/
Eating Disorders:  What Dietitians should know and considerations for prevention in our Eating Disorders:  What Dietitians should know and considerations for prevention in our

Eating Disorders: What Dietitians should know and considerations for prevention in our - PowerPoint Presentation

harmony
harmony . @harmony
Follow
348 views
Uploaded On 2022-06-01

Eating Disorders: What Dietitians should know and considerations for prevention in our - PPT Presentation

Laurie Fortlage MS RD CS Mott Childrens Hospital httpscreatekahootitshareeatingdisordersmythsvsfacts3f5defe171bb4daf84399f5014b77901 Objectives Eating Disorder Diagnoses Identifying Eating Disorders in your office ID: 913195

disorder eating disorders weight eating disorder weight disorders food binge eat screening behaviors loss environment body calories client feel

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Eating Disorders: What Dietitians shoul..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Eating Disorders: What Dietitians should know and considerations for prevention in our own practices

Laurie Fortlage, MS, RD

C.S. Mott Children’s Hospital

Slide2

https://create.kahoot.it/share/eating-disorders-myths-vs-facts/3f5defe1-71bb-4daf-8439-9f5014b77901

Slide3

ObjectivesEating Disorder DiagnosesIdentifying Eating Disorders in your officeAssessment tools

Treatment

Promoting environments and Acting in ways that do not promote disordered eating or thoughts about eating

Slide4

What is an Eating Disorder?Eating Disorders are neurobiological disorders rooted in the brain causing medical and psychological issuesThey are NOT a choice and not simply about control or weight management

Genetics, Environment, Temperament all play a role

Experienced by all genders, body sizes, SES

Slide5

Types of Eating Disorders Anorexia Nervosa (AN)Restriction of energy intake; Body image disturbance

Bulimia Nervosa (BN)

Recurrent binge eating episodes and compensatory behaviors that are meant to prevent weight gain

Binge Eating Disorder (BED)

Recurring and persistent episodes of binge eating with the absence of regular compensatory

behaviors

Other Specified Eating or Feeding Disorders (OSFED)

Symptoms of an eating disorder but don’t meet full

criteria

Avoidant Restrictive Food Intake Disorder (ARFID)

Limitations on the amount or types of food intake; without distress about body shape or size or fears of fatness

Slide6

Etiology of EDsImpossible to know the exact cause/causesOften referred to as the “Perfect Storm” of:

Environment

Genetics

Temperament

Stress activates this combination of

events

Individuals manage the stress by controlling food intake

Many have underlying anxiety disorders

Can’t treat the anxiety disorder until the person is nourished

Slide7

Screening

Slide8

Check your AssumptionsANY client can have or

could develop

an eating disorder

Don’t assume that by looking at someone you will know. EDs are

rarely

recognized by how someone looks

Initially assess in your usual manner, and keep an eating disorder in the back of your mind

EDs can’t exist if they can’t keep it a secret

Do no harm

Slide9

How does a client with an eating disorder show up in your practice?GI disturbances – IBS, food sensitivities, stomach pain, bloatingAthletes

New Vegetarians/ Vegans

Lengthy or complicated dieting histories

DM, Type 1 (

diabulimia

)

“Picky Eating”; Autism Spectrum; ARFID

Bariatric Surgery Patients

Polycystic Ovarian Syndrome

Slide10

AN TraitsPerfectionismPersonal self-imposed standards

Anxiety

OCD

tendencies

Rigid thinking

Risk avoidant

Experiential avoidant

Rule followers

Slide11

BN TraitsImpulsiveCompulsive

Novelty – Seeking

More likely to have a chaotic environment

Slide12

What to look for….Are they seeking weight loss? Weight history, desired weight

Do they count calories? What happens if they eat more than their goal for the day/meal?

Do they ever feel out of control around food?

Are there foods they won’t eat because of a belief or rule? Is there flexibility around this?

Do they “save” their calories for later in the day?

Will they eat food they haven’t prepared or don’t know the ingredients and/or calories of?

Do they avoid events with food or eating with other people?

Slide13

What to look for…..Food rituals; food rigidity

Do they ever sneak food? Have they lied about having something or not having something?

Do they feel the need to compensate for the calories they ate?

Are they weighing themselves? How often are they weighing themselves? How does weight impact their food choices, mood for the rest of the day?

