Symposium 8: Feeding size 0: The challenges of anorexia nervosa. Managing anorexia from a dietitian's perspective

The Retreat, York, UK.
Proceedings of The Nutrition Society (Impact Factor: 5.27). 06/2009; 68(3):281-8. DOI: 10.1017/S0029665109001281
Source: PubMed


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.

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Available from: Ursula Philpot, Aug 18, 2015
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    • "Other disciplines such as physiology and nutrition draw attention to biological processes (including neurological and endocrinological factors) that are associated with EDs or that trigger them. Their focus on micronutrient deficiencies, alterations in blood composition, hormonal balances, or even neurobiological vulnerabilities – although recognized as relevant (Kaye, 2008; Reiter & Graves, 2010) – does not eliminate the need for these investigations to justify their legitimacy in ED scholarship (Cockfield & Philpot, 2009). As recent studies have taken into account possible genetic risk factors at the individual level (Bulik et al., 2007; Hinney et al., 2004), other research areas, such as epigenetic and epidemiology studies, have explored the environmental and social dimensions of these disorders. "
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