The RD Road Map: Journey to Eating Disorder Expertise

Jill Sechi and Mateus Milhomens
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Welcome to The RD Roadmap: Journey To ED Expertise hosted by Jill Sechi, MS, RDN, CEDS-C, LD and Mateus Milhomens, MS, RDN, IBCLC, ACE-CHC. This podcast series has been developed to provide a roadmap and a couple of tour guides on your journey to understand and build confidence as a provider in the field of eating disorders.

  1. 09/15/2025

    Episode #14 The 14ers: Understanding PHP and IOP with your tour guide Jill Sechi, RDN, CEDS-C

    Today we welcome your tour-guide Jill Sechi, RDN, CEDS-C to discuss her experience with starting up one of the first PHP/IOP programs in Houston, TX called Houston Eating Disorders Center (HEDC).  Houston was a desert when Jill started in the field and now its a thriving rainforest of many RTC and PHP/IOP programs.  PHP programming generally is 5-7 days a week and usually upwards of 12 hours a day. Most PHP programs have IOP programs as "step downs" in which the patient often gets to work with the same treatment team for consistency and support. Learn from Jill when to refer to this level, when not and the functions of PHP and IOP programming.  Most states have PHP and IOP programming. Some even have apartments connected to them so that they do not have to travel to and from home which can be difficult. We hope you find this informative and helpful as you navigate when and HOW  to refer patients! Join us on Apple Podcasts to listen to the full extended episode in our Subscriber Backend episodes!

  2. 09/08/2025

    Episode #13 The 14ers: Understanding Residential Level of Care with guest Amanda Mellowspring, RDN, CEDS-C

    oday we welcome guest Amanda Mellowspring, MS, RDN, CEDS-C who is currently the COO (Chief Operating Officer) for a large outpatient business called Healthier Tomorrows. Learn more here: https://healthiertomorrows.com/dietitian/amanda-mellowspring-ms-rd-ceds-c/ Amanda previously was the VP of Monte Nido and has worked in a residential treatment for many years. She has hired and trained dietitians in residential as well.  Residential treatment or RTC is a level of care that can provide some medical monitoring but generally provides 24/7 containment for patients that need much more support to restore weight or interfere with behaviors so that they can nourish themselves and their brain to do the hard work of recovery. There are MULTIPLE residential facilities throughout the United States. Amanda will provide a back end view of understanding the function and purpose of this level of care. Enjoy!

  3. 06/09/2025

    Episode #11 The 14ers: Understanding Higher Level of Care and Beyond

    If you are a hiker, you know what "The 14ers" are; they are mountains that many like to climb located around the world. Not all of the hikes are difficult. What makes them difficult are the elevation changes. They are over 14,000 feet to the top and usually require a hiker to start at 6 am and "get back down" before noon as thunderstorms can develop quickly. We titled this new series The 14ers because we feel that understanding a Higher Level of Care (HLOC) can be difficult without exposure and a basic understanding of how to navigate:   When to decide to refer a patient to a HLOC   What are the different levels?   What facility do you refer your client to?   What level do you recommend? We will be having guest speakers that have worked in the various levels of care to give you perspective and an "inside look" into each level. If you are new to the field, knowing the basics and lingo is vital so that you can more accurately coordinate care and provide a good recommendation. Here are some resources on your journey from your tour guides! Know the lingo:   IP: Inpatient   RTC: Residential Treatment   PHP: Partial Hospitalization Program   IOP: Intensive Outpatient   OP: Outpatient Most states now have most levels of care (RTC through IOP). However, that doesn't mean those programs take your client's insurance or that they are a solid program. Ask around to other colleagues who are more seasoned in the field about which programs they might recommend. Keep in mind, not all clients do well in residential care on their "first round." They may not be ready or motivated, they may not have "stepped down" appropriately, or they may be too young and need family-based treatment, for example. We hope you find some good nuggets or perhaps just some validation of how difficult a 14er is. Experience, supervision, and knowledge are a good starting point even if you have never worked in that level of care.

