Navigating the Food and Eating Minefield, An interview with Robyn Goldberg, RDN, CEDRD
An interview with Robyn Goldberg, RDN, CEDRD, on what all therapists should know about nutrition, disordered eating, and eating disorders, as well as their own biases and relationship with food.
It’s time to reimagine therapy and what it means to be a therapist. We are human beings who can now present ourselves as whole people, with authenticity, purpose, and connection. Especially now, when therapists must develop a personal brand to market their practices.
To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.
Click here to scroll to the podcast transcript.Transcript
Interview with Robyn Goldberg, RDN, CEDRD
Robyn L. Goldberg, RDN, CEDRD, began her career at Cedars-Sinai Medical Center in Los Angeles as the in-patient dietitian in the Department of Cardiology. Over the last 21 years she has developed her own private practice in Beverly Hills, CA, where she specializes in medical conditions, disordered eating, eating disorders, Health at Every Size, intuitive eating and pre-pregnancy nutrition. Robyn promotes opportunity to excel in developing a new perspective with food in association with several medical groups. She serves as a Nutrition Consultant for the Celiac Disease Foundation. For the last eight years Robyn was the Nutritional Therapist for the Susan Krevoy Eating Disorders Program at Wright Institute Los Angeles was a consultant for Panda Restaurant Group and teaches the nutrition classes for the Motion Picture Wellness Program. Currently Robyn is the Director of Nutrition Service for The Control Center, an addiction IOP, where she sees all the eating disorder patients. She is a contributing author and is a nationally known registered dietitian nutritionist. She has been quoted in The New York Times, The Huffington Post, The Fix, Shape Magazine, Fitness, Oxygen, Pilates Style, Diabetes Forecast, BH Weekly and Life & Style. She has been on national television as the eating disorder expert on The Insider. Robyn has a body image and eating disorder group at several addiction centers in Los Angeles.
Learn more about Robyn at http://www.askaboutfood.com.
In this episode we talk about what therapist’s should know about nutrition, eating disorders and disordered eating:
“My overall platform and foundation and how I work with people is really to help them develop food freedom and develop a joyful–which sounds very scary for many of us–a joyful relationship with food in their bodies.” – Robyn Goldberg
- Diet Culture
- HAES: Health at Every Size
- Food freedom
- Collaboration between therapists and dietitians
- Treating eating disorders and disordered eating
- What to look for in the intake process
- Looking at your own belief system and bias around “fat” and “thin”
- Why you can’t make assumptions about your clients based on what they look like
- When to worry about eating patterns of your clients
- Orthorexia, Anorexia, Bulimia, Restricting, Binging
- Moving away from the idea that there is a “right weight”
- What therapists often miss related to eating
- How to find experts who work with Eating Disorders (what the qualifications are, what the dangers are when you work outside of your scope)
- Who needs to be on the team to treating EDs.
- Medical considerations and labs to request
- How little most people know about how to screen for eating disorders
- The differences between Registered Dietitian Nutritionist, Licensed Dietitians, Nutritionists, Health Coaches
“[Intuitive eating] is not about counting, weighing and measuring. It’s not about saying I’m excluding a specific food or food group. It’s really learning how to become present and conscious when we’re eating.” – Robyn Goldberg
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together any resources mentioned in this episode and put together some handy-dandy links.
Robyn’s Website: http://www.askaboutfood.com
Instagram: RobynGoldbergRDN
Academy of Eating Disorders: http://www.aedweb.org
International Association of Eating Disorder Professionals: IAEDP
Certifications for Eating Disorder Specialties (CEDRD, CEDS, etc.)
Certification in Intuitive Eating
Relevant Episodes of MTSG Podcast:
Are You Sure You’re a Specialist
Our Next Event:
The Therapy Reimagined Conference in Los Angeles in October 2018!!
Meet the Hosts: Curt Widhalm & Katie Vernoy
Curt Widhalm, LMFT
Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more about Curt at: http://www.curtwidhalm.com.
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more about Katie at: http://www.katievernoy.com.
