“Not just a meal plan”: exploring the therapeutic role of dietitians in eating disorders — a mixed methods study

Dietitians are recognised as key members of multidisciplinary eating disorder (ED) treatment teams. However, their role may vary, and evidence describing how dietetic care is experienced by those with lived experience remains limited. Existing guidelines are largely consensus-based and often lack consumer input, creating uncertainty about the core components of effective dietetic practice. This study explored dietetic ED treatment experiences to identify components perceived as helpful or unhelpful by people with lived experience. A cross-sectional, mixed-methods online survey was administered to a community sample in 2023. It included demographic and clinical measures (Eating Disorder Examination Questionnaire–Short; Hospital Anxiety and Depression Scale), closed-ended items (Treatment Experiences Sliding Scale Rater), and open-ended questions about most and least helpful aspects of treatment with a dietitian. Eligible participants were aged​​ ≥ 16 years and reported o​ne or m​ore experiences of ED treatment with a dietitian. Self-reported treatment experiences included therapeutic alliance, perceived helpfulness, treatment components, and open-text descriptions of most and least helpful aspects. Quantitative and qualitative data were analysed in parallel. Following descriptive statistics, group differences were examined using Chi-squared (χ²), McNemar’s, Wilcoxon signed-rank, and Mann–Whitney U tests, with Bonferroni corrections. A total of 129 participants were included (mean age 33.2 years, SD 11.3; 86.8% female). Most were from Australia or the USA. Therapeutic alliance scores were significantly higher for participants’ most helpful compared to least helpful treatment experiences with a dietitian (p < 0.001). Most helpful treatments more often provided nutritional education, psychological support, body image work, and consistent care. Qualitative themes generated from free text responses focused on most ​helpful and least helpful aspects of treatment. Most helpfu​l treatments included interpersonal connection, ED-specific expertise, individualised treatment, non-diet approaches, and sufficient time. Least helpful treatment experiences showed suboptimal rapport, limited ED knowledge, generic advice, and resource-related barriers. Findings highlight the central role of the therapeutic alliance, tailored and psychosocially informed dietetic care, and continuity of services. Strengthening counselling skills, embedding supervision, and addressing systemic barriers such as limited funding and continuity of care could enhance dietitians’ contributions to ED recovery. Not applicable. Eating disorders are serious and complex mental illnesses, and dietitians play an important role in supporting treatment and recovery. While guidelines recommend dietitians as part of the treatment team, little research has asked people with lived experience which aspects of dietetic care are helpful, or unhelpful, in real-world practice. This study surveyed 129 people who had received dietetic treatment for an eating disorder. Participants were asked about their experiences with different dietitians, including what helped them engage in treatment and what made treatment more difficult. Many people found dietitians helpful when they felt understood, supported, and treated as individuals. Clear nutrition education, collaborative goal setting, and support for body image and emotions were also important. Unhelpful treatment experiences included feeling judged, receiving generic or outdated nutrition advice, or working with a dietitian who had a limited understanding of eating disorders. Practical issues such as cost, inadequate appointment length, and inconsistent treatment access​ also impacted care. Overall, the findings show that effective dietetic treatment requires strong communication skills, specialised knowledge of eating disorders, and enough time and continuity to build trust to support the person in their ED recovery.