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Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Eating Disorders

ABSTRACT It is the position of the American Di- etetic Association that nutrition inter- vention, including nutritional counsel- ing by a registered dietitian (RD), is an essential component of team treatment of patients with anorexia nervosa, bu- limia nervosa, and other eating disor- ders (EDs) during assessment and treatment across the continuum of care. Diagnostic criteria for EDs pro- vide important guidelines for identifi- cation and treatment. In addition, indi- viduals may experience disordered eating that extends along a range from food restriction to partial condi- tions to diagnosed EDs. Understand- ing the roles and responsibilities of RDs is critical to the effective care of individuals with EDs. The complexi- ties of EDs, such as epidemiologic fac- tors, treatment guidelines, special populations, and emerging trends highlight the nature of EDs, which require a collaborative approach by an interdisciplinary team of mental health, nutrition, and medical spe- cialists. RDs are integral members of treatment teams and are uniquely qualified to provide medical nutrition therapy for the normalization of eat- ing patterns and nutritional status. However, this role requires under- standing of the psychologic and neu- robiologic aspects of EDs. Advanced training is needed to work effectively with this population. Further efforts with evidenced-based research must continue for improved treatment out- comes related to EDs, along with identification of effective primary and secondary interventions.

This paper supports the “Practice Paper of the American Dietetic Asso- ciation: Nutrition Intervention in the

0002-8223/$36.00 doi: 10.1016/j.jada.2011.06.016

Treatment of Eating Disorders” pub- lished online at www.eatright.org/ positions. J Am Diet Assoc. 2011;111: 1236-1241.

POSITION STATEMENT

It is the position of the American Di- etetic Association that nutrition inter- vention, including nutrition counsel- ing by a registered dietitian, is an essential component of the team treat- ment of patients with anorexia ner- vosa, bulimia nervosa, and other eat- ing disorders during assessment and treatment across the continuum of care.

E ating disorders (EDs) are psychi- atric disorders with diagnostic cri- teria based on psychologic, behav- ior, and physiologic characteristics. Diagnostic criteria from the fourth edi- tion text revision of the Diagnostic and Statistical Manual of Mental Disorders provide important guidelines for iden- tification and treatment of EDs (1). However, there is considerable vari- ability in the severity and the type of EDs. A comparison of diagnostic cri- teria with proposed revisions for the newest Diagnostic and Statistical Manual of Mental Disorders edition (Figure 1) notes binge eating disorder as an independent condition and identifies diagnostic thresholds that reflect current research (1-3). Further- more, disordered eating may exist along a range of symptoms from food restriction to partial conditions and then to full syndromes within the de- fined ED. Of special interest is the mul- tidisciplinary approach in the clinical care of individuals with EDs and the significant role nutrition care plays in the prevention of EDs and related complications.

ROLES AND RESPONSIBILITIES OF REGISTERED DIETITIANS

A registered dietitian’s (RD’s) role in the nutrition care of individuals with EDs is supported by the American Psychological Association, the Acad- emy for Eating Disorders, and the American Academy of Pediatrics (4- 6). RDs working with ED patients need a good understanding of profes- sional boundaries, nutrition interven- tion, and the psychodynamics of EDs (Figure 2). An RD may be the first to recognize an individual’s ED symp- toms or be the first health care pro- fessional consulted by a patient for this condition. RDs apply the Nutri- tion Care Process to identify nutrition diagnoses and develop a plan for res- olution (7). Key nutrition therapies require expertise in nutritional re- quirements for the life stage of the affected individual, nutritional reha- bilitation treatments, and modalities to restore normal eating patterns.

Multiple components of nutrition assessment performed by RDs can contribute to treatment plans. For ex- ample, a food history may be more practical than laboratory tests and more accurate than current food in- take for determining potential micro- nutrient deficiencies, specifically in anorexia nervosa and bulimia ner- vosa (8). Motivation or readiness to change, determined by motivational interviewing, can be used by an RD as a client-centered, collaborative ap- proach to enhance intrinsic motiva- tion to change (9). Lower readiness to change has been associated with low weight status (10). For individuals with anorexia nervosa, weight gain rate during inpatient treatment ap- pears to be a potential predictor of outcome (11). Advanced training and alignment with team members assist RDs in meeting the challenges of car- ing for individuals with EDs (12).

1236

Journal of the AMERICAN DIETETIC ASSOCIATION

© 2011 by the American Dietetic Association

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