Transcript Document

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Treatment often requires a long-term
interdisciplinary team approach
Nutrition therapy provided by a dietitian
trained in the area of eating disorders
plays a significant role in treatment and
management of eating disorders
The role of the nutrition therapist is to assist
with the normalization of the client’s
weight and eating behavior
Refer to Figure 16.1
 Assisting a client with an eating disorder
takes years rather than months
 Current research suggests that
approximately 46% of patients with
anorexia nervosa recover and 33%
improve while 50% of patients presenting
with bulimia nervosa recover and 30%
improve
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No counseling strategy is effective without
first establishing rapport with your client
 It is important for your client to see you as
knowledgeable
 The more you understand and empathize
with your clients, the greater likelihood of
establishing trust and bonding with them
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One of your goals will be to assist clients
in their motivation to make changes
The very first session often is crucial in
setting the stage for long-term outcome
It is important to utilize good interviewing
skills from the start and to avoid the
common traps that hinder progress
Assessment is a dynamic, comprehensive,
and organized system of gathering
information relevant to nutritional care of
your client
 It should identify contributing factors to the
eating disorder, starting points for therapy,
and whether goals are met along the way
 Assessment should be part of each session,
not just an activity for the first session
 Assessment questions should be presented in
a motivational fashion
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The initial medical evaluation of a client
with an eating disorder should include a
full physical examination performed by a
medical provider familiar with eating
disorders
This evaluation will assess vital signs,
physical growth and development, and
the physical signs of an eating disorder
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Low Blood Pressure
Seizures
Abnormal Heart Rhythm
Decreased Heart Rate
Anemia
Lowered Body
Temperature
Kidney Complications
Constipation
Scars on back of hand
Muscular weakness and
decreased muscle mass
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Painful Muscle Spasm
Swollen Feet
Decreased Sexual Drive
and Performance
Loss of Menstrual Cycle
Electrolyte Imbalance
Gastrointestinal Symptoms
Abnormal Liver Function
Regression of Breast
Development
Decreased Thyroid
Hormone
Increased Growth
Hormone
Cardiovascular
Changes
 Hematologic Changes
 Endocrine Changes
 Renal Function
Changes
 Lanugo Hair
 Muscle Atrophy
 Brain Changes
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Metabolic
Abnormalities
 Gastric Problems
 Osteoporosis
 Dental Problems
 Laxative Dependence
 Emetic Toxicity
 Swollen Glands
 Peripheral Edema
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When gathering a diet history, make sure the
client realizes your goal is not to judge but to
have a better understanding of his or her
food choices
 In order to obtain the most accurate
assessment of dietary intake the use of the
24 hour recall, a typical day recall, a food
frequency questionnaire, or a 3 to 7 day
food record are helpful tools
 Food records can provide meaningful
information, not only on types and quantities
of food eaten, but also patterns of intake
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Refeeding is a term often used when
discussing the weight-gaining phase of
treatment
 The refeeding process can be divided into
four phases
 During refeeding it is critical to work with the
medical professional and stay abreast of
vital signs, electrolytes, physical symptoms,
and weight changes to prevent refeeding
syndrome
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Refeeding syndrome is the series of
metabolic readaptation complications
brought about by the reintroduction of
fluids and nutrients after a period of
nutritional deprivation
The symptoms include swollen ankles,
shortness of breath, tiredness, and
anxiety
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It is important for your client to
understand that rebound edema is a
normal physiological side effect
May last for up to 10 days at which time
the body readjusts and the edema
subsides
Goal weight refers to the weight that will
restore normal physiological functioning
 Goal weight should approximate the
individual’s “set point”
 Set point refers to a weight range that the
client can maintain without needing to
restrict his or her intake or overexercise; a
weight where he or she is no longer
preoccupied with food
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It is unlikely that your client will comply with
this meal plan initially, but it will serve as the
goal to be accomplished as you work with
your client on cognitive behavioral exercises
 The objective of the meal plan is to provide
nutrient categories at structured intervals not
to exceed 6 hours
 Emphasize that you do not want clients using
diet foods
 Initially in treatment, avoid high-risk foods
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Ask the client to monitor thoughts, moods,
behaviors, and food intake
 Self-monitoring will enable the client to take
a closer look at his or her thoughts and
moods that precipitate eating disorder
behavior and will serve as the basis for
problem solving
 It is important to review the food record at
each session, always point out the positive
changes first
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Changing food attitudes and behaviors
in clients with eating disorders requires
knowledge and cognitive behavioral
strategies
Along with providing information about
food’s value to the body, you will also
help your client make the connection
between lack of food and current
symptoms.
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Nutrition-focused Cognitive-Behavioral
Therapy (CBT) involves teaching a
nutrition principle followed by techniques
to empower the client to change eating
behavior
CBT challenges the client’s irrational
belief system, and helps him or her make
positive changes in his or her life
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Filtering
Dichotomous Thinking
(Also referred to as
Black and White
Thinking)
Overgeneralization
Mind Reading
Catastrophizing
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Personalization
Discounting
Self-fulfilling Prophecy
“Shoulds”
Underlying
Assumptions
Decatastrophizing
Reattributon
Decentering
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Once the client has learned to identify his or
her distorted thinking, the client then can
begin to see how this way of thinking affects
emotions and behavior
The client then can move to re-evaluate his or
her current thought and underlying
assumption when asked 4 questions:
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What is the evidence to support or refute your current
thought?
What is the function of your thought? What do you
gain by holding on to that thought?
What are the implications of that thought?
What are the alternative explanations for your
thought?
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Do not assume the meaning of your
client’s words mirror your own
Conversely, your words may not be
interpreted literally
People with eating disorders may distort
the meaning of language as much as he
or she distorts body image
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Providing health care to individuals with chronic
illness in the current environment of cost
containment and outcome management has led to
a focused effort to move toward disease case
management
Chronic disease is defined as one that persists over a
long period
Almost 7 out of every 10 Americans who die each
year die of a chronic disease
A major contributing factor to the rising incidence of
chronic disease is the aging American population
The costs of chronic diseases are staggering
The increase in chronic disease means more
The health care team should be proactive
and integrated across time, place, and
condition when developing a chronic illness
care plan
 Interventions to improve outcomes for these
patients include:
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 The use of protocols and practice guidelines so
care is not erratic or outdated
 Improved patient education with emphasis on
self-monitoring
 Improved access to expertise
 Greater availability of clinical information
In 1997, the Nutrition Screening Initiative
(NSI) developed a nutrition care manual
specific to chronic disease care
 The NSI is a multidisciplinary coalition led
by the American Dietetic Association,
the American Academy of Family
Physicians, the the National Council on
Aging in collaboration with more than 25
national health and aging-related
organizations
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Patient-centered care emphasizes longterm, continuous, healing relationships
 Patients want to be partners in their own
care and receive more responsive care
from health care providers
 Care is individualized based on the
patient’s needs and values, and
emphasizes patient control in the health
care process
 Empowering patients through the provision
of information is at the heart of patientcentered care
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The Chronic Care Model is based on the
premise that functional and clinical
outcomes can be improved through
collaborative efforts among various
providers of healthcare
 Community
 Health Systems
 Self-Management Support
 Delivery System Design
 Decision Support
 Clinical Information Systems
Evidence-based practice is the reliance on
scientific data and the results of scientific
studies as the basis for practice decisions
 The goal of evidence-based practice is to
improve care using sound research
 It is important for dietetic practitioners to
have a systematic method for applying
new knowledge and research data,
regardless of practice setting, in order to
achieve quality outcomes
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