Julie Church is a registered dietitian in the Seattle area specializing in work with eating disorders. In this interview, Julie takes the mystery out of working with a dietitian and describes how her work recognizes the needs of those with eating disorders and meets those needs.
Question: There are many philosophies about dieting and healthy weight management. What do you believe it means to have a healthy relationship with food?
My philosophy is based on health at every size and a non-diet approach. Those two factors are related to one's relationship with food and to one's interaction with the body and weight. I'm always open to a person being one of a variety of shapes and sizes. And I think that's an important attitude to bring, because an eating disorder can force the person into some sort of ideal. That ideal may not be what her natural body shape and size is.
Clients very often will want to say that health equals that ideal picture and those associated numbers. I ask, "Is that really true? Let's look at your childhood growth grids, your weight trends, and what happens when you're not engaging in eating disorder behaviors with food or exercise, and then see where your weight lands." That could be thinner, average, or higher. I'm a neutral voice saying, "This may be where you are naturally."
The non-diet approach just means that in my work, I'm not taking an organized eating plan from a book, or saying, "This is for you; this works for everybody." I think that's the diet mentality: It's something very external and not personalized at all. The non-diet approach allows me to shape something for each person. Some people really want the structure of a meal plan, and maybe they need it because they're in that phase of recovery. But it's still unique for each client.
Also, I'm always trying to get people to be more in tune with their bodies and building trust in them. Early in recovery, a person may not have a sense of what the body is saying -- to eat or not to eat. So there needs to be a more "mechanical" eating phase, in which I recommend clear structure in the timing or pattern of eating to try to re-instill some of those cues. But for those who are experiencing hunger and fullness cues, I'm always going to go back to them. I'm not the expert; the person's body is the expert.
Q: How do you deal with the topic of weight during a session?
That also is very personalized. With some clients we never specifically do it. Maybe the person's weight is a non-issue in the whole thing; it isn't linked to any health concerns, and the client's pretty content with it. I don't necessarily have to monitor a client's weight.
But for some clients I need to get some sort of data point, even if I'm less concerned about their weight. That could be done by a doctor or in my office. For the majority of my clients, I'm always working toward helping them to trust a team member (a doctor or myself) to monitor the weight and to allow that information to benefit them. Typically, weighing themselves on their own can lead to destructive behaviors. If we can take that burden from them, we can make it helpful and useful.
Q: So it's reframed as a burden they might want to give up.
I usually ask, "What are the consequences of weighing yourself?" They typically have fairly negative consequences. But the person still might not want to give it up. So I might say, "You're not totally giving it up. Doing it here, at least you have the context of talking to a professional about the number and getting some education from it."
For some clients, we look at the number together and talk about it if it's important to them. With others, we do it blindly and then may communicate trends or changes as needed. We may agree on an acceptable weight range. So they can ask, "Am I in the range?" I can tell them yes or no, and then discuss why they think they're where they are. Different stages in recovery lead to different views of what that number means.
Q: There seems to be no consensus on how eating disorders arise. Do you have thoughts on what factors contribute?
They're all very complex. But when I quickly summarize it, I say that it's the means to simplify the complexities of life into a body shape and size. The reasons people might do that are very different. But it seems that we can boil it down to that point: Ultimately, that's what it seems each person is trying to do. But what led them to think that way is completely variable.
Q: A college medical staff refers a 19-year-old student to you. She seems to be underweight. What's the first appointment look like?
The first thing I'd check is her buy-in: Is she here because she has to be here, or because she wants to be here? We're not going to get anywhere if she's just here because the doctor says she has to be. Then I always ask, "What do you expect to get out of this time? What do you hope to have in your hands or your mind when you leave today?" I make sure to meet that expectation. Often, the response is, "I just need to know what to eat. I want to leave with a plan." And I usually say, "That's going to be hard to do in our first time, because my approach is so personalized, and I want to make sure that you get what is honoring to you. So I need background -- information about your relationship with food and what got you here -- before I can really give you a specific plan."
Q: And that calls her to have to look at herself as a person and not just a problem: "My background's important; I'm unique."
Yeah. So I'm sensitive about that. But I think they expect to talk about food. So I can ask, "What was eating like as a kid? When did you start seeing the patterns you're describing?" I usually leave it open-ended, to hear what they might share about what brought them to this place, and then I might ask more specific things as they share specifics. But the first session is oriented toward getting background and a sense of their journeys with food.
I want to give them something that helps them feel honored and that I want to know more. Most people are probably saying, "Just eat more," or "just eat less," or "just eat this way." I have to differentiate myself from other ways that people talk about food.
