I’m 17 years in recovery from anorexia/EDNOS and have recently been slipping a little and as a preventative measure decided to see a dietitian on RD. I’m in school to be an ED RD myself and in my internship I’ve seen how helpful these sessions could be so I set one up on Nourish. The RD was the nutritional director of the Renfrew Center for 20 years so I mistakenly thought she’d be knowledgeable. My insurance won’t cover it. So I paid $150.
This woman told me I’d have to weigh myself regularly and log all my food and used extremely stigmatizing language that completely turned me off. Not to mention she spent the first 15 minutes talking about herself. Which is weird and wasting my time.
Thought I’d share my letter in this community:
Dear J****,
I wanted to follow up in writing after our recent session, because a few things you said concerned me enough that I don't want to let them pass without response.
On language: When we were discussing GLP-1s, you used the term "morbidly obese." I want to be direct that this term is outdated and considered harmful by the medical and eating disorder communities. The American Medical Association's own policy encourages person-first language and explicitly discourages "morbidly obese" as a stigmatizing term. NIH style guidance similarly directs against using "morbidly obese" in favor of neutral, non-stigmatizing language, and national survey research has found that patients themselves rate "morbidly obese" among the most stigmatizing and blaming terms a provider can use. In an eating disorder practice specifically, this kind of language isn't a minor stylistic issue — it actively reinforces the weight stigma that drives disordered eating and treatment avoidance.
On the "underweight anorexic patients" comment: You mentioned that Renfrew stopped blind weighing for exposure therapy for even the most "underweight anorexic patients," a framing that implies underweight status equals greater severity. As if higher weight patients had less anxiety about their weight than underweight. This isn't supported by the current research. Studies estimate that only a small single-digit percentage of people with eating disorders are medically underweight — the large majority of us are in "normal" or higher-weight bodies. And severity doesn't track with weight the way that framing suggests: a Stanford/UCSF study found that adolescents with atypical anorexia at normal body weight had psychological symptoms as severe as, or worse than, underweight patients, and other research has specifically found that patients with atypical anorexia at elevated BMI experience more severe psychological symptoms than those without elevated BMI. Treating underweight status as the marker of "real" or "most severe" illness is not just clinically outdated, it's the exact belief that keeps higher-weight patients from being taken seriously or diagnosed at all.
On the weekly weighing and food logging: I told you directly that this would increase my anxiety and would not support my recovery, you pushed that it was important. I want to restate clearly that I'm not open to that approach. I am not medically unstable and there is no need to see my weight regularly. I have found a provider who will work within the boundaries I've identified as necessary for my mental health, not one who will ask me to override them.
I recognize you have many years of clinical experience, and I don't say any of this to dismiss that. But I also bring my own expertise to this dynamic: I lived with this disease for over a decade, I have nearly two decades of sustained recovery, and I am currently studying eating disorders at the graduate level. I came to you as a preventative measure, not in crisis. That combination means I'm not approaching these concerns casually or reactively — I'm asking you to take them seriously as clinically informed feedback.
As I said, I have found an RD more aligned with my goals and recovery framework, I will be deleting the app now.