- Hi there, thank you so much for checking back.
Now I know you all have been following.
I've been doing this series of videos with my friend
Kate Machado who is a registered dietician.
And if you haven't watched the previous videos, we're
kind of going in somewhat of an order, so I would
encourage you to go back and start at the beginning
so that you can kind of follow the path that we're
taking here.
Okay?
Now today's topic is something that I know many people
worry about and it's kind of tied up in the anxiety
of seeing a dietician and what that really means and
what she's gonna make me do or what do I have to be
prepared for and all those thoughts that we feel when
we are trying to make an appointment and we're thinking
and considering getting help, right?
So the question today is what or I guess how do you
put together a meal plan for someone and how much say
do we have if we have a concern or if we have a really
bad fear of food or if we have something we're actually
potentially allergic to.
- Sure.
- How does that all kinda work?
- So well thanks for having me again.
And this is a really I think one of the most important
topics when it comes to working with a dietician because
what we do is create meal plans and help for any client
or patient to begin eating again.
And getting to more of a consistent basis.
And so the last time we talked it was about our first
session and oftentimes within that there will be some
food maybe meal plan maybe food recommendations covered
for the first time.
But at this level it would be more of in the follow up
session or the week after that where it gets a little
bit more specific.
But definitely it will be some type of food recommendations
and oftentimes in the form of a meal plan.
With the different levels of care as we've talked about
before, it's gonna vary greatly.
So I think maybe speaking from the lowest level to the
higher level I can kind of go from there.
- Yeah.
- So when somebody comes in for maybe a follow up where
we're gonna actually be creating a meal plan it completely
depends.
- So you don't do it at the first session?
- Not usually 100%.
- Okay.
- Usually there's more of like a tester meal thing done
and then for me it's more important when somebody comes
back to know how they did.
Were they even able to eat at all.
- Okay.
- By theirselves.
And if not, it's not gonna be useful for me to create the
complete detailed meal plan for a whole week, every meal,
everything you should buy at the grocery store, if none
of that's gonna happen.
It's just a waste of both of our energy and then we get
we don't wanna tell the truth if it doesn't happen.
So it's more important to see how it goes maybe the first
time and then based on that what kind of thing can we do?
- Okay.
- So let's say somebody came in for their first session
and I gave some general recommendations maybe eating
three times per day and then maybe keeping track of what
they ate for me.
And then they come back and we kind of go over together
well what did they eat, how much were they able to eat,
were they comfortable eating it, were they missing any
major food groups, did they leave off fat totally, did they
not want to eat any carbohydrates, are they not eating
meat, are they being vegetarian in some type of form?
So based on whatever that individual is doing in an
outpatient setting, kind of like private practice setting,
I will work really closely with the individual basically
to get them to eat a certain amount of nutrients whether
that's calories, fat, protein, minerals, vitamins, things
like that.
And whichever way I can get a person to eat it, I'll do it.
It doesn't matter if it's the same thing over and over.
Cause in the beginning the most important thing is to just
eat again.
And then as time goes on and it may get easier and easier
or harder and harder then we adjust.
So there is a lot of input based on the individual level
at that private practice kind of outpatient level.
- Okay.
- Because you have to buy the food, you have to eat the
food, you're responsible for it completely.
But then taking it a step up if you are in a IOP or PHP
level of care there is going to be not very much say
over what you're eating while you're in the program
and that could be one to two meals per day.
And that will be designed by a dietician in order to
cover a lot of, I mean address everything.
So it's gonna cover the basic nutrient level, and it'll
be adjusted calorically based on your need and your
behaviors but the choice in what type of food to eat
won't really be very feasible.
- Cause everybody eats the same thing.
- At the same time.
- I mean if any of you've been to inpatient or any kind of
treatment it all looks the same, it is the same just to
on the therapy side there's a lot of comparison and general
body type, food, all sorts of things.
- Yeah.
- And that kinda puts the kabosh on that.
- Yeah.
And sometimes, depending on the treatment center, they
will allow maybe a few exceptions.
For example, if one of the things I really don't like to
eat is cilantro.
I am allowed to pick cilantro off of my food.
