A Lot on their Plates
Interns learn about more than just food through unique immersive program
By Sara Specht
“All foods fit.”
It’s a mantra Carrie Peterson repeats describing the dietetic internship she directs for the Department of Food Science and Nutrition. It’s not something you might expect to hear from a dietitian, and it’s not what nutrition students learn in class. But the lesson that all foods fit is especially important for her interns as they learn to counsel and treat people who suffer from eating disorders.
The eating disorder-track Dietetic Internship (DI-TEP) partners with The Emily Program, a nationally recognized eating disorder treatment program based in St. Paul. The competitive 36-week DI-TEP internship is the only one in the United States with an eating disorder focus, including nine weeks of immersive training at The Emily Program along with standard clinical training. Other internships might include a day or even a week of eating disorder education, but Peterson says her program’s level of training is invaluable.
“It’s important because eating disorders aren’t going away,” Peterson says. “There are many adults, and children as young as six or seven, who develop eating disorders. As a society, we need to address how to help these people. Dietitians are an integral part of the healing and recovery process.”
An estimated 20 million women and 10 million men in the country suffer from eating disorders. Up to 60 percent of elementary school girls surveyed in the U.S. admit to being concerned about their weight, and anorexia continues to have the highest mortality rate of any psychiatric disorder. Jillian Lampert, the chief strategy officer at The Emily Program, manages a national organization of residential eating disorder facilities, which offer only about 1,200 beds for treatment nationwide.
“There are probably 200 eating disorder programs around the country that hire dietitians, and they all want ones who are trained in eating disorder treatment,” says Lampert. At The Emily Program, “we end up training the majority of our new hires ourselves because there’s just not an easy way to get trained dietitians—after six weeks people are maybe ready to start working.”
Peterson says she had more than 150 applicants for the DI-TEP track internship this year, though she only had room to admit 14.
“There are over 100 medical nutrition therapy focused internships, including our other internship track here at the university,” she says proudly. “And there’s over 100 food service ones. There is only one dietetic internship which specializes in eating disorders—ours.”
During the eating disorder rotation, DI-TEP interns shadow working dietitians at one of The Emily Program’s nine Twin Cities locations, which serve a variety communities and treatment levels. While the details of individual treatment may vary between an outpatient adult and a residential adolescent, interns learn that the foundation for care revolves around therapy and eating.
“That’s where we come in,” says Lampert. “It’s a totally different education. You need to not just know about nutrition or about eating disorders, which are complex mental health illnesses, you also need to know about anxiety and depression, borderline personality disorder, bipolar disorder and panic disorder.”
Every patient has regular private appointments with a therapist and with a dietitian, along with a variety of other group sessions. Haley Snell, a recent DI-TEP graduate, says observing, and then participating in, patient and group therapy sessions was particularly beneficial. Hearing clients’ stories and learning the process of treatment is something she couldn’t get from coursework.
“The most surprising thing was how very different each eating disorder is, and it didn’t ever fit into one category,” Snell says. “I always assumed from textbooks, if someone has anorexia, this is how you define it. But I found that people can go from one extreme to the other. Maybe it started off just about restricting food, but then all of a sudden the disorder evolved to include binging. There’s a lot more behind the reason for a person’s relationship with food, as opposed to ‘it just started with dieting.’”
“Everyone kind of takes an eating disorder and personalizes it in a different way,” agrees Riley Larson, another graduate from the spring internship. “Classes just scratch the surface compared to working with clients for 9 weeks. In therapy, we’re helping people overcome fears and food judgments, to recognize their eating disorder when it comes up in their head not as them, but as their coping mechanism. It’s their anxiety saying, ‘this is how I should eat or not eat.’ That’s not good for their bodies—they’re dying and we need to help change their behavior.”
That behavior work doesn’t just happen in therapy sessions at The Emily Program. They also eat together. A lot.
“We eat meals together, and we eat snacks together. As a dietitian here, you have to be able to eat and talk and work at the same time,” says Lampert. “A lot of people show up thinking, ‘Oh, I know what to do.’ And then, ‘Oh, wow, people are crying at lunch, why is this happening? How do I help someone not cry at lunch? Or is it ok that they cry at lunch as long as they eat it?’ ”
The interns get practice in the planning and preparation of clients’ food and calorie exchange requirements, which is standard fare for dietetics work. Less standard is the mealtime experience. They spend a lot of time correcting food and table behaviors that commonly develop with eating disorders, like taking tiny bites or picking food apart, or using silverware for things that are usually considered finger food—cutting up pizza, a donut or a sandwich and eating it with a fork. They also learn to spot tricks clients might use to hide food—in cuffs or, in the case of peanut butter, on the underside of the table—to disguise their habits.
“It’s kind of incredible how crafty they can be,” Larson says. “It’s hard to see, because you want them to get better. But it’s not them doing these things, it’s their eating disorder. It’s the only way they know how to cope with the anxiety and the fear they feel. So you have to think of it that way, and not be mad at them. They’re not happy.”
That is exactly the kind of insight Peterson tries to instill in her interns, whether they go on to work with eating disorders or find work in another area. They leave the DI-TEP track program with a different perspective on food and eating and, she hopes, an understanding for how society views and judges food. She says graduates will find that knowledge useful when dealing with almost any kind of client, since they’ll likely work with an eating disorder at some point.
“Students go through this training, and they take away an entirely different perspective on food than they’re taught,” Peterson says. “Eat healthy, low fat, dessert once a day—all this stuff we go around preaching and talking about, with eating disorders, it is all foods fit. We live in a society where food is all around us and we need to learn how to eat it, deal with it and understand it. How do I fit into that eating, and how does that eating fit into my world? Does a Snickers bar fit? Absolutely! Have one!”