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ing vs universal or primary preven- tion approaches (34). To promote body acceptance and lessen risk of disordered eating, RD messages should support health-centered be- haviors, rather than weight-cen- tered dieting (23).

Alternative Therapy

Alternative therapy studies include both cost-effectiveness and clinical out- comes with alternative treatments in EDs. Researchers developed the Com- munity Outreach Partnership Program (COPP) to address the needs of individ- uals who struggled with traditional in- terventions (35). COPP assists clients to enhance quality of life by fostering independence, increasing hope, and en- hancing social skills in the context of a client’s economic, social, and physical living environment using hospital and community services. Preliminary re- sults revealed decreased ED and psy- chiatric symptoms with 4 or more months of COPP. In addition, inter- ventions using yoga, stress manage- ment skills, spirituality, and religios- ity may lead to alternative thoughts and behaviors to reduce food preoccu- pation, mealtime anxiety, and disor- ders related to food (7,35). Also, tele- medicine and internet-based delivery offer potential for individuals with bulimia nervosa and eating disorders not otherwise specified short versions of CBT in conjunction with self-help (35).

Pharmacotherapy

To date, no medications have Food and Drug Administration approval for the specific treatment of anorexia nervosa. Medication use for anorexia nervosa focuses on either reducing anxiety or alleviating mood symp- toms to facilitate refeeding. Different proposed regimens relate to the treat- ment goals of weight restoration and weight maintenance phases. For ex- ample, evidence suggests that selective serotonin reuptake inhibitors may be efficacious during the maintenance phase of treatment, although not in weight restoration, due to the hypose- rotonergic state caused by starvation (36).

Pharmacotherapy appears to re- duce eating disordered behavior and improve mood in patients with buli- mia nervosa when augmented with

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CBT. Currently, fluoxetine is the only medication with Food and Drug Ad- ministration approval for bulimia nervosa treatment (37). However, for patients who have not been previ- ously treated and are not severely de- pressed, psychotherapy often is at- tempted and evaluated prior to initiating medication management. Research is ongoing with the role that medications play in the treatment of EDs.

CONCLUSIONS

Ongoing efforts aim to identify evi- denced-based therapies to improve treatment outcomes related to EDs and effective primary and secondary interventions. Essential priorities for RDs include collaboration and com- munication skills, advanced training, and an understanding of the complex- ities and sensitivities of eating behav- iors. Also of note, risks for eating pa- thology increase with dietary changes and weight management efforts. As RDs participate in limiting the pro- gression of EDs, they can support ef- forts for sustainable outcomes for ED prevention, intervention, and treat- ment.

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