Therese Waterhous RD specialist in Eating Disorders

Meeting 3 of Fall 2020

Week 6: 11/4/20

Estimated attendance: 11 (total)

Guest Speaker: Therese Waterhous

Focus: Eating Disorders

Undergrad at OSU and masters at Alabama, doctoral work in vitamin D

Pediatric fellowship with children with special needs -- worked with Henrietta Cloud, did a lot of work for dietitians  

  • Has private practice - Willamette nutrition source

    • Private practice is a good way to do your best work although challenging

  • Experienced with a family member with eating disorders

  • What a normal day looks like working with eating disorders

    • She can control her schedule (25 people a week is busy) -- 4 people a day, contacts with other providers, and billing

      • She currently sees 12-20 people a week 

      • She does a lot of educating for doctors and other providers

      • Committee work -- what you specialize in, you will be called on 

  • How the profession looks different during covid

  • The eating disorder field has changed a lot in the last 15 years -- changed from faults to understanding that is a biological, genetic and 

  • Has a private office so that she could  do measurements and see people

    • Moved out of office during 

    • Had to teach parents to look for symptoms and teach them how to take weights 

    • Need to know weights to adjust care and plans -- have to reach out 

  • Challenges

    • Getting insurance reimbursement

    • Working with other health professionals who do not understand what we do 

    • IN specialty -- working with others primary care/therapists/parents don't really know how to -- takes a lot of education to understand how to treat eating disorders - she spent 3 years (after her Ph.D., fellowship) getting training with the top people in the world -- being a specialist

    • AN -- highest mortality rate 

    • Able to help a lot of families understand the disorders feel understood 

  • One thing you wish the health care field understood 

    • If other providers don’t understand that families do not intentionally cause disorders

    • Genetics, the negative energy balance can trip up neurobiological pathways, need to get overweight stigma and weight bias

      • Other providers are not always compassionate to people that are not in the ideal weight

      • Our profession is moving away from dieting, weight cycling is bad for health, not all health conditions have been tied to weight -> this type of beliefs trigger eating disorders -- a type of anxiety -- people tend to have a type of anxiety and depression

  • Genetics -- social media influences

    • Genetic part interacts with bio/active/social

      • Media brings forth our susceptibility to stressors and how it is processed

        • The messages of our society are toxic -- how we process our stress, different in how we process and respond to these messages

        • Genetic and intergenerational stress -- susceptibility to anxiety

        • Epigenetics carry through 3 generations in men (grandfather exposed to war zones and can be carried down through 3 generations -- the brain is telling us that there is danger out there.

  • What steps to become a specialist

    • Need training for 3 years, join the academy, access any conferences, need mentorship from a supervisor in the profession with 3-5 years minimum and  a certification


Eating Disorder Update -- went to Samaritan Hospitals

  • Explain to new clients what eating disorders really are - there are still a lot of myths

  • Screening tools left with doctors -- sooner it is treated, the better the prognosis

  • w/ only 1/10 patients with an eating disorder receiving treatment and psychological intervention -- have to restore nutrition first

  • The high-risk group -- between 12 and 25, women in different life transitions, those with family history, 

    • Let's go back and talk about what normal eating is -- being able to eat what you need and like without fear 

    • men/boys often overlooked

  • Effective treatment includes multidisciplinary with nutrition therapy (something that promotes behavior, cognitive) had to be skilled in CBT and ACT

    • Returning to and maintaining normal eating

      • Early end to eating disorder behaviors (restriction of calories or food groups, purging, binging -- objectively large amount of food typically within 2 hours, excessive exercise)

      • Anxiety about food venus and occasions leading to 

  • Components of effective treatment

    • Behaviors can be stopped with educated support from parents, family, and support for adults -- teach the supportive people how to be supportive

    • Weight is not the end goal

      • “State” (mental, pulse, hormone  status, DEXA measures, etc) vs “Weight”

  • ARFID -- looks like AN, restriction of food, but not due to the evaluation of body shape and size -- 70% of people with eating disorders also have OCD

  • BED - health risks associated with weight stigma, weight cycling, effects of eating in a manner that does not support overall health or metabolic fitness

    • Often refer to metabolic fitness -- away from the stigma of weight, getting rid of chaotic eating patterns 

  • Weight stigma/weight bias

    • Discrimination against people 

      • Weight stigma prevents people from seeking healthcare -- health care should never involve shame or judgment 

      • HAES principles Health at every size

        • Weight inclusivity -- don't just judge a health condition because of weight -- have furniture and scales to work for everyone

        • Health is a choice -- work through what they eat, what it means to them if you increase/decrease a piece -- there is a mental component as well -- eat for comfort, do that to take care of you mentally - working for health enhancement -- doesn't have to be so specific -- a lot more to food than just metabolic fitness, there is also a mental health aspect

        • Respectful care -- she sees providers shaming for BMI

        • Not just looking at BMI etc 

        • HAES is a social justice movement -- means that health is a choice and she respects that, weight loss is never a goal

          • Type 2 diabetes -- wants to quit using insulin -- that is their goal so they will work toward that

          • Refraining from blaming people 

  • Seen effectiveness of microwave oven -- children were responsible for making food on their own in the microwave  -- now there is childhood obesity epidemic -- there is no blame for this -- take back values of buying and preparing meals for the family