  4. 06/09/2025 • Subscribers Only

    Backend | Episode 11 EXTENDED: The 14ers - Understanding Higher Level of Care and Beyond

    If you are a hiker, you know what “The 14ers” are; they are mountains that many like to climb located around the world. Not all of the hikes are difficult. What make them difficult are the elevation change. They are over 14,000 feet to the top and usually require a hiker to start at 6 am and “get back down” before noon as thunderstorms can develop quickly. We tired this new series the 14ers because we feel that understanding a Higher Level of Care or HLOC can be difficult without exposure and a basic understanding of how to navigate 1-when to decide to refer a patient to a HLOC 2-what are the different levels? 3-what facility do you refer your client to? 4-what level do you recommend? We will be having guest speakers that have worked in the various levels of care to give you perspective and and “inside look” into each level. If you are new to the field, knowing the basics and lingo is vital so that you can more accurately coordinate care and provide a good recommendation. Here are some resources on your journey from your tour guides! Know the lingo: IP: Inpatient RTC: residential treatment PHP: partial hospitalization program IOP: intensive outpatient OP: outpatient Most states now have most levels of care (RTC through IOP). However, that doesn’t mean those programs take your client’s insurance or they may not be a solid program. Ask around to other colleagues that are more seasoned in the field what programs they might recommend. Keep in mind, not all clients do well in residential care on their “first round.” They may not be ready or motivated, they may not have “stepped down” appropriately, they may be too young and need family based treatment for example. We hope you find some good nuggets or perhaps just some validation of how difficult a 14er is. Experience, supervision and knowledge are a good starting point even if you have never worked in that level of care.

  5. 06/03/2025

    Episode #10 Navigating the Rocky Path of Medical Complications Part 4

    This is our last installment of medical complications to look for in eating disorder care.  Today's episode covers refeeding and underfeeding syndrome in eating disorder care. Now we are looking beyond the basics of what to pack in your backpack and more so of navigating what trail to take, what additional things to pack and how much time you have in a given day with the trail you've chosen. Refeeding syndrome can evoke fear and underfeeding syndrome (the less common one most think about) can evoke confusion! As your "tour guides" here are some things to consider before your journey. What additional things to pack beyond the basics and knowing where you are going and what is waiting for you on your journey.  Know the continued labs to follow and other considerations when working with someone with malnutrition. How little have they been eating, how rapid has their weight dropped or what is their BMI are all items that can place a person at higher risk for refeeding syndrome (pack a medical kit). Know what physical symptoms can be present with refeeding such as night sweats, sore muscles upon waking or heart palpitations and weight restoration. Make sure you are requesting they visit with a doctor to monitor this things (pack a rain jacket and light coat. The weather can change fast!) Understand underfeeding syndrome (which is way more common than refeeding). How much energy is added and when is vital to keep internal organs functioning (including the brain) and keeping up with metabolic demands as the body is repairing itself. How much weight do they need to gain and where to start calories all need to be considered.  (Avoid overpacking and starting too late on your journey. Eating disorders are like an 8 miler over several days. Make sure you have adequate fuel along the way).

  6. 06/03/2025 • Subscribers Only

    Backend | Episode 10 EXTENDED: Navigating the Rocky Path of Medical Complications Part 4

    This is our last installment of medical complications to look for in eating disorder care. Today’s episode covers refeeding and underfeeding syndrome in eating disorder care. Now we are looking beyond the basics of what to pack in your backpack and more so of navigating what trail to take, what additional things to pack and how much time you have in a given day with the trail you’ve chosen. Refeeding syndrome can evoke fear and underfeeding syndrome (the less common one most think about) can evoke confusion! As your “tour guides” here are some things to consider before your journey. What additional things to pack beyond the basics and knowing where you are going and what is waiting for you on your journey. * Know the continued labs to follow and other considerations when working with someone with malnutrition. How little have they been eating, how rapid has their weight dropped or what is their BMI are all items that can place a person at higher risk for refeeding syndrome (pack a medical kit). * Know what physical symptoms can be present with refeeding such as night sweats, sore muscles upon waking or heart palpitations and weight restoration. Make sure you are requesting they visit with a doctor to monitor this things (pack a rain jacket and light coat. The weather can change fast!) * Understand underfeeding syndrome (which is way more common than refeeding). How much energy is added and when is vital to keep internal organs functioning (including the brain) and keeping up with metabolic demands as the body is repairing itself. How much weight do they need to gain and where to start calories all need to be considered.  (Avoid overpacking and starting too late on your journey. Eating disorders are like an 8 miler over several days. Make sure you have adequate fuel along the way).

