Eating Disorders: Nutrition Education And Therapy - Dieticians Role in Treatment of Eating Disorder

Written by HealthyPlace.com Staff Writer

GUIDELINES FOR NUTRITION THERAPISTS REGARDING COMMON ISSUES IN THE NUTRITIONAL TREATMENT OF EATING DISORDERS

WEIGHT

Weight is going to be a touchy issue. For a thorough assessment and to set goals, it is important to obtain current weight and height for most clients. This is especially true for anorexic clients, whose first goal should be to learn how much they can eat without gaining weight. For clients with bulimia nervosa or binge eating disorder, measurement is useful but not necessary. In any case, it's best not to rely on the client's own reporting of either of these measures. Clients become addicted to and obsessed with weighing, and it is helpful to get them to relinquish this task to you. (Techniques for accomplishing this are discussed on pages 199 - 200.)

Once clients learn not to associate food with weight gain or normal fluid fluctuations, the next task is to establish weight goals. For the anorexic client, this will mean weight gain. For other clients, it is very important to emphasize that weight loss is an inappropriate goal until the eating disorder has been resolved. Even for bulimics and binge eaters, a weight loss goal interferes with treatment. For example, if a bulimic has weight loss as a goal and eats a cookie, she may feel guilty and be driven to purge it. A binge eater may have a great week with no bingeing behavior until she weighs herself, discovers that she hasn't lost weight, becomes upset, feels that her efforts are useless, and binges as a result. Resolving a client's relationship with food, not a certain weight, is the goal.

Most nutritionists refrain from trying to help clients lose weight because research shows that these attempts usually fail and can cause more harm than good. This may seem extreme, but it's important to avoid buying into the client's immediate "need" to lose weight. Such a "need" is, after all, at the core of the disorder.

SETTING A GOAL WEIGHT

To determine goal weight, a variety of factors must be considered. It is important to explore the point at which the focus on food or on weight began and to explore the intensity of the eating disorder symptoms in relation to body weight. Get information on food preoccupation, carbohydrate craving, binge urges, food rituals, hunger and fullness signals, activity level, and menstrual status. Also ask clients to try to recall their weight at the time they last had a normal relationship with food.

It's difficult to know what an appropriate weight goal is. Various sources, such as the Metropolitan Life Insurance Weight Tables, provide ideal weight ranges, but their validity is the subject of debate. Many therapists believe that in the case of anorexics, the weight at which menses resume is a good goal weight. There are rare cases, however, of anorexics who regain their menses when they are still emaciated.

Physical parameters, including body composition, percentage of ideal body weight, and laboratory data, should all be considered when establishing goal weight. It may also be helpful to obtain information about the client's ethnic background and about the body weights of other family members. The target goal weight range should be set to allow for 18 to 25 percent body fat at 90 to 100 percent of ideal body weight (IBW).

It is important to note that goal weight should not be set at ranges below 90 percent of IBW. Out-come data show a significantly high relapse rate for clients who do not reach at least 90 percent of IBW (American Journal of Psychiatry 1995). Take into account the fact that clients do have a genetically predetermined set-point weight range and be sure to obtain a detailed weight history.

WHAT IS IDEAL BODY WEIGHT?

Many formulas have been devised to determine IBW, and one easy and useful method is the Robinson formula. For women, 100 pounds is allowed for the first 5 feet of height, and 5 additional pounds of weight are added for each additional inch of height. This number is then adjusted for body frame. For example, the IBW for a women with an average frame who is 5 feet and 4 inches tall is 120 pounds. For a small-framed woman, subtract 10 percent of this total, which is 108 pounds. For a large-framed woman, add 10 percent for a weight of 132 pounds. Thus, the IBW for women who are 5 feet and 4 inches tall ranges from 108 to 132 pounds.

Another formula commonly used by health professionals is the Body Mass Index, or BMI, which is the individual's weight in kilograms divided by the square of her height in meters. For example, if an individual weighs 120 pounds and is 5 feet and 5 inches tall, her BMI equals 20: 54.43 kilograms (120 pounds) divided by 1.65 meters (5 feet 5 inches) squared (2.725801) equals 20.

Healthy ranges of BMI have been established, with guidelines suggesting, for example, that if an individual is nineteen or older and has a BMI equal to or greater than 27, treatment intervention is needed to deal with excess weight. A BMI between 25 and 27 may be a problem for some individuals, but a physician should be consulted. A low score may also indicate a problem; anything below 18 may even indicate a need for hospitalization due to malnutrition. Healthy BMIs have been established for children and adolescents as well as for adults, but it is important to remember that standardized formulas should never be relied on exclusively (Hammer et al. 1992).

Both of these methods are flawed in some respect, as neither takes into account lean body mass versus fat body mass. Body composition testing, another method of establishing goal weight, measures lean and fat. A healthy total body weight is established based on lean weight.

Whatever method is used, the bottom line for determining a goal weight is health and lifestyle. A healthy weight is one that facilitates a healthy, functioning system of hormones, organs, blood, muscles, and so forth. A healthy weight allows one to eat without severely restricting, starving, or avoiding social situations where food is involved.