That's interesting because for me that just makes my food
less enjoyable but there are limits to what it can be.
It can't be like oh I don't eat cheese.
Or anything with fat.
I don't eat grains.
It's not gonna be a broad category, but it'll be something
very specific that will really maybe before your eating
disorder started there was a food item that you really
didn't enjoy and that will maybe be allowed but other than
that you will most likely be required to eat whatever
you are served and eat the full amount and that sounds
really scary if you're just hearing this for the first
time but it gets a lot easier because there's a lot of
support, everyone's doing it, the dietician or a dietician
assistant, or a therapist will be eating and supporting
the group during that time.
- Yeah, you don't eat alone.
We'll eat with you, we'll eat the same thing as you,
we talk about it, we keep, you know.
And then after that usually I would run a group, we used
to do this shop and cook night and once after the meal
we would run a group and we would go around and everyone
would talk about the challenges, how they feel, so you
have that time to process.
I know it's scary like Kate was saying but we're there
to help, that's why we're there.
- And then just at an even higher level of care, maybe
you're in residential or even hospitalization level
you may get to choose between option a and option b
occasionally or you may get to work with a dietician to
develop exactly what your breakfast plan will be and
your lunch plan will be, and your dinner plan and the
hospital staff or the clinic staff will prepare it for you.
But once that is decided, and there may be like two choices,
you're required to eat 100% of it.
And so the first week of treatment is usually really the
hardest part with food.
Because the therapy is really nice, it's really helpful,
they're really connecting and enlightening and the food
sucks.
But it's also really freeing because obviously you haven't
been eating in a normal, regular fashion for quite a while
and your body is probably not doing okay because of it
and so when you're given permission to eat again and to
eat foods that are normal it's scary but it feels so good
because you're allowed to eat this food.
And so there's part of it that's really freeing for your
healthy self and as treatment goes on it gets easier and
easier and then we work a lot more with that side.
And the more progress you make with eating regularly
and not having to refuse to eat or not eating all of it,
the more freedoms are given on somebody's meal plan.
- Yeah.
- It's really hardest in the beginning and it gets a lot
easier and it gets to be a lot of, I don't wanna say fun,
but it can be exciting when you start to include foods
that you thought you might never be able to eat again
and to your normal life.
I think it gets to be really exciting.
- Yeah.
And it's exciting for us to watch I think as well
because like she said, the beginning you're trying to
connect with me and we're having a good time, we're
just kind of trying to get to know one another.
And then you're gonna probably be frustrated with Kate
or whoever your dietician is because like she said there
aren't a lot of choices in the beginning and it's gonna
be overwhelming but that's why you have me and then
later on you'll love the fact that you have Kate to
incorporate certain things that used to be a binge food
and you couldn't eat regularly, any kind of thing that
you used to do.
She'll slowly incorporate it in and we can do food
challenges or we go out and we eat out at a certain
restaurant or do something that used to be a binge
thing or we eat a normal amount, it's exciting.
- Yeah, yeah.
I think it's exciting.
I like to work with people on their meal plans because
it's all individual and then getting to a level where
it starts to become just a regular process.
- Yeah.
So that's just a little kind of snippet about what
working with a dietician looks like and as you're going
through each session kind of what to expect and not to
be so scared of what a meal plan looks like because like
Kate's saying she'll work with you and we'll just take
it from where you are.
We're not gonna start you at level 2,000 if you're just
thinking about it, right?
Don't be so scared, just be as honest as you can.
Just like I say with the therapist, the more honest you
are the more we can work with you and the better
treatment you'll have and the more success
we'll have, right?
So I hope that was really helpful.
Don't forget to subscribe to my channel so that when
I post more videos of, we're gonna ask some more
questions of Kate and bug her just a little bit more,
you'll know about it and get notified and don't forget
to check out my website.
I have a free workbook on there that is great to get
you started.
I know if you're just thinking about recovery and it
seems really scary this is a great tool to kinda get
those wheels turning and get you thinking about recovering
or eating and kind of they why and what purpose it serves.
Right?
So let's just keep working together, right?
We're in this together as we work towards a healthy
mind and a healthy body.