Therese Waterhous RD specialist in Eating Disorders
Meeting 4 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 https://www.willamettenutritionsource.com/
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 is able to 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 PhD, 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
Slides
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
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
An early end to eating disorder behaviors (restriction of cals or food groups, purging, binging -- objectively large amount of food typically within 2 hours, excessive exercise)
Anxiety about food venues 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