1. Understanding Our Nutrition Philosophy Deborah Hinds, DTR Michelle Berger, RD/LD Castlewood Treatment Center

2. Our focus today Castlewood’s philosophy Our role as a Nutritionist / Dietitian Food rituals, trauma foods, fear foods Nutrition therapy Exercise philosophy Life after residential treatment

3. Castlewood’s philosophy Stop eating disorder behaviors Understand how it got to this point Work on internal core belief system Facilitate autonomy around eating

4. Our role as a Nutritionist / Dietitian Gaining the client’s trust Understanding the client as a whole Therapy Nutrition intake Body image

5. Our Goal as a Nutritionist / Dietitian To manage the clients food and fluid intake Gradually work with client to increase autonomy Teach mindful and respectful eating Work to understand hunger and fullness

6. The keys to meeting our goals Connect the dots Process along the way Decrease shame Aid in compassion

7. Anorexia, Bulimia, and Binge Eating Disorder Stabilize eating with consistent meals and snacks Increase variety of foods Look at how they “use” food Address all food rituals Get to a stabilization weight and gradually increase autonomy

8. Food Rituals Work to eliminate from beginning Understand the function Facilitate client desired change Polarized food rituals Vary differences depending on diagnosis

9. What underlies food rituals? Fear of not getting enough Fear of getting too much Never enough and always too much

10. Trauma foods Not encouraged until therapist indicates and/or trauma has been processed Work gradually to decrease association between food and trauma Continue processing with client during and after eating Encourage client to be patient

11. Eating disorder fear foods Introduce from beginning Consistently increase variety Help them maintain variety as autonomy increases

12. Fluids Restriction Fluid loading Understand what’s behind the behavior

13. Realistic Structure Artificial Sweeteners Soda Caffeine

14. Nutrition Therapy Process vs. Content

15. Deprivation and… Self hate Control Numbness

16. Knowing Self Fears Strengths and weaknesses Deepest desires Foods place in your life

17. Respecting your body Listen Acknowledge Consistancy Support

18. Our exercise philosophy Very individualized Learning moderation and re-learning what it feels like to enjoy exercise A privilege – the food comes first The mind, body connection Pilates / Yoga

19. Life after residential treatment Stepdown Intensive Outpatient Program (IOP)

20. Stepdown Learning life skills with support Meal planning Preparing and cooking food Grocery shopping Meal outings / challenges Using peers for support Maintaining “stabilization weight”

21. Intensive Outpatient Applying life skills Meal planning with support Preparing and cooking food independently Grocery shopping independently Continuing to challenge fear foods, trauma foods, food rituals Continuing to maintain “stabilization weight”

22. Recovery process An ongoing process Constant challenging of fear foods, trauma foods, food rituals Maintaining “stabilization weight” Utilize support from others Eliminating the “I can do this myself” mentality

23. Questions?