Managing anorexia from a dietitian's perspective

Abstract

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 psychosocial 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. Anorexia nervosa: Tube feeding: NutritionAnorexia nervosa is a psychiatric condition that varies in severity, from mild to severe and chronic cases, resulting in extreme dieting and starvation (1) . With a mortality rate amongst the highest of all psychiatric illnesses (2) , anorexia nervosa is a life-threatening disorder. Not only does severe weight loss increase the risk of medical complications, but other associated behaviours, such as bingeing, purging, over-exercising and deliberate self-harm, pose a substantial risk to both physical and psychological health and wellbeing.As a result of its complex nature a multidisciplinary team approach to the management and treatment of anorexia nervosa is essential. It has been suggested that the most successful way to achieve recovery in this patient group is to blend together the expertise of the numerous members of the multidisciplinary team (3) . Dietitians are becoming increasingly recognised as an important part of the team, providing a specialist role in assisting patients to restore a normal body weight, achieve a dietary intake that meets nutritional requirements and to provide nutrition education. They have a unique mix of skills and knowledge in areas including nutrition, physiology, psychology, sociology and behaviour change, which can be appli...

Symposium 5: Joint BAPEN and Nutrition Society Symposium on ‘Feeding size 0: the science of starvation’ Severe malnutrition: therapeutic challenges and treatment of hypovolaemic shock

“…In the 2008 meeting of BAPEN a dedicated session on feeding the size 0 has enabled some comparisons to be made (for example, see Cockfield & Philpot (39) ). What is apparent is that there are many lessons to be learned across the specialities, from Africa to UK and vice versa.…”

Gastroenteric tube feeding: Techniques, problems and solutions

“…Enteral nutritional support plays a very significant part in the management of patients with poor voluntary oral intake [1,2] , chronic neurological or mechanical dysphagia [3][4][5] , or intestinal failure [6,7] , and in the critically ill [8,9] . Enteral feeding is not only more physiological than parenteral nutrition (PN), but has also been shown to improve patient outcomes, decrease costs [10] and reduce septic complications [11,12] in comparison to PN.…”

Seeing Beyond the Eating Disorder: The Complexities of Eating Disorder Care in New Brunswick, Canada

“…Endorsing a collaborative interdisciplinary treatment approach to intervention [19] [20], dieticians emphasize the importance of a strong patient-professional alliance [21] and wellestablished protocols for nutrition management [19]. A slow approach to prevent refeeding syndrome, a potentially life-threatening complication related to nutrient deficiencies [9], is required, especially in the initial 7-10 days of nutritional treatment [21]. Tube feeding practices are considered a last resort, with other approaches regarded as more favourable for weight restoration [21].…”

“…A slow approach to prevent refeeding syndrome, a potentially life-threatening complication related to nutrient deficiencies [9], is required, especially in the initial 7-10 days of nutritional treatment [21]. Tube feeding practices are considered a last resort, with other approaches regarded as more favourable for weight restoration [21]. There is a need for ongoing research to establish norms for disordered patterns of eating and best dietary practice.…”

“…There is a need for ongoing research to establish norms for disordered patterns of eating and best dietary practice. Without such guidelines, professionals rely on clinical judgment [21] and personal experience [20] to recognize maladaptive eating patterns before they become medical crises.…”