Do they ever feel guilty or shameful during or after eating?

What happens if they eat more than they wanted?

Slide14

Screening tools for Eating DisordersEating Attitudes Test (EAT-26)EDGE Symptom SurveyBED Screening

Female Athlete Screening Tool (FAST)

SCOFF

Eating

Disorder Screening Tool for Primary

Care

(ESP)

Slide15

Eating Attitude Test (EAT 26)https://www.seattlechildrens.org/globalassets/documents/healthcare-professionals/pal/ratings/eat-26-rating-scale.pdf

Slide16

Binge Eating Disorder Screener (BEDS-7)https://www.vyvansepro.com/documents/Adult-Binge-Eating-Disorder-Patient-Screener.pdf

Slide17

Female Athlete Screening Tool (FAST)https://uhs.nd.edu/assets/165496/female_athlete_screening_tool_2011_12.pdf

Slide18

SCOFF QuestionnaireThe SCOFF questions* Do

you make yourself

S

ick because you feel uncomfortably full?

Do

you worry you have lost

C

ontrol over how much you eat?

Have

you recently lost more than

O

ne stone (14

lbs

) in a 3 month period?

Do

you believe yourself to be

F

at when others say you are too thin?

W

W

ould

you say that

F

ood dominates your life

?

*One point for every “yes”; a score of 2 indicates a likely case of anorexia nervosa or bulimia

Morgan

, Reid, Lacey, “The SCOFF questionnaire: assessment of a new screening tool for eating disorders,” British Medical Journal (BMJ), 319(7223): 1467–1468, December, 1999.

Slide19

Eating Disorder Screening Tool for Primary Care (ESP) Are you satisfied with your eating patterns? (A “no” to this question was classified as an abnormal response).

Do

you ever eat in secret? (A “yes” to this and all other questions was classified as an abnormal response). •

Does

your weight affect the way you feel about yourself? •

Have

any members of your family suffered with an eating disorder? Do you currently suffer with or have you ever suffered in the past with an eating disorder?

Cotton

, Ball, Robinson, “Four Simple Questions Can Help Screen for Eating Disorders” Journal of General Internal Medicine,18(1): 53–56, January, 2003.

Slide20

Assessment

Slide21

Assessment ToolsHealth history, family historyLifestyle assessment including social impact of eating disorder

Review of lab results to assess nutrient status

Food

i

ntake assessment and analysis

Meal Planning

Metabolic assessment (RMR) and estimated needs analysis

Slide22

Consequences of UndernutritionMedical Instability Vital Sign Abnormalities

Adaptive, compensatory response to malnutrition

“Hibernation Mode”- hypothermia, hypotension, hypoglycemia

Slide23

Consequences of UndernutritionBradycardia <60 bpmHeart muscle atrophy

Severe Sinus Bradycardia <50 bpm

Often <45 while sleeping

Glucose < 60 high risk

Low glucose is a result of depletion of glycogen scores

Cold extremities

Edema

Lanugo

Hair Loss

Slide24

Consequences of UndernutritionAmenorrheaNot always present even in critically ill clients

Osteopenia

With AN body loses bone secondary to low estrogen

Weight restoration is the gold standard

Birth control pill are not helpful

Keep

Vit

D levels > 30 ng/UL

Slide25

Consequences of Undernutrition GastroparesisEmptying 5x slower

Decreased peristalsis

Early fullness, bloating, gassiness, nausea

Frequent meals

Challenge “safe” versus dense

foods

Brain

Loss of gray matter

Serotonin and dopamine receptors impaired (pleasure/pain/reward)

