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Nutrition and Dietetics: Eating disorders - Coggle Diagram
Nutrition and Dietetics: Eating disorders
care pathway
primary care then outpatient clinic. May directly or over time be trasnferred to SEDU (specialist ED unit) or inpatient
often see ED patients diagnosed or undiagnosed in acute gastro wards, paed wards, diabetes, mental health
Aims of treatment: regular eating, restore weight and nutrition, least restrictive options, reduce refeeding risk
need to be gaining weight at the same time as psychotherapy with anorexia for successful treatment
treatment options/ methods
can give supplements to meet micronutrient deficit in short term with long term ai to meet this with food (ARFID)
ARFID vs anorexia- absence of fear surrounding body weight and shape
weight loss should not be a goal in any patient with an ED
RAVES Model- pathway for working with eating disorders in outpatient setting. start with regularity and build up
Regularity- eating regular meals (x3 daily, reduces hypoglycaemia which increases binge eating)
Adequacy-- nutritional adequacy of diet
Variety-
eating socially (often patients first choice)
spontaniety
Intuitive eating practices
Psychoeducation- (ask for permission to give info. first with patients)
Minnesota experiment- when refed, improvements with physical symptoms when re-fed but psychological symptoms improved later = although starved against own will which is different to ED, same effect seen in ED patients
Maslows hierarchy- need to give ED patients basic needs (nourishment) before psycholgical/ self-actualisation
Dietary advice-
regular eating, wide variety (breaak rules), do not follow eatwell guide,
patients often want a guide to follow- Dietitian Association Australia 'The Real Food Guide' - high energy, sugar, fat foods are important part of fun and social eating
Energy graph typical in eating disorders- drops in blood sugar/hypoglycaemia from starvation result in liklihood of binging and rapid rise as a result= normalise this with ED pateitns
weight expectations
0.5-1kg/week OP, 1-1.5kg/week IP
NICE 2017- No longer reccomends average guide for weight gain
Watch out for compensatory behaviours
hiding weight in hiar, legs
heavy clothing, jewellery
how often they weight themselves?
refusing to be weighed? weigh blind, non-negotiable rule. good for understanding that weight will not gain rapidly in one week (often patients fear extremely rapid weight gain 5-10kg in a week)
MUAC to determine , sometimes have to negotiate
if not losing weight, why? Laxatives, exercise, purging behaviours
Treatment inpatient
prefer to treat at home- not 'real world' so don't face challeneges to overcome like news/diet culutre/ family and friends, sense of identity outside of ED not present
younger people- maudsley model
adults- talking therapy and weight restoration
CBT-E model (goal focused talking theraoy), address influence of thoughts on behaviour
patients discharged <18.5 had 100% chance of re-admission
over evaluation of shape and weight and their control is cetnral to maintenance of all eating disorders- if whole self-worth is about how you look and bad comment made, disorder will rapidly worsen= NEED TO ADDRESS CORE MAINTAINING BELIEFS
refeeding- use MEED guidelines (not 5-10kcals)
MEED (May 2022)= Mangement of Medical Emergencies in eating disorders