Eating Disorders: Nutrition Education And Therapy - Eating Disorders Nutritional Review

Written by HealthyPlace.com Staff Writer

WHAT TO AVOID

Individuals with eating disorders often go into the field of nutrition as a result of their own obsession with food, calories, and weight. Any nutritionist should be assessed for signs of eating disorder thinking or behavior, including "fat phobia." Many individuals with eating disorders are fat phobic. If the nutritionist is also fat phobic, nutrition therapy will be negatively affected.

Fat phobia can refer to dietary fat or body fat. Many people are afraid of eating fat and of being fat, and this fear creates a negative attitude toward food with a fat content of any kind and fat people. The existence of fat makes these fat-phobic individuals fear the prospect of losing control and becoming fat. The prevailing cultural attitude is that fat is bad and fat people should change. Unfortunately, many nutritionists have perpetuated fat-phobia.

When discussing body size and weight, individuals should look for a nutritionist who does not use a chart to determine a client's proper weight. The nutritionist should discuss the fact that people come in all shapes and sizes and there is no one weight that is a perfect body weight. Clients should be discouraged by the nutritionist from trying to make their bodies conform to a certain selected weight but rather encouraged to accept that, if they give up bingeing, purging, and starving and learn how to properly nourish themselves, their body will reach its natural weight.

However, avoid a nutritionist who thinks natural eating alone will always restore a person to a normal, healthy weight. For example, in the case of anorexia nervosa, an excessive amount of calories, beyond what is considered normal eating, is necessary for the anorexic to gain weight. It may take as many as 4,500 calories or more per day to begin weight gain in severely emaciated individuals. Anorexics must be helped to see that in order to get well they need to gain weight, which will require an excessive amount of calories, and they will need specific help in how to get those calories into their diet.

After weight restoration, a return to more normal eating will sustain weight, but a higher calorie level than individuals without a history of anorexia is usually required. Binge eaters who become obese from bingeing and who desire to return to their more normal weight may have to eat a diet that is lower in calories than the amount originally needed to sustain their pre-bingeing weight. It is important to reiterate that these circumstances as well as all areas involved in the nutritional treatment of eating disorders require special expertise that takes into account a variety of circumstances.

HOW OFTEN DO CLIENTS NEED TO SEE A NUTRITIONIST?

How often a client will need to see the nutrition therapist is based on a number of factors and is best determined with input from the therapist, the client, and other significant members of the treatment team. In some cases only intermittent contact is maintained throughout recovery as the psychotherapist and client deem necessary. In other cases continuous contact is maintained, and the nutritionist and psychotherapist work together throughout the recovery process.

Usually clients will meet with a nutrition therapist once a week for a thirty- to sixty-minute session, but this is highly variable. In certain instances a client may want to meet with a nutritionist two or three times a week for fifteen minutes each time, or, especially as recovery progresses, sessions can be spread out to every other week, once a month, or even once every six months as a checkup, and then on an as-needed basis.

MODELS OF NUTRITION TREATMENT

Listed below are various treatment models that can be used with eating disordered clients depending on the severity of the clients illness and on the training and expertise of both the nutritionist and the psychotherapist.

FOOD PLAN ONLY MODEL

This involves a one- or two-session consultation where an assessment is made, specific questions are answered, and an individual food plan is designed.

EDUCATION ONLY MODEL

The nutritionist meets with the client six to ten times discussing various issues in order to meet the following five objectives:

• Collect a detailed history with relevant information in order to:

  • Determine the variety of and quantity of weight loss and eating disorder behaviors

  • Determine nutrient amount and intake patterns

  • Identify effect of behaviors on client's lifestyle

  • Develop treatment plans and goals

• Establish a collaborative, empathic relationship.

• Define and discuss principles of food, nutrition, and weight regulation, for example:

  • Symptoms and bodily responses to starvation

  • Metabolic shifts and responses

  • Hydration (water balance in the body)

  • Normal and abnormal hunger

  • Minimum food intake to stabilize weight and metabolic rate

  • How food and weight-related behaviors change during recovery

  • Optimal food intake

  • Set point

• Present hunger and intake patterns (calories included) of recovered persons.

• Educate the family on meal planning, nutrient needs, and effects of starvation and other eating disorder behaviors. Strategies for dealing with food and weight-related behaviors should be done in conjunction with the psychotherapist.