Who trained you in family-based treatment (FBT)?
I am is a Registered Dietitian that has worked in the field of eating disorders for over 15 years. In 2006 she coordinated with The Hough Center for Eating Disorders at the William Beaumont Hospital in Royal Oak, Michigan, to implement FBT in the treatment of eating disorders. Since we have been begun collaborating and doing case consultation using this treatment approach, we have seen promising outcomes. This is not a pure Maudsley method, however, we have found that skilled RDs are a vital part of the treatment team.

What is your general philosophy regarding parents in treatment of an adolescent with an eating disorder?
I believe parents can be the best resource for planning, preparing, and providing meals and snacks. When given the tools and expectations, empowered parents play a powerful role in the recovery process. I assist the parents and patients to externalize the eating disorder to avoid taking or giving blame. I have worked with young pre-teens, teens, and college age patients using FBT. FBT is best utilized when the parents make the recovery a priority and set aside time to implement this approach.

What are your thoughts on the causes of eating disorders?
There is not one cause of eating disorders. They are brain based disorders that are environmentally impacted. Patients may be genetically predisposed with a family history of anxiety, depression, substance abuse, or eating disorders. Also, having a temperament or personality traits of perfectionism, compulsiveness, or poor impulse control may contribute to being vulnerable for an eating disorder.

I have witnessed a variety of events that trigger weight loss resulting from a caloric deficiency:
  • Excess physical activity or sports training
  • Change of diet to be “healthy” or become vegetarian
  • Learning about fat grams and calories in a health class
  • A child who has picky eating tendencies, stomach problems, or a very limited diet
  • Dieting or just wanting to “lose a few pounds”
Bottom line: don’t spend time on the why but take action as soon as possible.

What do you see as
your role in working with families or caregivers helping those with eating disorders?
Initially, my role as a RD is to establish an assessment of current nutritional status, educate parents, and child or teen on medical consequences of malnutrition or eating disorder behaviors. I assist in the establishment of a treatment team that consists of a medical doctor, therapist, psychiatrist, and parent coaching group.

Next, I make a determination of the ideal weight range using the patient’s previous growth records and adolescent growth charts, and menstrual history if available. Finally, I provide parents with the tools to assist their child in providing the correct amount of balanced nutrition to support metabolism, growth, activity, and weight restoration.

The goal of these steps is to return my patient to normal eating, hunger and fullness cues, enjoyment, and a proper relationship with food and body image.

What kind of meal plan do you recommend during treatment?
Meal plans need an individualized approach, and varies with parental skill and knowledge. The meal plan can be constructed to include the a variety of food that was typical for the family prior to the eating disorder. The system that is best understood and easiest for the parents is used.

Adjustments to the meal plan are made more frequently in the beginning of the nutrition counseling process, when meal and snack times are established. Most of the times calorically dense foods and liquid nutritional supplements are recommended. Also, I will administer dessert and food challenges into the nutrition therapy process. The level of parental supervision and support during the meals is evaluated and determined individually.