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Nutrition assessment: Identify nutrition problems that relate to medical or physical condition, including eating disorder symptoms and behaviors.

  • Perform anthropometric measurements; including height and weight history, complete growth chart, assess growth patterns and maturation in younger patients (ages 20 years and younger)

  • Interpret biochemical data; especially to assess risk of refeeding syndrome

  • Evaluate dietary assessment; eating pattern, core attitudes regarding weight, shape, eating

  • Assess behavioral-environmental symptoms; food restriction, bingeing, preoccupation, rituals secretive eating, affect and impulse control, vomiting or other purging, excessive exercise

  • Apply nutrition diagnosis and create a plan to resolve nutrition problems, coordinate plan with team members

Nutrition intervention: Calculate and monitor energy and macronutrient intake to establish expected rates of weight change, and to meet body composition and health goals. Guide goal setting to normalize eating patterns for nutrition rehabilitation and weight restoration or maintenance as appropriate.

  • Ensure diet quality and regular eating pattern, increased amount and variety of foods consumed, normal perceptions of hunger and satiety, and suggestions about supplement use

  • Provide psychosocial support and positive reinforcement; structured refeeding plan

  • Counsel individuals and other caregivers on food selection considering individual preferences, health history, physical and psychological factors, and resources

Nutrition monitoring and evaluation: Monitor nutrient intake and adjust as necessary.

  • Monitor rate of weight gain, once weight restored, adjust food intake to maintain weight

  • Communicate individual’s progress with team and make adjustments to plan accordingly

Care coordination: Provide counsel to team about protocols to maximize tolerance of feeding regimen or nutrition recommendations, guidance about supplements to ensure maximum absorption, minimize drug nutrient interactions, and referral for continuation of care as needed.

  • Work collaboratively with treatment team, delineate specific roles and tasks, communicate nutrition needs across the continuum of settings (eg,

inpatient, day treatment, outpatient)

  • Act as a resource to other health care professionals and the family, provide education

  • Advocate for evidenced-based treatment and access to care

Advanced training: Seek specialized training in other counseling techniques, such as cognitive behavioral therapy, dialectical behavior therapy, and motivational interviewing.

  • Use advanced knowledge and skills relating to nutrition, such as refeeding syndrome, maintaining appropriate weight and eating behaviors, body image, and relapse prevention

  • Seek supervision and case consultation from a licensed mental health professional to gain and maintain proficiency in eating disorders treatments

Figure 2. Roles and responsibilities of registered dietitians caring for individuals with eating disorders. Data from references (3-6,14,15).

ciated complications is early identifica- tion of altered eating patterns and distorted body image, which may be re- vealed through questions with pre- teens and adolescents, as well as with adults (6,18,20).

Comorbid Illness and EDs

Patients with EDs often experience other psychiatric disorders (3,21). Axis I psychiatric disorders (including de- pression, anxiety, body dysmorphic dis- order, or chemical dependency) and Axis II personality disorders (particu- larly borderline personality disorder) are frequently seen in the ED popula- tion (3,4,21). The characteristics of these conditions increase the complex- ity of treatment and necessitate addi- tional counseling skills.

Emerging Patterns of EDs

Two areas of research on the course of EDs include the range of ED symp-

toms and problems associated with unhealthy weight management prac- tices that can be associated with in- creased risk of binge eating and purg- ing behaviors (22). Proposed changes in diagnostic criteria for binge eating include the number of binge days (eg, subthreshold binge eating with at least two uncontrollable binge eating episodes or days per month for at least 3 months) (3,20). Further de- scription of purging disorder and night eating syndrome is under re- view (2,20). The trend of orthorexia nervosa (not officially recognized in the fourth edition of the Diagnostic and Statistical Manual of Mental Dis- orders), an unhealthful fixation about eating so-called healthful foods, ap- pears to be on the rise (23). The rise in hospitalizations affecting men, women, and younger-aged children and restric- tive eating practices in athletes point to increased need for ED prevention and care (24,25).

Insurance Coverage for EDs

Health care reimbursement and utili- zation affects availability, accessibil- ity, and quality of care for EDs (4). Health care providers, including RDs, need to understand health insurance limitations to maximize the treatment benefits to individuals with EDs. Na- tional legislation such as the previously proposed Federal Response to Elimi- nate Eating Disorders Act would ad- dress treatment as well as prevention, research, and education needs. Ongo- ing priorities for RDs include educating insurance companies and policy mak- ers about treatment needs for EDs, participating in cost-effectiveness anal- yses and outcome studies, and under- standing how to navigate and guide families through the health insurance system.

TREATMENT GUIDELINES FOR EDS

EDs require a collaborative approach by an interdisciplinary team of men-

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August 2011 Volume 111 Number 8

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