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
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Modern Therapist’s Survival Guide Creative Credits:
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Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:01
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Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:12
Welcome back to the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and today we’re joined by Robyn Goldberg, certified eating disorder Registered Dietitian. She’s here to talk to us about a lot of the stuff that clinicians miss about clients with food issues that come up. She’s a very dear friend of ours. I’ve known Robyn for quite a few years. Worked with her on some cases before, and such a phenomenal wealth and resources here to talk to us about some of the stuff that we just don’t have come up unless we work really in depthly into the world of disordered eating and eating disorders. So very happy to have you here, Robyn.
Robyn Goldberg 0:54
Thank you so much. Curt and Katie, it’s such an honor to be on your show.
Katie Vernoy 0:58
Yes, we’re super excited, and I am, I have to be honest, I wasn’t aware of all of the things that went into being a registered dietitian and you’re also a nutritional therapist, right?
Robyn Goldberg 1:10
Yes
Katie Vernoy 1:10
Is that right?
Robyn Goldberg 1:11
Yeah. So, so what that means is I actually help people connect their feelings centered around food. I’m not a mental health clinician, but I think often as people associate registered dietitians is people to put them on diets or meal plans. And I want to say that’s like the passe way. And unfortunately, there’s some that exists, whereas the more and more of my colleagues were nutrition therapists. And you know, we’re trying to get more and more dieticians to be certified eating disorder registered dietitians, because that helps clients with insurance reimbursement. And it’s the highest level of certification in the eating disorder community that one can obtain, and they have it for mental health clinicians as well, and physicians, all ancillary health practitioners.
Katie Vernoy 1:55
Nice, nice. So that explains your certification, which sounds like there’s a lot of as Curt was describing a breadth of knowledge and a depth of kind of resource. A depth full, I think, is what you said, Curt, but a very deep resource that local clinicians can reach out to to learn more about this stuff. But let’s kind of step back and just if you could tell us a little bit about your practice you’re in the Los Angeles area, just tell us a little bit about what you’re putting out in the world where you’re practicing that kind of stuff.
Robyn Goldberg 2:19
So I have a practice in Beverly Hills for the last 21 years where I see kids, teens, tweens and adults with body image issues, eating disorders and medical issues. As I started my career at Cedars Sinai Medical Center, I was the cardiac dietitian for five years and then shifted into the department of gastroenterology. So my overall platform and foundation and how I work with people is really to help them develop food freedom and develop a joyful which sounds very scary for many of us, a joyful relationship with food in their bodies is, you know, diet culture teaches us that we must eat a certain way and look a certain way. If not, we have failed. When, when in fact, it’s really getting back to that primitive place that we were all born and blessed with, of being an intuitive eater, of eating when we’re hungry, stop when we’re satisfied, and honoring cravings without any guilt or shame. And by doing so, when we function that way, our body will be where it’s naturally meant to be at for that individual, at whatever stage of life they’re at. So it’s not about counting, weighing and measuring. It’s not about saying I’m excluding a specific food or food group. It’s really learning how to become present and conscious when we’re eating, which definitely parallels the Health at Every Size paradigm which I’m in that community.
Katie Vernoy 3:40
That sounds great. I love that idea that intuitively, we really know how to eat, and that you’re able to help people.
Robyn Goldberg 3:46
Yes, and you know, to get to a place where there can be this genuine place without feeling you have this recipe to follow for success is really what I like to help clients achieve. It’s a slow and long journey, and can definitely bring up a lot of feelings, which is the reason I like to collaborate with mental health clinicians, because then they can really, you know, unpack that on a deeper level.
Curt Widhalm 4:11
I know for me, and I tread carefully into the work that I do with clients presenting with eating issues or eating disorders, and it makes things very easy when they self identify these issues from the initial phone call, that when they are pointing out that I’m having restriction issues or I’m having binging issues, not all of the clients that I’ve worked with that have food related issues or food related emotional issues self identify that from the very beginning, And this is something that I’ve learned to increase my intake process and be able to look at how I ask clients from the very beginning about their relationship with food. This is something that I had to come across in even some of the shared work that I had with some of the cases with Robyn, some of the other dietitians that I’ve worked with. Robyn, what do you recommend that clinicians look for from the very beginning, or maybe even add into their intake paperwork.