  7. 04/02/2025 • Subscribers Only

    Backend | Episode 8 EXTENDED: Navigating the Rocky Path of Medical Complications Part 2

    With hiking, climbing mountains or traveling, choosing the best pathway can be daunting. Often you might be hearing “word of mouth” for a particular trail or you’ve found a great “hiking trail” app on your phone. Individuals provide a few pictures, “what to look out for”, and perhaps a few pros and cons. This is so similar to treating those with eating disorders. Especially when it comes to navigating GI issues, food intolerances or perceived allergies. You’ll find they have eliminated every possible “route” (food) due to fear and misunderstanding. As the provider you are tasked with pushing them towards a trail head they are terrified of and YOU are equally scared because you have never hiked the trail either. Do you know what you are talking about? What will this look like in the room? The client is convinced they have gluten intolerance but they binge on pies, cookies and cakes with normal flour/gluten content. What now? In this episode we dig deep into allergies and food avoidance. First though, you need to have a decent understanding of food allergies, tests that are often ordered yet are not evidence based, and a general understanding of what causes food intolerances. Clients get to the point of severe malnutrition due to all the food elimination at the same time having visited multiple doctors (with their own bias and opinions) and a myriad of tests that are expensive, time consuming and often unnecessary. Understand an intolerance (often due to malnutrition) vs a food allergy (immune system). We’ll also talk about a few clinical presentations and how we support these cases in session... Here are a few resources to support your learning:

Food allergies and sensitivities:
Podcast: Unbiased Science: Food Allergies: https://www.unbiasedscipod.com/episodes/food-allergy-the-real-dill-food-sensitivity-not-eggs-actly

 American Academy of Allergy Asthma and Immunology: https://acaai.org/allergies/allergic-conditions/food/
90% of food allergy reactions are attributed to these 9 foods: eggs, milk/dairy, peanuts, tree nuts, fish, shellfish, wheat, soy, sesame 

Recommended Book: The Mind Gut Connection by Dr. Emeran Mayer
https://www.amazon.com/Mind-Gut- Connection-Conversation-Impacts-Choices/dp/0062376551/ref=sr_1_1?ie=UTF8&qid=1462734526&sr=8-1&keywords=emeran+mayer

Body Works: Picture of the Vagus Nerve and other nerve endings Happy Listening!

  8. 04/02/2025 • Subscribers Only

    Backend | Episode 9 EXTENDED: Navigating the Rocky Path of Medical Complications Part 3

    With any type of hiking excursion, especially trails that are infrequently traveled or are not highly populated, its so important to have essentials packed in a backpack regardless of how far you plan to travel that day. Eating disorder treatment and care is exactly this. Often you are one of the few providers who understand and know eating disorders; the "population" of other providers you might encounter or work with often have no training in eating disorders, can be quite dismissive or miss the mark altogether. The more essentials you can pull out and use in this field the better!
 As your “tour guides” here are some essentials to pack: water, map, compass
 * Know the basics of labs and what labs to order as potential markers of assessment of malnutrition (water) * Know that when lab work often show “something might be wrong” your client most often has already been highly impacted by their eating disorder. “Normal” doesn’t equal “you’re fine.” (the map of malnutrition) * Most often an individual with an eating disorder has typically been struggling for up to 3-5 years before they seek treatment (tell someone where you are going and expected time to be home) Thus, if you see “mild” anemia, “loss of cycle” or “abnormal thyroid function” this has been going on a lot longer, so dig deeper (so pack a compass).  Great overview article of the endocrine system and malnutrition:
https://www.acute.org/blog/endocrine-dysfunction-anorexia-nervosa-patients
 Oral Contraceptive Pills: https://www.gaudianiclinic.com/gaudiani-clinic-blog/2019/6/12/2g91vdohlt3fm437vvuqfwyq3zfw28
 Read, read, read: Sick Enough by Dr. Jennifer Guadiani
Or Eating Disorders: A Comprehensive Guide to Medical Care and Complications

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About

Welcome to The RD Roadmap: Journey To ED Expertise hosted by Jill Sechi, MS, RDN, CEDS-C, LD and Mateus Milhomens, MS, RDN, IBCLC, ACE-CHC. This podcast series has been developed to provide a roadmap and a couple of tour guides on your journey to understand and build confidence as a provider in the field of eating disorders.

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