Understanding levels of care in eating disorder treatment

Eating disorders thrive in isolation, which means getting support is vital to recovery. To combat an eating disorder, it takes a specialized team. Several factors, such as the severity of the eating disorder and one’s openness to recovery, will determine which type of care is the right fit for an individual.  

While it’s not necessarily the dietitian’s job to determine which level of care is most appropriate for a patient, it’s beneficial to have a foundational understanding of what each level of care offers. This can help a dietitian know where to refer a patient (outpatient vs. treatment center) and be more equipped to answer questions a patient or caregiver may have about treatment.  

The goal in eating disorder recovery is for a patient to gradually move toward the lowest level of care before becoming fully independent. As the saying goes in eating disorder recovery, recovery isn’t linear. No matter where someone begins, there may be times when they need to step back up to a higher level of care before progressing again. Some may revisit certain levels multiple times, take breaks from the recovery process, or even require ongoing treatment indefinitely. Every journey looks different—and that’s okay.  

What are the different levels of care? 

Inpatient: This is the highest level of care for the most acute patients. Patients who go to inpatient settings are medically unstable and, therefore, require constant medical monitoring. Inpatient is appropriate for patients who are experiencing things like gastrointestinal complications, signs of refeeding syndrome, or who need to be tube-fed. Here, patients are offered a multidisciplinary team including a psychiatrist, medical doctor, therapist, and dietitian.  

Residential: This level of care is for those who need 24/7 monitoring to interrupt eating disorder behaviors. Some residential centers have a clinical aesthetic, while others have a home-like atmosphere. Patients receive group and individual therapy, where they learn coping skills to tolerate emotional distress and how to feed themselves appropriately. Friends and family are also included to learn how to support patients in their recovery.  

Partial Hospitalization Program (PHP): PHP is structured similarly to residential, but lasts 6-10 hours a day, 5-7 days a week. PHP offers daily structure during waking hours, meal support, individual and group therapy, and partial integration back into their daily lives.  

Intensive Outpatient Program (IOP): IOP is offered for about 3 hours a day, 3-5 days a week. This is a transitional opportunity for patients to eat on their own and take on more daily responsibilities- like school or work- while still receiving significant support. At this level, some treatment centers do not offer psychiatry or medical monitoring.  

Outpatient: In an outpatient setting, patients are medically stable and able to challenge eating disorder behaviors/thoughts with guidance from the outpatient team. At the very least, an outpatient team consists of a dietitian and therapist, but can also include a psychiatrist, medical doctor, speech-language pathologist, and/or medical specialists.  

What is a dietitian’s role in the treatment of eating disorders? 

Regardless of the level of care, dietitians strive to help patients work toward developing a healthy relationship with food and their bodies. How a dietitian does that is individualized for every patient, yet there are some commonalities across patient care:  

• Meet the patient where they are. Help them identify SMART (specific, measurable, achievable, relevant, and time-bound) goals and motivation in their recovery journey. 
• Calculate the patient’s nutritional needs. With this information, dietitians can create a meal plan and help a client weight restore, if appropriate.  
• Normalize eating behaviors. Challenge disordered thoughts and find effective coping strategies.  
• Offer meal support (as needed). This may involve having a patient eat a meal/snack in a session. During this time, a dietitian may prompt them to take bites, redirect disordered eating behaviors, guide a patient through emotion regulation, or model appropriate behaviors by eating with the patient.  
• Collaborate with the multidisciplinary team. It’s imperative that all members of the team are on the same page to ensure the patient is getting sound, cohesive care.  
• Provide nutrition education. Dietitians help patients (and caregivers) understand what adequate, balanced meals look like, debunk diet culture beliefs, and recognize behaviors that impact health.  
• Support with exposure work. Similar to meal support, dietitians can help a client conquer fear foods or poor body image by helping them build tolerance to triggers in a contained, safe environment. This often requires significant planning and care to ensure trauma isn’t perpetuated.  
• Process body image concerns. This helps a patient get closer to body tolerance and respect.  
• Educate caregivers. Teach how to support their loved ones in recovery. 

What are some factors to consider in eating disorder treatment options?  

There are multiple factors to take into consideration when recommending a higher level of care to a patient:  

• Are they medically unstable? Take into account their eating disorder behaviors, weight, bloodwork, vitals, nutrition intake, and mental health. If a patient seems like they would benefit from close medical monitoring, offer them treatment center options. Treatment centers often offer free assessments and will determine which level of care is the best fit for the patient. 
• What is their willingness for treatment? Patients may hesitate to enter a higher level of care for many reasons—financial concerns, conflicts with work or school, location challenges, or fear of letting go of the eating disorder. It’s important to explore (and eliminate, if possible) these barriers, meet clients where they are, and, at the very least, provide resources for when they are ready to seek support. With the growth of virtual treatment options in recent years, access to care has become more attainable. 
• Are there financial barriers? Unfortunately, access to resources is a common barrier for people. While most treatment centers take major insurances, there is often still a cost to treatment. Some treatment centers pair with scholarship programs, like Project Heal, to offer treatment for free or at a reduced cost. Likewise, some outpatient dietitians take insurance, offer sliding scale options, and/or occasionally offer pro-bono services.  
• What identities do they hold? Treatment is likely to be more successful when the patient feels seen and safe with their providers. If possible, recommend options that feel like a good fit to the patient based on their intersectionality, if neurodivergence is a consideration, and the type of eating disorder. Many treatment centers offer programs or groups that are for a specific eating disorder, such as binge eating disorder (BED) or avoidant/restrictive food intake disorder (ARFID), or are specifically for transgender, nonbinary, or BIPOC individuals.  

Support is vital for eating disorder recovery. What that support looks like is individualized and unique for each person. When a dietitian is familiar with the available resources, it removes one more barrier between the patient and the support they need for recovery.

Dietitians On Demand is a nationwide staffing and recruiting company for registered dietitians, specializing in short-term, temporary, and permanent-hire positions in acute care, long-term care, and food service. We’re dedicated to dietitians and helping them enhance their practice and excel in the workplace. Check out our job openings, request your coverage, or visit our store today!

References

Types of Eating Disorder Treatment. National Alliance for Eating Disorders website. Accessed 8/9/25. Available at: https://www.allianceforeatingdisorders.com/types-of-eating-disorder-treatment-levels-of-care/.  

AED Report 2021 | 4th Edition Eating Disorders: A Guide to Medical Care. Accessed 8/9/25. Available at: https://higherlogicdownload.s3.amazonaws.com/AEDWEB/27a3b69a-8aae-45b2-a04c-2a078d02145d/UploadedImages/Publications_Slider/2120_AED_Medical_Care_4th_Ed_FINAL.pdf.  

Baker J. Eating Disorder Treatment. F.E.A.S.T. website. Accessed 8/9/25. Available at: https://feast-ed.org/treating-eating-disorder/.