Robyn Goldberg 5:06
So several things I really appreciate and respect, Curt that you’ve tried to broaden your screening questions, because I think for many clinicians that I work with will say, I don’t work with eating disorders, or I don’t treat them, and anyone that sits in anyone’s office could have, they may not have a full blown eating disorder, but they could have disordered eating or thinking. So the first thing that I would actually suggest is that the therapist really explores their association with what rabbit ears, I’m going to say thin or rabbit ears fat is unless you’ve been challenged, one is living with a certain belief system, because this is what our culture has ingrained in us, especially and being able to explore our own biases, because if we’re not aware of our own biases, we can do more harm than good as mental health clinicians. Being able to explore your own biases of what quote unquote fit is and what quote unquote fat is, is really necessary before you go to the next level of those evaluation questions.
Katie Vernoy 6:13
In different communities, there’s even a different tolerance for different types of behaviors. I know one of the things I live in the beach cities, and there’s a lot of orthorexia, which is that whole idea of super over healthy eating and restricting in that way. And it’s something where being able to really identify how impacted am I by that, with the whole clean eating movement, and, you know, just so many pieces where you know what is healthy, what’s not healthy, what’s thin, what’s fat. I think that’s a really good place to start, because even if you’re asking the right questions, if you’re not really understanding the answers from a really neutral, objective place, you may be missing stuff anyway. Once clinicians kind of have their stuff, at least they understand it. Maybe they don’t have it in check, but they understand it. What are the assessment questions that you think all clinicians should do, because I know that that I don’t specifically have a part of my practice that’s for eating disorders or disordered eating but I know what comes into my room, and I’ve had those conversations with clients. But how do I make sure I’m screening right away for it?
Robyn Goldberg 7:14
Well, I think the first thing is not to assume by how an individual looks that like, they can’t be sick enough, or they live in a larger body, and they would never assume that this person has eating disorder. So they think assuming that a person looks emaciated is that, oh, they have an eating disorder? Maybe these are their genetics. Like all of our bodies are predetermined from the day we’re born and who we’re going to take after in our life, but how we’re going to look. So that’s the first thing, is not making any assumptions. Also, I want to say and that eating disorders come in all shapes, sizes, genders. I mean, walk down the street, anyone around you could have some sort of food or body image issue. That’s very important. Also being able when someone expresses their own views about I like to use the term joyful movement, activity. And as you said, Katie, living the beach cities where you’re experiencing, as I am in Beverly Hills, quite a bit of orthorexia. And for our listeners that don’t know what that is, it is the obsession to be healthy to an umph degree where it affects their personal life, their emotional life, that they have very rigid parameters, living in a box, and what they, quote, unquote, can and cannot eat. And if it doesn’t fall into that, then they live in this very, very narrow world. You know, I think that those are just some things I wanted to say right off the bat. And certainly I can, you know, talk about statements and questions that you know, an individual might make, which could be like, Oh yeah, I’m going to ask about that.
Curt Widhalm 8:52
When should clinicians be worried about the eating patterns that clients are demonstrating or talking about? For instance, when and I work a lot with adolescents, but if I have a 15 year old who has all of a sudden pushed into a vegetarian diet or to adopt one of the other diets that might be running around in the news, when does that become a concern versus when should I really respect a client’s choices as far as how they go about looking at their food and their food intake.
