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If you or someone you know is struggling with an eating disorder, there are many ways to get help. Outpatient treatment is available for people who need support but don’t need extensive inpatient services.

Outpatient eating disorder support takes a multidisciplinary approach, combining medical, mental health, and nutrition resources. The goal is to help people overcome their eating disorders and live healthier lives.

Learn more about eating disorders and the outpatient nutrition resources available at UPMC.

What Are Eating Disorders?

An eating disorder is an illness characterized by a disturbance in eating behaviors and a preoccupation with food. These behaviors may include depriving yourself of food, binge eating, purging, and more. Often, someone with an eating disorder has become obsessed with thoughts of body image, size/weight, and even food itself.

People with eating disorders may have psychological symptoms like severe anxiety or depression.

If left untreated, an eating disorder can cause severe physical symptoms. These include digestive issues, heart problems, anemia, osteoporosis, and kidney failure. Eating disorders can even cause death.

“An eating disorder does start out as a psychological disease,” says Allison Lutz, RDN, dietitian and interim clinical nutrition manager, UPMC Western Maryland. “It’s a mental health issue, but it very quickly evolves into a physical issue. There are a lot of physiological side effects that come up, and long term, it can lead to premature death.”

Types of eating disorders

Common eating disorders include:

• Anorexia nervosa.
• Binge eating disorder.
• Bulimia nervosa.
• Restrictive/avoidant food intake disorder.

These disorders can overlap. People may fluctuate between different eating disorders.

“Very often, patients will exhibit symptoms of multiple eating disorders,” Lutz says.

According to a 2020 report by the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), 9% of Americans will have an eating disorder in their lifetime. That amounts to 28.8 million people.

Outpatient Treatment for Eating Disorders

For people struggling with eating disorders, outpatient treatment is one potential option. Outpatient care focuses on people who have an eating disorder but can still maintain daily activities.

People whose disorders are affecting their daily lives and children whose disorders are affecting growth and development may need inpatient support.

Navigating Outpatient Nutrition Treatment for Eating Disorders

Outpatient support for eating disorders usually begins with a doctor’s referral for medical nutrition therapy. Those patients may or may not have a diagnosed eating disorder at that point, Lutz says. The patients themselves may not even recognize their eating disorder.

“It might be that they’re trying to lose weight, and that’s all they’ve said to the physician,” Lutz says. “So, the physician sends a referral for weight loss, and once you get started talking, you recognize maybe there’s some binge eating going on. And then you might request a new referral for an eating disorder.

“Sometimes, they have lost a lot of weight, and they’re not sure why. So, the physician will refer for that, maybe for weight stabilization. And then once you get talking with them in that regard, you recognize again that it’s an eating disorder.”

Dietitians use an assessment tool to identify eating disorders. If they determine someone has an eating disorder, they can help set up the appropriate care.

• If someone has an eating disorder but can still maintain their overall health, they may be a candidate for outpatient treatment.
• If the eating disorder is disrupting a person’s growth, development, or ability to perform daily activities, they may need inpatient treatment.

How Does Outpatient Eating Disorder Treatment Work?

Outpatient eating disorder treatment is a multidisciplinary effort. Patients will meet with a medical provider, a licensed clinical professional counselor, and a dietitian.

The medical provider — typically a primary care provider (PCP) or a physician who specializes in eating disorders — tracks the patient’s physical health.

“They’re going to do labs on them regularly to make sure that their electrolytes are stable as they begin the refeeding process,” Lutz says. “And they’re also going to be taking measurements, keeping track of their weight. I try not to put a whole lot of emphasis on weight because we want to really work on the relationship with food, and that often involves letting go of a number on the scale.”

The mental health provider will also regularly meet with the patient to provide counseling, such as cognitive behavioral therapy.

The dietitian provides nutritional counseling and training. Most often, that begins with assessing the patient’s diet.

Lutz says she often counsels patients early on about the dangers of eating disorders and the importance of a healthy, balanced diet. Many patients have strict “food rules,” which they base on misinformation, Lutz says. These include not wanting to eat more than a certain amount of food or not wanting to eat a certain type of food.

“The dietitian has to dispel those notions that are myths and give them the evidence-based facts about nutrition,” Lutz says. “So, we talk about balance and the importance that all foods fit. It’s like a puzzle.”

From there, the dietitian and patient work together to create a meal plan that helps them get the nutrients they need. Lutz says she may have a patient keep a food log of what they’re eating and drinking.

Nutritional counseling often begins with one visit per week. Over time, visits may become less frequent.

“The dietitian’s really there for education,” Lutz says. “Once the education is complete and the goals are being met, then it’s about support.”

How Long Does Outpatient Eating Disorder Treatment Last?

The length of outpatient eating disorder treatment varies from patient to patient, Lutz says. Some patients will need less support from the dietitian after getting on healthy meal plans. Others may need ongoing support over several years.

“I think the people who have graduated have all recognized it themselves,” Lutz says. “A lot of times, I’ll leave it up to them. I’ll say, ‘What do you think? A month? Three months?’ And they might say, ‘I think I’m doing really well. I’m just going to call you [when I need you].’

“And that’s completely fine. Whenever they feel confident like that and I know they are meeting their nutrition needs, I think that’s the best indicator.”

Outpatient Eating Disorder Support at UPMC

UPMC offers outpatient nutrition counseling for people with many different nutritional needs, including eating disorders. The goal is to provide support to help people live healthier lives.

“It’s portrayed in the media or in society as very negative, and it’s almost like a taboo subject,” Lutz says. “It’s hard to talk about for people, but I can guarantee that whatever symptom you have, or whatever strategy you’re using, someone else is doing the exact same thing, and there are a lot of people who are also struggling.

“So, it’s just giving them the information and the hope that they’re not the only person and that they can get better.”

To find outpatient nutrition support near you, visit our website. Not all locations offer all services. Contact your local office to see what it provides.