading. Strategies used in clinical practice were learned from dietetic training and intuition. Seventy-one percent of the dietitians surveyed were dissatisfied or very dissatisfied with the educational opportunities currently available, hence there is a definite need for continuing education opportunities in the area of eating disorder nutrition counseling. At this time, Canadian dietitians do not have access to routes of learning that have been recommended by the American Dietetic Association and dietitians who are leaders in the field of nutrition counseling and eating disorders. These recommendations include more intensive and formal modes of training such as courses and mentorship or supervision programs. Courses and mentorship were also the routes of learning most frequently requested by Canadian dietitians themselves.

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