Robyn Goldberg 9:23
But clients bringing up their food choices is, if it goes to a place of that they like to eat alone, they don’t want to eat with their family or friends, it gives them anxiety and what that’s about, and being able to process that on a deeper level, because they might say, Oh, I was always judged by my dad, or, you know, there was nonverbal looks, you know, presented to me. So that’s one thing. Also, when a client has, you know, they feel guilt about eating anything, not just a particular food or food group, and then they feel the need to exercise after. Or they’re cutting back, or they’re restricting, and it’s normal to have fun foods in our diet. It’s normal to have what I like to call effective foods. And when a client is phrasing, well, you know, I had some Doritos, and now I’m going to go to the gym. That’s a red flag in the beginning. Also, that they are not flexible with food choices, times of eating, if they will go out to a restaurant, again, it’s a very narrow world that they exist in. Potentially even just an observation, when you’re sitting with a client, you see that their hair is thinning or falling out, and I know kind of then there’s a lot of health questions I like to have unfold after that. But you know, if you see someone who’s always like, putting their hand through their hair, or they’re brushing you like, oh, this person, like, has pretty hair. I mean, this is common in males amongst females too, then you could start to probe questions about, well, have you noticed that when you brush your hair, like, more hair comes out than usual, or on your pillow or in the shower? Oh yeah. It’s like, assuming their labs are normal, which we can talk about and there isn’t a thyroid abnormality. That’s another place, depending on your level of comfort, and asking that. They lack variety. They eat the same handful of foods over and over again. Well, how can you eat the same handful of foods over and over again? Well, I like them. Well, you’re a teenager. What if you know, you want to, you know, dinner with your friends for pizza Friday night? Oh, I would meet up with them after. It’s like they have all these reasons and excuses in regards to the reason that they’re not able to be in that circle, which then is an idea of like, okay, there’s something going on and or even they compulsively weigh themselves. Like I have a teenager I see who originally came to me from her therapist, actually, because they were talking about the anxiety she had traveling to another country. And the client was like, how am I going to put my scale in the luggage. So the therapist asked about that a little bit, and it’s like but it’s very common that our younger clients can learn these behaviors from other family members, and she’s become so entrenched in her values and self worth are tied into what the number says. That’s just another one. Another thing could be that a person is not going to go on that vacation, or they’re not going to buy a new outfit until they’re at the right rabbit ears “weight.” Like, what is the right weight? It’s like the place we’re at. So if we’re a female, able to menstruate, if you’re a male, that your testosterone levels are within normal limits, like, these are all indicators that your body’s in a healthful place for you.
Katie Vernoy 12:51
Yeah, it sounds like there’s a lot of rigidity. I mean, there’s there’s medical stuff, which I think a lot of therapists may not be comfortable addressing, because there’s a lot of different reasons somebody’s hair could be thinning that we have no idea about. Someone who’s emaciated or has a larger body can there can be different reasons, and it can be healthy, even if it looks different than what you know fashion magazines tell us is “healthy” rabbit ears.
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Katie Vernoy 13:15
But it sounds like there’s this a lot of rigidity and really restricting, even If it’s not restricting food. It could be restricting yourself from different areas of life, hiding out and eating behind closed doors so that people don’t see what it is you’re eating, or not eating certain types of food, or not allowing yourself to enjoy life. And it seems like as therapists, we would notice this, but, but my sense is that we probably miss it more often than we think. What do you think that therapists most often miss when they’re working with somebody that maybe has one of those, either subclinical or well hidden eating disorders?
Robyn Goldberg 13:46
You know, a lot of things Katie, and I think it is, I’d say, somewhat medical, but I think it’s a question that any therapist can really tap into. If a client is coming in and they’re speaking about like, oh, I have a stomach ache, or I have an upset stomach, and it’s not just like, oh, once in a blue moon, it’s reoccurring. You know? It’s like, oh, did you just have lunch? Did you just eat something that you hadn’t had in a while? Or food poisoning? “Stomach problems” rabbit ears, whether it’s constipation, whether it’s gi gastrointestinal distress after eating. It’s reflux. These are all symptoms of a person who is not eating the amount of food that their body needs. The good news is that this can all be resolved with what I like to call vitamin F, which is food. So I think it’s common, because a lot of people, you see will say, I get so much anxiety when I go to therapy or talking about such and such. So the anxiety we get those butterflies in our tummy, and I think to be able to talk about, what’s that like for you, how what went on in your life, today? And those are some unfolding questions that can occur in a mental health clinician session.
