Eating disorders

Anthro

Ht

Wt

Current

Usual

Wt Hx

Wt loss/ gain % + timeframe

Pts desired wt

BMI

SGA

Psychosocial

Clinical

Classification

Diagnosis

Treatment

Hospital admission

Medical ward

Aetiology

Comorbidities

Complications of treatment

AN (anorexia nervosa)

BN (bulimia nervosa)

BED (binge eating disorder)

OSFED (other specified feeding or eating disorder)

Persistent energy restriction

Intense fear of gaining wt

Disturbance in self perceived wt or shape

Repeated episodes of binge eating

Compensatory behaviours

Excessive emphasis on body shape or wt

Repeated episodes of binge eating

Pts are often overwt/ obese

Self-induced vomiting

Excessive exercise

Laxatives

Pts may present with AN, BN, or BED symptoms

Do not meet full diagnostic criteria

Pts may present with a combination of:

Distorted body image

Extremely disturbed eating habits

Overevaluation of shape and wt

An intense fear of gaining wt

DSM-5

Criteria for admission:

Medical ward

Mental health ward

HR <40 or >100

BP <90/60 or >10mm postural drop with standing

Electrolyte disturbance

Failure of outpatient treatment

BMI <14kg/m2 (admit to medical ward if BMI is <12kg/m2)

Suicidality

Rapid wt loss

Biochem/ Medical tests

MNT for ED

RAVES

3 step plan for oral nutrition

Medical ward vs mental health ward

kJ targets

Four primary goals

Medical stabilisation

Prevention (and treatment) of re-feeding syndrome

Weight restoration

Reversal of cognitive starvation

Medical ward: commence 6300kJ 24/24 continuous NGF

Mental health ward: commence 6300kJ oral meal plan, low fibre

Gradual progression to goal nutrient intake by increasing 2000kJ every 2 days

3 main meals + 2 snacks

  1. Meal plan
  1. Supplement replacements
  1. Enteral feeds (bolus)

R: regularity

A: adequacy

V: variety

E: eating socially

S: spontaneity

Admission: 6300kJ (NGF or oral)

Day 3: 8400kJ

Day 5: 10,500kJ

Day 7: 12,600kJ

Day 9: 14,700kJ or transition to oral meal plan

Aim to reach goal energy requirements within 10 days

4 stage nutritional rehab program...

Re-feeding syndrome

High-risk of developing re-feeding if...

BMI <16kg/m2

Unintentional wt loss >15% within the last 3-6 months

Little or no nutritional intake for more than 10 days

Low levels of potassium, phosphate or magnesium prior to feeding

Supplement with thiamine and MVI

Consequences if left untreated

Malnutrition

T1DM

Coeliac Disease

Depression

Anxiety

Thiamine deficiency

Symptoms:

Muscle weakness

Muscle wasting

Cardiomegaly

Oedema

Tachycardia

Cessation of menstrual cycle

Oseteoporosis

Hair loss or excessive hair gross

Irregular HR

Kidney and liver damage

Low BGLs

Infertility

Anaemia

Bulling

MDT

Psychiatrists

Drs

Nurses

Dietitians

Previous illness resulting in wt loss

Depression and/or anxiety

History of abuse

NIS

Solid foundation for eating pattern

3 meals and 3 snacks

Adequate nutrition

Medical stability

Wt restoration

Nutritional rehab

Step outside of safe food list

Challenge eating behaviours

Eat across the food groups

Quality: food groups

Quantity: energy intake

Eating with others

Challenge social isolation and eating fears

Social re-engagement with friends and family

Flexibility in thinking

Outpatient treatment based on:

Compliance

Support at home

Environment

Readiness to change

Plasma Lipids: TC, LDL, HDL, TGs

FBC

?vitamin/ mineral deficiency

Bone density

BP

HR

Electrolytes: Na, K, PO, Mg, Ca

N/ C

V/ D: ?self-induced

Loss of appetite

Anorexia

Git disturbances

Slower peristalsis

?Constipation from laxatives

Hydration status

Metabolic acidosis or alkalosis

Albumin

Bullying

Self-esteem

Hx of abuse

Mental health status (anxiety, depression)

CRP

Perfectionist traits

Personal Hx

Living arrangements/ environment

Employment arrangements/ environment

Health behaviours (smoking/ alcohol)

Support (family, friends, partner)

ED hx

Hx of abuse (physical, emotional)

Cultural/ religious beliefs

Exercise habits

Current medications

Age

Gender

Friends/ family food beliefs

Diet

Diet hx

Food preferences

Food restrictions/ avoidances

Food

Fluid

?supplements

Dietary considerations

Eating and compensatory behaviours

Attitude to food and nutrition

Avoided food groups i.e. vegetarian eating

Food segregation (e.g. good vs bad food)

Trigger foods

Rituals and obsessive eating behaviours

Food combinations

Fluids, drinks and chewing gum

Duration, frequency, times, and locations of meals

Purging, laxatives, diuretics

Exercise

Nutrition goals

Address vitamin/ mineral deficiencies

Improve nutrition status

Weight maintenance/ restoration

Meet kJ requirements

Abdominal pain

Supplementation (thiamine and MVI)

RAVES

Beliefs/ attitudes to food and nutrition

Duration/ frequency of intake

Prevent re-feeding

Medical hx

Nutritional guidelines

All meals and snacks: 2 courses and a nutritional drink for wt restoration

All main meals should contain CHO

All main meals should contain Pro

Dairy 5-6 times per day

Fruit 2-3 times per day

Salad and veg to compliment main meals

Liberal use of fats/ oil