scholarly journals Managing anorexia from a dietitian's perspective

2009 ◽  
Vol 68 (3) ◽  
pp. 281-288 ◽  
Author(s):  
Annette Cockfield ◽  
Ursula Philpot
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Multidisciplinary Team ◽  
Best Practice ◽  
Tube Feeding ◽  
Evidence Base ◽  
Inpatient Setting ◽  
Team Approach ◽  
Normal Behaviour ◽  
Weight Restoration

Anorexia nervosa has the highest mortality rate of any psychiatric condition and its management is complex and multi-faceted, requiring a multidisciplinary team approach. Dietitians are an important part of the multidisciplinary team, offering objective nutritional advice with the aim of helping the patient to develop an improved relationship with food. Refeeding patients with a low body weight requires careful management; nonetheless, refeeding the low-weight patient with anorexia presents many additional complications, largely of a psychological nature. Treatment plans need to consider psychological, physical, behavioural and psycho-social factors relating to anorexia nervosa. Currently, there is no consistent approach and a paucity of evidence to support best practice for weight restoration in this group of patients. Tube feeding is utilised at varying BMI in anorexia nervosa, mainly in an inpatient setting. However, its use should be seen as a last resort and limited to a life-saving intervention. Weight restoration is best managed by an experienced dietitian within a specialist eating disorders team, using normal foods. This approach is ideal for nutrition rehabilitation, promoting skills for eating and normal behaviour and providing a longer-term solution by challenging unhelpful coping strategies from the onset. Dietitians have a unique mix of skills and knowledge in numerous areas including nutrition, physiology, psychology, sociology and behaviour change, which can be applied to support patients with thoughts and behaviours around food, weight and appetite. Further research is required into the effectiveness of dietetic interventions in eating disorders in order to establish an evidence base for best practice.

scholarly journals Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth K. Parker ◽  
Sahrish S. Faruquie ◽  
Gail Anderson ◽  
Linette Gomes ◽  
Andrew Kennedy ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Weight Gain ◽  
Statistical Significance ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Retrospective Chart Review ◽  
Refeeding Syndrome ◽  
Restrictive Eating ◽  
Weight Restoration ◽  
The Mean

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047;p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

Atypical Eating Disorders and Specific Phobia of Vomiting

2017 ◽  
pp. 270-290
Author(s):  
Alexandra Keyes ◽  
David Veale
Keyword(s):  
Eating Disorders ◽  
Weight Loss ◽  
Anorexia Nervosa ◽  
Disordered Eating ◽  
Clinical Features ◽  
Food Restriction ◽  
Clinical Case ◽  
Evidence Base ◽  
Specific Phobia ◽  
Case Conceptualization

Some individuals with specific phobia of vomiting (SPOV) (emetophobia) may present with disordered eating, including food restriction and weight loss. Such cases may be misdiagnosed as anorexia nervosa (AN), thus complicating case conceptualization, formulation, and treatment. This chapter outlines the clinical features of SPOV, including those that overlap with AN and other disorders. Treatment approaches and their evidence base are discussed, and a clinical case example of an individual with SPOV and disordered eating is presented. More research is needed to address the overlap between eating disorders and SPOV in order to better distinguish overlaps in presentation and to develop treatments that effectively target the central fears in these cases.

scholarly journals Outpatient CBT for Underweight Patients with Eating Disorders: Effectiveness Within a National Health Service (NHS) Eating Disorders Service

2018 ◽  
Vol 47 (2) ◽  
pp. 217-229
Author(s):  
Paul E. Jenkins ◽  
Ceri Morgan ◽  
Catherine Houlihan
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Real World ◽  
Evidence Base ◽  
Behaviour Therapy ◽  
Psychosocial Impairment ◽  
Cognitive Behaviour

Background: Underweight eating disorders (EDs) are notoriously difficult to treat, although a growing evidence base suggests that outpatient cognitive behaviour therapy for EDs (CBT-ED) can be effective for a large proportion of individuals. Aims: To investigate the effectiveness of CBT-ED for underweight EDs in a ‘real-world’ settings. Method: Sixty-three adults with underweight EDs (anorexia nervosa or atypical anorexia nervosa) began outpatient CBT-ED in a National Health Service setting. Results: Fifty-four per cent completed treatment, for whom significant changes were observed on measures of ED symptoms, psychological distress and psychosocial impairment. There was also a large effect on body weight at end-of-treatment. Conclusions: The results suggest that good outcomes can be achieved by the majority of those who complete treatment, although treatment non-completion remains a significant barrier to recovery. Future studies should focus on improving treatment retention, as evidence suggests that CBT-ED in ‘real-world’ settings is effective.

