Dietician appt tomorrow - feeling slighly cynical....

So after all my ranting about how unhappy I am with my current dietician for the reasons of - a) she just seems to tell me to eat chocolate and cake, b) she won't tell me how many calories my meal plan is and c) I don't feel I have a long term plan with her of how our sessions will progress to get me through recovery - I have an appointment with her tomorrow. I had made this appointment 2.5 weeks ago when I last saw her and have decided to keep it to give her one last go....

I did e-mail her after our last session to tell her I didn't feel eating pastry and chocolate was sustainable behaviour to gain weight and also to ask about how she sees our sessions going forward to help me recover and this was her reply:

I see that my role is to continue to stay focused, increase your variety of foods thru challenges, manage weight gain and provide support and stragies for anxiety. Eating choc and pastry isnt about weight gain it is about normalisng and you practicing having these and seeing that it is normal. As your weights gets closer to its set point the weight gain will slow and you will overall feel better. At this point in would be about practicing connecting with internal signals of hunger, satiety appetite and preference and using these to guide decisions rather the a meal plan as such. This would also be the time to be workingon including normal leves of activity for enjoyment.

I would just be curious to hear if others have more defined plans from their dieticians/nutrionists on the road to recovery as I really want to get some thoughts together to make the most of our session tomorrow.

The other advantage is that I will get a 'measured' weigh in rather than just using pay scales in a local store... let's hope the weight I believe I have gained is actually there...

Any thoughts on if I should pursue the calorie content question around my meal plan???

Sorry - these may sound like silly questions but I really want to get value from this and not just have a chat about - yeah you need to get comfortable with eating variety of foods, fear foods and just don't exercise...

i think theyre crap.  the only thing good was that it was someone monitoring my progress+weight.

do u have a scale? someone to weigh u each week at the same time, same conditions?

also, i set goals w 1 that i had, like each week to add more cals or a food or eat out.

that was when i was new to recovery.  when i finally did it, it was a ll on my own, it was "simple" in terms of, ok, get to 2500 ASAP, didnt gain 1 week, add 250 cals.

yeah i am not feeling i am getting much value out of it but i will give her one more go... my mum feels that the dietician may be able to help me be more accepting of my fear foods and help me increase flexibility in my eating style etc and that would be a definite bonus if she could do that!

i am hesitant to buy scales at this stage but that is a cheaper way for me to monitor my weight than appts with a dietician for sure! :)

you are right - pretty straight forward - if not gaining, eat more - when you are at the goal weight then ease off.

I have a nutritionist and she recommends NOT counting calories, as it is very triggering and only furthers obsessive ED behavior. However, my nutritionist still encourages me to eat a VARIETY of foods, both healthy AND unhealthy, not just eating sweets and chips all day. Instead of counting calories, she has me on a plan of 3 meals and 2 snacks plus supplement drinks (Ensure or Boost Plus).

I love my nutritionist because she teaches me about healthy eating, serving sizes, etc but still encourages me to go ahead and have that dessert as long as I've had an adequate and healthy dinner.

If you aren't connecting with your nutritionist, then find a new one. However, I think it's helpful to have one. Not counting calories is hard when you're so used to it, but I think it's good to try to get rid of that habit fast because it can further ED thoughts. That's just my personal opinion.

Best of luck!

Why is finding out the calorie total of your meal plan so important? To be honest I think she has a valid point in trying to show you that eating should be about appetite, cravings, hunger and satiety - not about playing the numbers game.

If you don't like her approach then by all means find a new dietitian, but I think she sounds pretty sensible. Far more sensible than nurtitionists I have heard of that give weight gainers diet meal plans! You don't have to eat things like chocolate and pastry all the time, but including them in your meal plan should help to normalise those things for you.

so the thing i disagree w regarding eating by your apetite is that so often ppl recovering from EDs have such skewed hunger cues, from having had ignored their hunger for so long, that they then might not eat, or not eat enough.

also, ppl r scared to trust their hinger cues and again not eat enough.

somehow u or someone needs to know how much ur eating, calories, and exchange plan, something?

Thanks to everyone for their replies. Yes I agree that counting calories can be triggering and as such i would like to avoid it but i guess i just need to learn to incorporate more calorie dense options into my meals and snacks to make sure i am not just staying in my old habits of only eating healthy, low calorie foods.

Coco - your nutritionist sounds great! She sounds like one i had before I moved states as she just planned out balanced 3 meals and 2 snacks so I should try to dig out the plans she made for me...

I really do have a lot to do to increase my flexibility so i am not stuck in the same eating routine/food choices every day and I don't hesitate at buying a muffin for morning tea rather than having yoghurt (i love muffins so much but can't bring myself to buy them!).

If you give me a personal message sometime, I can give you an example of some of the meals I eat and an example of the plan my nutritionist has for me! 

Original Post by agruskin:

so the thing i disagree w regarding eating by your apetite is that so often ppl recovering from EDs have such skewed hunger cues, from having had ignored their hunger for so long, that they then might not eat, or not eat enough.

also, ppl r scared to trust their hinger cues and again not eat enough.

somehow u or someone needs to know how much ur eating, calories, and exchange plan, something?

That's true, but she has a meal plan made by her dietitian.

my meal plan is good and i did ask for one with flexibility but am finding that i am not using the flexible options wisely as i always choose the 'safe' foods over my 'fear foods' so this is something i want to address with her tomorrow - whether it means i need a more rigid plan or another solution i am not sure!