Curt Widhalm 15:07
When a client is identified as needing a dietician or needing nutritional advice for food plans, there’s a lot of scope of practice issues that come up. A lot of scope of competence issues. A lot of times, the treatment team will include a psychiatrist. What do you recommend that people look for in building a treatment team for a client who’s facing food issues, eating disorders, disordered eating.
Robyn Goldberg 15:31
It’s and you probably see this, whether it’s Psychology Today or these other like preset platforms, it’s like, check off, check off. Yes, I specialize in LGBT issues. I specialize in eating disorders. How come you’re an expert in eating disorders? Have you worked in an eating disorder treatment center? Are you recovered from your own eating disorder? So ideally, like, we want to have a team, and, by the way, going to the occasional lunch time session or webinar does not make you an expert. It’s going to our National Eating Disorder conferences, the Academy of eating disorders, which going to IDEP, which is the International Association of eating disorder professionals, not just locally. It’s like going to the headquarters of where these national conferences are, because you’re aware of what’s the latest and greatest in the eating disorder world. So this is out of a clinician scope of practice or expertise. Like I had this addiction therapist say to me, like, Well, I think I can work with this eating disorder patient, because there’s so many parallels with addiction and eating disorders. I was like, not really. I mean, I ran a number of body and eating disorder groups at a few female sober livings. So unless you live and breathe it like I do, you really need an eating disorder expert. And I think just ethically and having the professional integrity to be able to inquire if you don’t know clinicians, or going on one of the mental health clinician listservs, to say who is a male eating disorder therapist, and by the way, like that, I’m a certified eating disorder registered dietician. There’s for mental health clinicians, what’s called CEDS, certified eating disorder specialists. And it’s not just like, oh, okay, I work here occasionally. We have this elaborate resume, test, the whole thing you have to go through to be there and being able to find eating disorder therapists and eating disorder trained dietitian, eating disorder trained psychiatrists, which that’s harder to find. We have fewer of them. And then, of course, an internist or pediatrician, that I want to say is, if we have an expert, great, there’s even fewer of them than psychiatrists. But you can really encompass the entire team and be well armed and not feeling greedy or needy that you’re not gonna have another client because that clinician can do more harm than good.
Katie Vernoy 18:05
I think that’s a really good point, because I think there’s a lot of people, I include myself in this, who shy away from really digging into eating disorders, because I realized that the training needed really is specialized. I try to stay aware so that I can really know when to refer and know how to be sensitive to the subclinical eating issues. But I think what, what really is important is, is identifying where is the correct team that can help these clients? Because this is, I feel like, in a lot of ways, this is one of those, those issues that that therapists uncover and work with, that is life or death. I mean, there’s a lot of that stuff, but this is and it’s so medical. And so I really appreciate your your description of how someone really becomes a specialist in eating disorders, because I think a lot of people…
Robyn Goldberg 18:52
They poo, poo it, they take it lightly.
Katie Vernoy 18:55
Yeah. And so there’s that piece, but there’s also the folks who either are not aware that they’re not identifying people who need this type of treatment, or who just shy away completely and so they don’t even ask the questions. And there’s people who are kind of hiding in the shadows with their eating disorders and getting treatment that isn’t necessarily addressing the right issues.
Robyn Goldberg 19:14
Definitely. I mean, I think Katie, I couldn’t have said it better myself, and truthfully, like, sometimes, as you both know, we can’t pick the teams we’re a part of. There was a client that was a part of a team, and then secondarily, the eating disorder piece came up in conversation. Maybe they were coming to you for life transition or anxiety in school, or bullying, and it’s like, oh yeah, you know, I have, you know, been told that I’m fat, or I have been told that I won’t be on the track team. If you know, I don’t look a certain way, because I won’t be fast. Like these things can come up in conversation, because when you think about it, the therapist has a golden opportunity. And it’s oftentimes like, Curt the dad, Katie’s the mother, I’m the aunt, like we’re the only same people that our clients have. So more and more golden nuggets are dispersed in those sessions.
