How Does Nutrition Therapy Help with Healing Eating Disorders within AAPI Communities?

Food is intertwined with our daily lives. Beyond mere survival needs, food serves as the vessel carrying the rich cultural heritage, age-old traditions, and vivid stories of Asian Americans and Pacific Islanders (AAPI). For AAPI individuals struggling with eating disorders or disordered eating, nutrition therapy is a crucial tool to healing and rebuilding peaceful connections with food. In this blog post, we will delve into what nutrition therapy is, how it works and what strategies are used to support eating disorder recovery, especially within the Asian American and Pacific Islander (AAPI) communities.

What is Nutrition Therapy?

Nutrition therapy is offered by Registered Dietitian Nutritionists (RD or RDN), to provide nutrition-based treatment to individuals. RD/RDNs are nutrition professionals credentialed through the Commission of Dietetic Registration and the Academy of Nutrition and Dietetics.

Nutrition therapy is an essential part of the multidisciplinary approach, along with medicine and psychotherapy, to treat eating disorders. In the context of eating disorders, nutrition therapy would include a combination of nutrition rehabilitation (restoring nutritional status), nutrition education, behavioral therapy and skill building. Nutrition therapy is pivotal in eating disorder treatment, as the individual and the dietitian work together to redefine the misconceptions on food, nutrition and eating behaviors, which supports individuals to cultivate a peaceful relationship with food, heal from body shame and build confidence in themselves.

Note that not all dietitians have training in eating disorders, so it’s important to work with someone who has prior experience with EDs and make sure their approaches are aligned with weight-inclusive care (e.g., Health At Every Size ®, Body Trust ®, anti-diet, fat positivity, weight inclusivity).

How does Nutrition Therapy work exactly?

If you have never worked with a dietitian before, it could feel very intimidating. Let me walk you through the typical steps an RD would take when working with a client:

1. Assessment

A dietitian will examine all the aspects related to your health. They should include culturally-sensitive questions in the assessment to understand how to support you. This would include:

• Your goals from nutrition therapy and current concerns

• Past health history

• Family health history

• Medications, supplements and herbal/alternative remedies

• Current weight and weight history (this could be triggering for lots of clients, so we could use the method of blind weighing)

• Labs/blood work

• Medical test/procedures

• Gastrointestinal symptoms

• Eating patterns and behaviors

• Dieting history

• Physical activity patterns

• Beliefs related to food/body image/exercise

• Cultural factors – cultural practices, beliefs, support system, knowledge on eating disorders and mental health conditions, alternative healing remedies

• Lifestyle – sleep, interpersonal relationships, mental health status
  

2. Individualized Care Plan

After going through the assessment, the dietitian will create an individualized care plan for you. This plan outlines the nutrition-related goals that support recovery. The treatment goals usually include:

• Restore nutritional status for medical and health stability

• Promote non-restrictive eating and liberalize food options

• Normalize physical activity

• Absence of restrictive or compensatory behaviors

• Develop different coping strategies for stressors that would trigger eating disorder behaviors

• Cultivate support system to prevent or manage future relapses

To restore nutritional status and ensure adequate intake, a meal plan may be used to provide a framework for eating. A meal plan might include: 

• Timing and frequency of meals and snacks

• Types of food groups to be included

• Additional supplements, if necessary

Most of my clients will start with nutrition restoration – building consistency with meals (e.g., eating every 3 to 4 hours) and having different food groups with recommended servings at each meal (e.g., carbohydrates, proteins and fats) that fit their nutritional needs. For AAPI cultures, most dishes are shared with other family members, so I will check what utensils/containers (like rice bowls or plates) they use at home to better estimate serving sizes. I will include foods and dishes that my client or client’s family often eat, and educate what food groups they fall into. This is especially helpful for dishes with mixed ingredients, like stir-fry, stews or soups. 

3. Nutrition Education & Development of Skills

As nutrition status stabilizes, the dietitian will provide nutrition education if appropriate. Potential topics would include:

• Basic nutrition information (e.g., nutrients, food groups)

• Principles of “normalized” nutrition (e.g., adequacy and consistency of meals, variety and balance of nutrients)

• Management of gastrointestinal symptoms during recovery

• Long-term eating patterns

• Grocery shopping

• Cooking or food preparation

When individuals are medically and mentally stable, this is usually a good point to build skills that cultivate self-trust, confidence and autonomy with eating in the long run. This could be done by:

• Build interoceptive awareness on hunger and fullness cues (e.g., Intuitive Eating ®)

• Challenge perceived and distorted beliefs on portion sizes, food choices, eating behaviors, body sizes, weights and physical activities

• Develop coping skills during challenging food or body image situations

• Communicate with client’s loved ones and/or care team to coordinate care and provide education on how to support the client

Specifically for AAPI individuals, it’s crucial to understand cultural beliefs and practices related to food and body image. Concerns or comments regarding body sizes, eating habits and food choices are often expressed with loving intentions, as a way to demonstrate care. Most of my clients have had experiences with their family members saying things like, “Did you gain/lose weight? Were you eating too much/too little?” or “You should not eat this because it’s bad for you.” These well-intentioned expressions can pose challenges for AAPI individuals on their healing journey to eating disorders. 

In this case, I found it helpful to explore how these statements and beliefs affect how my clients feel, and how they internalize them. I also do role-playing with my clients so they get to practice how to handle potential triggers at social gatherings or when eating out. Furthermore, involving families or loved ones is particularly crucial with AAPI cultures since decision-making often occurs as a group. Collaborating with psychotherapists, we will work together to educate the recovering individuals and their families how to react to food, eating and body image. 

For guidance on sensitively addressing eating disorder issues among loved ones within the AAPI community, please refer to the "How to: Address Eating Disorder" resource here.

Lastly…

Nutrition therapy is important in supporting eating disorder recovery within AAPI communities. I hope this blog post helps to give you an overview of a typical process. Remember to reach out to culturally-competent Registered Dietitians who have a deep understanding of the cultural nuances and can provide more effective care! For additional information, visit the AAPI Eating Disorder Directory here.