Hi. I have seen many nutritionists in my day. Some good and some bad or some we just did not match. I really feel one must work as a team rather then against each other for this to work. Yes there are certain guidelines you need to follow but also certain things that can be flexible. I encourage you to use your voice and tell her what you need and feel. In most programs and op I use exchange meal plans. Each meal and snack is broken up in to that and meets the calorie needs but makes one more flexible. I think intuitive eating is very hard when one is on weight gain or even if not because the mind/body is still so confused. You need to train it to become intuitive. I think having a road map so to speak for the day can be helpful and does not have to be rigid. Part of my recovery was doing food challenges like having cake or fast food and it was planned into my mp through the exchanges.

Thanks abbi - I will definitely be taking the opportunity to be open and honest with her today and discuss my challenges and how I am struggling a bit with incorporating fear foods into my meal plan if I have the option between that or a safe food.

I am learning more about the exchange plan and a few people on this forum have kindly shared some of their exchange based meal plans with me but I am just curious as to how keeping that flexibility and using the exchange plan can help me incorporate fear foods - won't i always just choose the healthy option?

Or do you mean to work from an exchange plan basis but then plan say a week of meals down to the meal on each day and use different options each day?

Well like with my nutritionist when I got to a healthier weight set goals with me for every day for ex picking either a snack or meal out and choosing an item like a bakery muffin or milkshake. I had a list of challenge foods that caused anxiety and had to try them and more then one time to see nothing "bad" happened. You still have your healthy meals and snacks but then also choose things out of your comfort zone.At first pre planning may help you stay consistent but then you can get to a point where it becomes more routine and you will choose foods at the time according to the plan. Like if you are out and got a tuna salad sandwich that could be your protein/2carbs/2fats. When I first started and was increasing I would pre plan each night for the next day and make sure it fit into my plan but as time and weight has went on I am trying to be ore in the moment but fill me needs still.

just got back from seeing my dietician and she has helped me focus on my snacks (she didn't want to overwhelm me by trying to increase flexibility/challenge around main meals - we will look at that next time) and trying to incorporate one challenge food into one of my snacks per day - sounds similar to you abbi!

So what we did is plan out a ‘challenge’ snack for me for the next week/2 weeks each day. It is mapped out as either morning or afternoon tea (for the one I don’t have the challenge snack I can have my normal snack but make sure its decent e.g. apple + yoghurt +muesli bar).

Today I am having a muffin for morning tea. Other things for me to tackle for snacks this week include: cheese & crackers, scone/scroll, chocolate bar.

First good job on the challenges. You can do it. I am confused though about your feelings that she was not helping you. Did you talk to her or do you feel better about things after this meeting?

Thanks - yes I am looking forward to getting to the next weight goal in 2 weeks.

I had a chat with my mum about my frustration with my dietician and she thinks I might just be frustrated with myself and possibly not pushing myself as hard as I could be but that I am reflecting that back on others - so the more I take ownership and push myself - the more others can help me progress along the road to recovery.

I did have a chat with my dietician about goals along the way so feel better after this session and will be going back to see her in 2 weeks.

yup after reading thru all of this stuff, i have come to the conclusion that you are looking for some one to be pissed off with. because recovery is tough. and obviously your ed is screaming at you that cakes and pastries and choc is bad. some ppl never truly recover. they never resume normal eating. they eat clean clean clean (we know who im talking about!) and live in mortal fear of ever eating something with hydrogenated fats or refined sugar. real recovery is about adopting a happy and healthy attitude to all types of food. the dreaded sugars, the greasy pastries, the Christmas dinner, the fruits, the veggies we hated as kids, the meat's we are sure are going go turn us into personified lumps of lard. you can do this half-assed or you can grab this opportunity by the balls and scream that you want freedom

your nutritionist sounds awesome. she emails back... thats pretty cool. why is it so important for you to know the cals.. did you know em when you learned to feed yourself as a child? did you know anything about them before you developed an eating disorder. her degree is in this sort of stuff. what difference would it make if you did know the calorie content? you would probably try to adjust it to something you feel is proper. and if that was the case then why the hell did you enlist the help of a nutritionist at all?

finally, a nutritionist or dietician is just that. their interest is in adequate nutrition and calorie intake to sustain the gain to normal bodyweight. she is not a therapist so there is less of a need to 'click' perfectly with them.... ideally a nutritionist is doing their job correctly if you are eating what they suggest and you are gaining weight.

hi fidget - thanks for this - I absolutely needed someone to bang some sense into me and that is what my mum tries to do - i need logical and honest advice like this - it motivates me.

So stupid that it has taken me this long to have the realisation that it is myself holding me back and I cannot blame anyone else for the slowness of my progress - it is me who has the power to do this - I can only use others as tools and support in this recovery.

You are right - i don't need to know calories and up until yesterday (for the last few weeks) i had been tracking my food (or trying to) through the calorie tool on this website thinking that it was useful as i then knew if i was getting enough calories... but in actual fact i just made sure i got to 2500 and then i would think that i shouldnt probably eat more that day. I don't want a life controlled by calories!!! I want that carefreeness of enjoying food, eating what I want and knowing that I wont get fat!

I am taking a new attitude to my dietician and really seeing her as you describe above - she is the one with the degree in this - she is a specialist in ED dietics/nutrition and she knows what I need to do from a nutrition perspective to move through this recovery. I just need to put that into practice.