Katie Vernoy 20:15
And if we don’t know what to look for, we could miss them. And it can be really, really hard for these people to get the help they need.
Robyn Goldberg 20:20
For sure, they miss the boat. Also, if one is not resolve their own issues, these clients are very savvy. They are super smart, and if they see that a person is not resolving, they will be on to the next person. Because oftentimes they know the language. They’ve been down this path many times. Mean, I have so many physicians and other clinicians I work with, like I had no idea, like, I’m seeing a pregnant lady with bulemia nervosa and her gynecologist, like I had no idea Robyn that she’s purging during her pregnancy, like two or three times a day.
Katie Vernoy 20:48
Oh, wow.
Curt Widhalm 20:53
Speaking of being on treatment teams where not everybody is going to necessarily have the same lengths. Where I often run into this is when it comes to some of the medical professionals who don’t have the training and the eating disorders. And I often find myself mostly from stuff that I’ve learned from Roby, but requesting them to look at things from a medical perspective that they never would have thought to ask. And I think that even some of this stuff. I don’t always necessarily understand why I’m asking for certain blood tests to be done, but when I do point them out to the internists, they’re like, that’s a really good idea. How did you know to ask that? Can you maybe walk us through a little bit of things that you find recommending to medical professionals in order to look at how a client’s relationship with food is affecting their physical selves.
Robyn Goldberg 21:43
Definitely. Well, the first thing I want to say is that oftentimes labs are within normal limits. They don’t show everything, which is the reason their vitals, the vitals are blood pressure, pulse, capillary fill time, a whole multitude things are needed to be done after each time. Like I see clients, oftentimes, more often than they go to their doctor. So I do all these tests with them. And so this is how Curt’s become, you know, more of an expert than most through the, I’m gonna say, harem of dietitians, he surrounds himself. So with this, the first thing I would say, because there’s so many, if it’s a female: estradiol. That’s hormonally related, and based on, like, if they’re not menstruating too, and our estradiol level changes through each age period, okay, so, like, if you’re a teenager versus if you’re menopausal, and that’s just one, like with a male testosterone, because basically, as I develop a relationship with males, I see they feel comfortable, I mean, in so many words, I ask them, like, are they able, you know, to wake up in the morning, you know, having some awareness of what their body’s doing.
Curt Widhalm 23:02
You can say erection, if you want to.
Robyn Goldberg 23:06
Having a hard on. I didn’t know if I need to be politically correct on here.
Katie Vernoy 23:10
No, no political correctness required.
Robyn Goldberg 23:14
Right, can you get it up?
Katie Vernoy 23:15
There we go. There we go. So in addition to these hormonal tests, the estradiol and the testosterone. Are there other things that you recommend that patients ask, or that therapists suggest to their patients that they ask for?
Robyn Goldberg 23:26
Correct and their thyroid panel, their t3, t4, TSH, these are all the components of their thyroid. Because, like, I was listening to a client today who’s 19, and went to her internist, and she’s like, oh, you know, I’ve never had a thyroid issue. I said, You know what? That’s because your body is in a starved state. You do not have to be on thyroid medication, and is, one is increasing their intake, the thyroid function all becomes normal, in addition to, actually, the cholesterol. If you’re malnourished as well, you’ll have a falsely elevated total cholesterol within that lipid panel, also iron levels. It’s very common that clients you know have anemia. Amylase and lipase, if clinician is concerned about them, purging. And I’m referring to purging, meaning via vomiting versus purging through compulsive exercise. Amylase and lipase are reflectors on a like one last time was someone purged and where their body is at. Those are just a few. Oh, also magnesium, if their nutritional status is I mean, there’s so many, I’m just kind of doing some highlights, but magnesium, if they’re starved as well, phosphorus, like when we’re going through refeeding syndrome, which is basically increasing their intake and puts them in a higher metabolic state, because your metabolism, you’re making work. You know, phosphorus is like a very important lab in being able to reflect that. And what I say to clinicians, if they go on the Academy of eating disorder website, there’s a whole downloadable pamphlet that gives all of the labs that we would recommend to have done in addition to, like, the bone density, EKG. I mean, there’s many of them. So I just wanted to give a little snapshot.