Anorexia nervosa and attachment

2017 ◽  
Vol 41 (S1) ◽  
pp. S552-S552
Author(s):  
H. De la Red Gallego ◽  
A. Alonso Sánchez ◽  
A. Álvarez Astorga ◽  
S. Gómez Sánchez ◽  
L. Rodríguez Andrés ◽  
...  
Keyword(s):  
Emergency Department ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Clinical Case ◽  
Cognitive Distortions ◽  
Insecure Attachment ◽  
Weight Restoration ◽  
Competing Interest ◽  
The One

IntroductionAttachment is an innate programming whereby a child seeks for security. There is scientific and empirical evidence that insecure attachment is usual in eating disorder patients [1].ObjectivesTo highlight the relevance of attachment between child and caregivers, as well as its significance in therapeutic approach.MethodsA 17-year-old girl hospitalized after attending to emergency department due to fainting. BMI: 12.89. She reports restrictive behavior since age 11 that her mother regards as “child issues”. Divorced parents, she grew up with her mother, diagnosed of hypochondria, who mentions not understanding why she is not the one who is hospitalized.ResultsDuring hospitalization, she turned 18-years-old. Guardianship of her younger siblings was removed to her mother. She had a secure relationship with her 24-year-old sister, so she decided to move in with her. Later on, she had a positive progress, maintaining the gained weight and mood stability, although cognitive distortions persist.ConclusionsAmong developmental and maintaining factors of eating disorders, impaired attachment is becoming increasingly interesting. Even though the main goal of treatment is weight restoration, exploring attachment patterns can facilitate to achieve that aim. This clinical case emphasizes the importance of attachment in eating disorders among child and young adults.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effectiveness of multidisciplinary team approach and prognosis of inpatients with eating disorders

2002 ◽  
Vol 1241 ◽  
pp. 137-141
Author(s):  
Nobuatsu Nagai ◽  
Tetsuro Naruo ◽  
Naoko Homan ◽  
Yoshiki Tatebe ◽  
Tetsuro Muranaga ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Multidisciplinary Team Approach

Can temporary cessation of CBT really be therapeutic? A case study

2017 ◽  
Vol 10 ◽  
Author(s):  
Paul E. Jenkins
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Psychiatric Illness ◽  
Psychological Treatment ◽  
Evidence Base ◽  
Psychological Theories ◽  
Symptom Measures

AbstractAnorexia nervosa (AN) is a notoriously costly and challenging psychiatric illness to treat. Despite an accumulating evidence base, psychological treatment fails to achieve symptom abstinence in many patients with eating disorders, a shortcoming that is likely to be further pronounced in AN. The case study reported here describes how a mutually agreed break in a course of psychotherapy following an initial lack of progress might have influenced outcome for a client with a severe eating disorder. The patient received 26 sessions of CBT and results, consistent with those of larger studies, showed significant improvement on primary symptom measures. These results are discussed in the context of relevant psychological theories and an exploration of the client's motivation. Consideration is also given to other factors that may have influenced outcome.

Management and treatment of feeding and eating disorders

2020 ◽  
pp. 1087-1095
Author(s):  
Susan L. McElroy ◽  
Anna I. Guerdjikova ◽  
Nicole Mori ◽  
Paul L. Houser ◽  
Paul E. Keck
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Behavioural Therapy ◽  
Lisdexamfetamine Dimesylate ◽  
Interpersonal Therapy ◽  
Feeding And Eating Disorders ◽  
Cognitive Behavioural ◽  
Weight Restoration ◽  
Family Based

This chapter reviews the management and treatment of feeding and eating disorders. The cornerstone of managing anorexia nervosa (AN) is refeeding, nutritional rehabilitation, and weight restoration. Evidence of efficacy is strongest for family-based psychotherapy for adolescents with AN. Other forms of psychotherapy have less evidence of efficacy. No medication has regulatory approval for the treatment of AN; agents with possible efficacy are zinc, olanzapine, and dronabinol. For bulimia nervosa, there is evidence of efficacy for cognitive behavioural therapy (CBT), interpersonal therapy (IPT), antidepressants, and topiramate. For binge eating disorder, there is evidence of efficacy for CBT, IPT, lisdexamfetamine dimesylate, topiramate, and antidepressants. Less is known about the management and treatment of pica, rumination disorder, avoidant/restrictive food intake disorder, and other specified feeding or eating disorders. As feeding and eating disorders often co-occur with medical and other psychiatric disorders, the management and treatment of these conditions must also be addressed.

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