Slide26

4 C’s of MalnutritionCold

Crabby

Constipation

Poor Circulation

Slide27

Treatment

Slide28

Anorexia NervosaInitial goal: adequate

calories; dense foods are predictive of recovery outcomes

Normalized

and balanced eating will come in time

Meet

them where they are

*

Full weight restoration*

90

% IBW- about 50% relapse

%

body fat better predictor than BMI/Weight

Intuitive

Eating---takes time

Slide29

Anorexia NervosaExtremely high calorie

need

Require

more calories to maintain the rate of weight gain

Post

weight restoration, these clients require more calories to maintain their weight

Hyper-metabolism

usually lasts 3 to 6 months, but can last up to a year after weight restoration

Slide30

Bulimia NervosaRecurrent binge episodes

Recurrent

use of inappropriate behaviors to prevent weight gain

Both

B/P occur on average, >1/week for 3 months

Self-evaluation

focused on weight/shape

Does

not meet criteria for Anorexia

Slide31

Bulimia NervosaInitial goal is to stop the purging cycle

Often

5 pound weight gain once purging stops. Fluid shifts

Regular

meals and snacks

Need

satisfying foods: fat

Find

the sweet spot: not too hungry/not too full

Slide32

Binge Eating DisorderReoccurring episodes of eating large amounts of food

Feelings of loss of control during binge episode, as well as marked distress

Binge episodes occur on average >1x/week for 3 months

Slide33

Binge Eating DisorderAssess timing of food intakeRegular meals and snacks

Mindful eating with focus on food

Structure areas for eating

Pacing

Weight loss is not the primary goal – leads to shame and keeps people in disordered eating patterns which increases the change of binging

Slide34

What to do about WeightsThe weight of the client is not the only issue or even the main issueCrucial to develop trust

Set up plan ahead of time with client

Clients who should always be weighed: AN, laxative abuse, purging, just out of treatment center

Slide35

Determining Expected Body Weight

Set at least a 5 pound range – understanding this may change along the way

Growth charts

Weight history

When do behaviors and thoughts begin to diminish?

Don’t aim too low

Slide36

Working with ClientsPatients are hesitant to trustSecretive disorder

Has been the driving force of their life

You

won’t automatically be seen as an ally – even if they initiated the appointment

There is a paradox of not wanting to give up the eating disorder and also not wanting to work with someone the eating disorder can fool

They want to know you’re on their side while still challenging their eating disorder thoughts and behaviors

You cannot work on weight loss and recovery from an eating disorder at the same time

Separate the eating disorder from the person

Eating disorder will behave in ways the person client wouldn’t

Feel shameful of their eating disorder behaviors

Slide37

Working with ClientsPay attention to your own assumptions

Be

neutral until you know their reaction

Know what matters to your patients – you can use this to make challenges

relevant

Learn to sit in silence with your clients

Listen to what’s not being said

Learn to ask questions differently (sometimes normalizing ED behaviors so they know you won’t be shocked/judge them)

Don’t jump in and try to fix things

Meet them where they are – let them be involved in decision making while also understanding what’s not negotiable

Actions follow thoughts

Slide38

Create a Safe Environment for your ClientsHumor, kindness, compassion and empathyTough fairnessSafe environment for client to show frustration and anger

Environment to share and process the relationship with the eating disorder and support them to use alternative behaviors to cope

Explore and understand maladaptive thinking patterns that are directed at the behaviors and understanding the disease

Don’t be afraid of the client.

Slide39

Treatment TeamWe cannot work with these clients aloneMulti-disciplinary team of Therapist, Physician, Psychiatrist if neededIdeally the team should be specialist in eating disorders

Obtain release of information to speak to all treatment team members

Talk with clients ahead of time about talking with parents, care takers, spouses

Slide40

9 Truths about Eating Disorders#

1:

 Many people with eating disorders look healthy, yet may be extremely ill.

#

2:

 Families are not to blame, and can be the patients’ and providers’ best allies in treatment.

#

3:

 An eating disorder diagnosis is a health crisis that disrupts personal and family functioning.

#

4:

 Eating disorders are not choices, but serious biologically influenced illnesses.

#

5:

 Eating disorders affect people of all genders, ages, races, ethnicities, body shapes

and weights

, sexual orientations, and socioeconomic statuses.

#

6:

 Eating disorders carry an increased risk for both suicide and medical complications.

#

7:

 Genes and environment play important roles in the development of eating disorders.

#

8:

 Genes alone do not predict who will develop eating disorders.

#

9

: Full recovery from an eating disorder is possible. Early detection and intervention are important.

Produced in collaboration with Dr. Cynthia

Bulik

, PhD, FAED and the 

Academy for Eating

Disorders

, along with other major eating disorder organizations.

Slide41

Prevention of eating disordersPatient centered careThink about the language and terms that we useBroaden the focus; weight is not a behavior we can change

Focus on the person – we are all unique

All weight loss is not good weight loss

Changing a client’s food intake or restriction removes a coping mechanism. Be prepared to help find alternatives and/or work closely with the client’s team so that someone is supporting them