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

Written by HealthyPlace.com Staff Writer

THE EDUCATION/BEHAVIOR CHANGE MODEL

This model necessitates that the nutritionist has special training and experience in treating eating disorders.

Education Phase. This comes first and early in treatment (see education model above).

Behavior Change or Experimental Phase. The second, or experimental, phase of this model begins only when the client is ready to work on changing food and weight-related behaviors. Sessions with the nutritionist are intended to be the forum for planning strategies for behavior change, thus freeing psychotherapy sessions for exploration of psychological issues. The primary objectives are:

• Separate food and weight-related behaviors from feelings and psychological issues.

• Change food-related behaviors slowly until intake patterns are normalized. Behavior change is most effective when coupled with education. Treatment must be individualized and not oversimplified. Clients will need constant explanation, clarification, reiteration, repetition, reassurance, and encouragement. Topics that will need to be covered include the following:

  • Being purge free or eating better for months does not mean recovery.

  • Setbacks are normal and are learning opportunities.

  • Self-monitoring techniques should be chosen and used carefully.

  • Target specific medical or cosmetic concerns first (results are easier to see).

  • Make changes little by little.

• Slowly increase or decrease weight. Proceeding too quickly may cause the client to become defensive and withdraw.

• Learn to maintain a healthy weight without abnormal or destructive behaviors.

• Learn to be comfortable in social eating situations (usually in later stages of recovery). Changes in social eating habits can be directly related to eating and weight issues but can also be due to relationship difficulties in general. (Refusing to eat may be a way of controlling the family or avoiding abuse or embarrassment.)

THE INTERMITTENT CONTACT MODEL

Intermittent contact with the dietitian (who is trained in eating disorders) is maintained throughout recovery, as the client and the psychotherapist deem necessary.

CONTINUOUS CONTACT MODEL

Both the therapist and the dietitian work together with the client throughout the recovery process.

NUTRITIONAL SUPPLEMENTATION AND EATING DISORDERS

It is common sense to assume that individuals who restrict or purge their food may have specific nutrient deficiencies. There has even been some question and research as to whether certain deficiencies existed before the development of the eating disorder. If it were determined that certain deficiencies predisposed, or in some way contributed to, the development of eating disorders, this would be valuable information for treatment and prevention. Regardless of which came first, nutritional deficiencies should not be overlooked or undertreated, and correcting them must be considered a part of an overall treatment plan.

The area of nutrient supplementation is a controversial one even in the general population and even more so for eating disordered individuals. First, it is difficult to determine specific nutrient deficiencies in individuals. Second, it is important not to impart to clients that they can get better by the supplementation of vitamins and minerals instead of the necessary food and calories. It is common for clients to take vitamins, trying to make up for their inadequate intake of food. Vitamin and mineral supplements should be recommended only in addition to the recommendation of an adequate amount of food.

However, if supplements will be consumed by clients, especially when adequate food is not, the least that can be said is that clinicians may be able to prevent certain medical complications by prudently suggesting their use. A multivitamin supplement, calcium, essential fatty acids, and trace minerals may be useful for eating disordered individuals. Protein drinks that also contain vitamins and minerals (not to mention calories) can be used as supplements when inadequate amounts of food and nutrients are not being consumed. A professional should be consulted regarding these matters. For an example of how future research in the area of specific nutrients may be important in the understanding and treatment of eating disorders, the following section on the relationship of zinc deficiency to appetite disturbance and eating disorders has been included.

ZINC AND EATING DISORDERS

A deficiency of the mineral zinc in eating disordered patients has been reported by several researchers. It is a little-known fact that a deficiency in the mineral zinc actually causes loss of taste acuity (sensitivity) and appetite. In other words, zinc deficiency may contribute directly to reducing the desire to eat, enhancing or perpetuating a state of anorexia. What may start out as a diet motivated from a desire, whether reasonable or not, to lose weight, accompanied with a natural desire to eat, may turn into a physiological desire not to eat, or some variation on this theme.

Several investigators, including Alex Schauss, Ph.D., and myself, who coauthored the book Zinc and Eating Disorders, have discovered that through a simple taste test reported years ago in the English medical journal The Lancet, most anorexics and many bulimics seem to be zinc deficient. Furthermore, when these same individuals were supplemented with a certain specific solution containing liquid zinc, many experienced positive results and, in some cases, even remission of eating disorder symptoms.

More research needs to be done in this area, but until then it seems fair to say that zinc supplementation looks promising and, if done wisely and under the supervision of a physician, may provide a substantial benefit with no harm. For more information on this topic, consult Anorexia and Bulimia, a book I wrote with Dr. Alexander Schauss. This material explores nutritional supplementation for eating disorders and specifically how zinc is known to affect eating behavior, how to determine if one is zinc deficient, and various reported results of zinc supplementation in cases of anorexia nervosa and bulimia nervosa.