Do You Need a Dietitian, a Therapist, or Both?

You have decided to get help with food. That was the hard part, and you already did it. ‍

Then you start looking, and you hit a wall. Some websites say to start with a dietitian. Others say a therapist. Somebody told you to see your regular doctor first. Nobody explains what any of them actually do, and the longer you sit with the list, the easier it gets to close the tab and deal with it later.

Do you need a dietitian, a therapist, or both?

Usually both. Eating disorders affect what someone eats and how they think and feel about eating, and those two things keep feeding each other. Standard practice is a team that includes a medical provider, a mental health professional, and a registered dietitian, though the right starting point depends on what is going on.

Samantha White, MS, LPC, an eating disorder therapist at our Columbia office, spent years on a multidisciplinary eating disorder team with physicians, nurses, dietitians, and social workers. Her answer is direct.

"This would be a discussion related to the right level of care and the severity of the disordered eating," she says. "More often than not though, an individual would begin with both a dietitian and therapist."

Treatment guidelines agree. Coordinated care for eating disorders is generally described as including, at minimum, a medical provider, a mental health professional, and a registered dietitian.‍ ‍

What does a dietitian actually do?

‍A dietitian handles the nutrition side. That includes planning meals, rebuilding regular eating patterns, and helping someone reconnect with hunger and fullness cues that often stop working during an eating disorder.

‍Sam puts it this way: "A dietitian would focus on nutrition, meal planning, restoring regular eating habits, as well as hunger cues."

‍This is not a lecture about vegetables. An eating disorder dietitian is working on something much more specific, which is helping a body get consistent, adequate nourishment again when the rules and the fear have made that nearly impossible.‍ ‍

What does a therapist actually do?

‍A therapist works on the psychological and behavioral side. That means the fear, the rules, the urges, and everything the eating disorder is doing for the person that nothing else is currently doing.

‍"A therapist would focus on the psychological and behavioral aspects of the eating disorder," Sam says.

‍In practice, that can look like learning to get through intense emotions without falling back into old patterns, noticing rigid rules and practicing flexibility, and eventually working toward foods and situations that have become frightening. It also means addressing whatever else is in the picture. Trauma and eating disorders often show up together, and each one makes the other harder to treat.‍ ‍

Why do they need to work together?

Because progress in one area depends on the other. A brain that is not adequately nourished has a much harder time doing therapy, and insight alone rarely changes eating patterns. Working on only one side often means slower progress on both.

‍This is the part most people do not know, and it is the reason we push toward both rather than either.

‍"An individual needs to be nourished to do certain types of therapy to help decrease the ED overall," Sam says.

‍That is not a small technical note. It changes the order of treatment. A therapist who has not worked in eating disorders may start deeper work with someone whose body is not ready for it, and then wonder why nothing is landing. ‍

Should you call the dietitian or the therapist first?

‍Either one is a reasonable place to start, as long as the person you call specializes in eating disorders. Call whichever appointment you can actually get. A good specialist will help you build the rest of the team from there.

‍Do not let the sequencing question become another reason to wait. Whoever you reach first should be able to tell you what else you need and help you find it.

‍If something feels medically off, start with your physician. Anything happening in your body needs an actual medical evaluation, not an internet answer.

Does the dietitian need to specialize in eating disorders too?

Yes. Eating disorder treatment is a specialty within dietetics the same way it is within therapy. A general nutrition approach that works well for other goals can make an eating disorder worse.

‍Professional practice standards for dietitians working in eating disorders describe a specific set of skills and training these clinicians need, separate from general nutrition practice.

‍Ask the same kinds of questions you would ask a therapist. What training do you have that is specific to eating disorders? Do you work with therapists and physicians? How do we coordinate?‍ ‍

What if you can only do one right now?

‍Sometimes cost, scheduling, or availability means both is not realistic today. That is worth naming instead of pretending otherwise.

‍Start with one. Tell that person it is the only piece you can do right now, so they can plan around it. Then treat the second piece as something you are working toward rather than something you skipped.

‍Starting with one is better than waiting for the perfect setup that never quite arrives.‍ ‍

Frequently Asked Questions

Can a therapist give me a meal plan?

No, and you should be cautious with one who offers. That is a dietitian's work. Sam will coordinate with your dietitian, but she stays in her lane.

Do I need a diagnosis before I can see either one?

No. You can start because something with food has stopped feeling manageable.

What if I already have a dietitian?

Great. Bring this up when you begin therapy and consider signing a release of information so your therapist and dietician can work together as needed. Sam is used to working alongside dietitians and will coordinate with yours.

What if I need more than weekly appointments?

Then Sam will tell you that. Some people need more frequent or medically supported care before outpatient therapy is useful, and she will help you figure out where to go.

Start Eating Disorder Therapy in Columbia, MO

‍You do not have to have the whole team assembled before you make the first call.

‍Sam White works with adults and young adults at our Columbia office and online throughout Missouri. She spent years on a multidisciplinary eating disorder team, which means she knows what belongs to her and what belongs to a dietitian or a physician, and she will be honest with you about both.

‍To get started, reach out online or call our Columbia office at 573-328-2288. If you are closer to Kansas City, our Lee's Summit office is at 816-287-1116. You can read more about Sam and how she works before you call.

‍Whenever you're ready for effective care and lasting change, we're here.‍ ‍

About the Author

Written by Jessica Oliver, MSW, LCSW (formerly Jessica Tappana), founder and Clinical Director of Aspire Counseling, based on conversations with and written responses from Samantha White, MS, LPC. All quotes are Sam's own words.

‍Samantha White, MS, LPC is a Licensed Professional Counselor at Aspire Counseling in Columbia, Missouri, who also sees clients online across the state. She spent most of the past decade at a community mental health center in Joplin, where she served on the eating disorders team, the DBT team, and the Radically Open DBT team. She helped design and integrate exposure therapy services into a multidisciplinary eating disorder team that included physicians, nurses, dietitians, and social workers, and trained those providers in using exposure within their own roles. Sam has completed more than forty hours of continuing education specific to eating disorder treatment and has presented on exposure therapy for disordered eating through SHOW-ME ECHO.