Katie Vernoy 25:27
That is so helpful. Because I think as a clinician, I wouldn’t necessarily say, Oh, I I want to make sure that you get this blood work done, because I would worry about scope of practice, but knowing, kind of, from what you described, what the logistics are, the reasons are for those, and then having a downloadable thing that the clients can take with them to their doctors, that just seems so helpful. Thank you.
Robyn Goldberg 25:49
Yeah, so I oftentimes, I make a list, and I’ll give it to the client, and they’ll just give it to the physician or the medical assistant in the lab, and after they get the prescription for the order. And again, it’s not always going to show everything. Over time it will.
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Curt Widhalm 26:04
And this has been my experience, and Robyn’s by far way more of an expert in this than I am, but I remember working with some of my early clients, showing eating disorder issues, recommending them to go get a physical, a blood test done, and all that doctors were screening for was a lipid panel showing a slightly elevated level of cholesterol, and all of these things that Robyn just described weren’t even screened for. So there really is a fundamental lack of training in a lot of different areas, mental health, medical health, surrounding eating disorders that we all need to at least be looking at, as far as a at least a screening factor in order to get clients to people who are more experts, more sensitive to some of these issues. But it starts even just with conversations like this, to raise some of the awareness and recognize where our limitations are.
Katie Vernoy 27:02
I think that’s so important. And to that end, I wanted to ask another question, because I think oftentimes what I’ve seen from from the people who I see is that they will, they’ll have a health coach, or they’ll be talking to a nutritionist, or they’ll, they’ll, they’ll be with a dietitian, and I think a lot of therapists, and in our first conversation, Robyn, I didn’t realize that there were big differences. Can you speak to the differences so people can be aware of how to best refer? Because I think when this stuff is coming up, we need to have a dietitian. But I don’t know that people know why.
Robyn Goldberg 27:33
Absolutely. And I want to just say it was in between what Curt said and what you said, the other type of person that I think really needs to understand and be aware of this are the coaches that our clients see. Their high school, track coach, the football coach, the gymnastics coach, the tennis coach, because it’s so common and being a former college tennis player and then triathlete, these coaches really want to push each person to their fullest, maximum potential without recognizing the language, the stigmatizing wording they’re using is doing more harm than good. And like, yeah, the you know, they’re not menstruating, they have sleeping problems. So these are all things that are important regarding the health coach. Sorry, repeat the question.
Katie Vernoy 28:25
Sure, sure. So oftentimes, I think as therapists, when we get these clients who are coming in that maybe are, you know, they might present it as self esteem issues or or I need to diet, or I’m overweight, like they’re not presenting it as eating disorders. Oftentimes they’ll either try to, you know, kind of start working on things related with a health coach or or a nutritionist and, and some will seek out dietitians. But I think that the therapist community may not know the difference. So if you can describe the differences and kind of pros cons of…
Robyn Goldberg 28:57
Okay, sure, okay, so I’ll start with the Rolls Royce of options, registered dietitian. So to become a registered dietitian, and our credential used to be RD, and now we’re called RDNs registered dietitian nutritionists through the Academy of Nutrition and Food Science. They changed their name recently, so I still have like the old one in my head, but through the academy, an individual is required to obtain their bachelor’s or their master’s in dietetics, which like where I went to school, at Cal State Northridge. And a lot of schools have the same department. It’s under the Department of Family environmental sciences. So one obtains their bachelor’s or master’s in dietetics, then we apply for a dietetic internship, which is like residency. It’s computer matched. So I did mine in Virginia State University, and I was there for a year and a half. You have rotations in all these different elements. You’re in a dialysis center, you’re in a community health center, you’re in an outpatient Diabetes Center. I was actually in the State Penitentiary, mental health, all kinds of environments. I was in a private practice, which is helpful to allow you to become more well rounded, of course. And every dietician does this. You know, you have the hairnets, you’re learning about whatever size scooper this is serving gumbo. I mean, I did all this. And then you’re eligible to take the nationwide examination, which has areas that I can’t even tell you I practice or remember anymore in my career. Every single dietician does this anywhere you live. Some states have an RDN, registered dietitian nutritionist. Some states have RDN comma, LD, licensed dietitians, and that’s licensure, where what that means, I know people still do it. Anybody can call themselves a nutritionist, the postman, the guy at Whole Foods, the guy who puts gas in your car. Oh, what is your standard of experience and credibility? Oh, I’ve been reading about health and nutrition for years. Oh, I ran the LA Marathon last year. Okay, now you’re an expert. So anybody can see there, they’re a nutritionist. So I always like to start off on the right foot, just to be politically correct, because all dietitians are nutritionists, but not all nutritionists are dietitians.
Katie Vernoy 31:33
But I appreciate that distinction, and I’m assuming nutritionists and health coach are just two different titles for pretty much the same thing?
Robyn Goldberg 31:42
Yeah. So you know what? It’s interesting, Katie, I was speaking to someone a couple years ago. I I knew from the gym that was looking to change careers and through her own history of orthorexia, nervousa was like, Well, I really like to go to school to be a registered dietitian, but I don’t know if I can get through, you know, the two years of chemistry and years of biology, and this is a long time to be in school. Like, maybe, like, what do you think about me taking one of these, like, online courses or a weekend? I was like a Mickey Mouse course? I mean, I was just very forward. Like, yeah, I could be, like a health coach. Well, I know health coaches that are ethical. They are intuitive eating health coaches. They’ve gone through the intuitive eating training. So they are a certified Intuitive Eating counselor, so anybody can be it. And the two authors, Evelyn Tribole and Elyse Resch, actually go through and screen each person you have to go through this workshop and this test and this whole thing. So I know health coaches that stay within their scope of practice, and when it gets in over their heads, they refer out, or they, you know, collaborate with dietitians. I feel like that’s rare, hard to find, kind of like, you know, needle in a haystack. So a health coach, I never, you know truthfully, have understood the premise and what that’s about, versus you’re looking for the Cliff Notes version, versus putting the hard work in, if that makes sense. I mean, I know life coaches who are wonderful, but a life coach and a health coach are different.
Katie Vernoy 33:20
Okay, yeah, I think that makes sense. I think to me, what you really have brought home is that we need to make sure that we’re assessing the other professionals that we’re working with, and if we’re really working with disordered eating or a lot of food issues, we need to find the dietician. A nutritionist could be somebody that’s just interested in nutrition and has no area of expertise. There’s also health coaches that could potentially have some great coping strategies, but if they start talking about diet plans and food plans and nutrition, we should get a little cautious, because they don’t have that training.
Curt Widhalm 33:57
Robyn, where can people find out more information about you?
Robyn Goldberg 34:00
My website is www.askaboutfood.com, and my instagram name Robyn with a Y Goldberg, RDN.
Curt Widhalm 34:12
We’ll include links to both Robyn’s website and her Instagram in our show notes, as well as a little bit of a write up about some of the blood tests that Robyn was talking about that you might want to recommend if your clients are needing some of that medical component. If you ever get a chance to hear Robyn speak, she talks at some of these conferences worldwide. She travels all over the place. She’s a wealth of knowledge. And if you are in the Los Angeles area and can plan out your lunches like three or four months in advance, you should definitely get on her calendar. She knows some of the best restaurants in town. But you can find our show notes on our website, mtsgpodcast.com, while you’re there, check out our conference, the Therapy Reimagined Conference, coming up in October 2018 here in the Los Angeles area, two days and 14 CEUs about crafting better clinicians to better serve our clients, and it’s generously sponsored by SimplePractice. And until next time, I’m Curt Widhalm with Katie Vernoy and Robyn Goldberg.
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