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Nutrition Counseling in the Treatment of Eating Disorders
Marcia Herrin and Maria Larkin have collaborated on the second edition of Nutrition Counseling in the Treatment of Eating Disorders, infusing research-based approaches and their own clinically-refined tools for managing food and weight-related issues. New to this edition is a section on nutrition counseling interventions derived from cognitive behavioral therapy-enhanced, dialectical behavioral therapy, family-based treatment, and motivational interviewing techniques. Readers will appreciate the state of the art nutrition and weight assessment guidelines, the practical clinical techniques for managing bingeing, purging, excessive exercise, and weight restoration as well as the unique food planning approach developed by the authors. As a comprehensive overview of food and weight-related treatments, this book is an indispensible resource for nutrition counselors, psychotherapists, psychiatrists, physicians, and primary care providers.
eBook
Alternative Viewpoint on National Institutes of Health Clinical Guidelines
The use of the National Institutes of Health (NIH)
Clinical Guidelines to guide assessment and treatment of overweight and obese patients is the source of considerable debate. The guidelines rely, in part, on research with methodological problems. The standard treatments for obesity outlined in the
Guidelines have not proven to be successful long term. Evidence suggests obesity may be a result of biochemical defects, not eating and exercise patterns. Dieting, one of the recommended treatments, is a known risk factor for development of an eating disorder. Further, there is no conclusive evidence that weight loss improves health outcomes. Nutrition education professionals need to develop approaches that improve health independently of weight loss for Americans seeking to lose weight.
Journal Article
Counseling Interventions
The inspiration for our counseling interventions comes from an eclectic mix of five different models, namely: cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), family-based therapy (FBT), motivational interviewing (MI), and, most recently, acceptance and commitment therapy (ACT). We chose these models for several reasons. In the beginning of our practices, CBT was the most revered and evidenced-based model for the treatment of eating disorders (EDs), namely, bulimia nervosa (BN). The well-thumbed chapters on CBT treatment for anorexia nervosa (AN) and BN in the Handbook of Treatment for Eating Disorders (2nd ed.; Garner, Vitousek, & Pike, 1997; Wilson, Fairburn, & Agras, 1997) and Fairburn, Marcus, and Wilson's (1993) comprehensive CBT treatment manual for BN and binge-eating disorder (BED) helped launch our evidence-based approach to nutrition counseling in the treatment of EDs. Although CBT has since fallen somewhat out of the limelight, we believe it to be \"the mother\" of the newer models and the foundation of our work. This is especially evident with the new enhanced version of CBT (CBT-Enhanced), which incorporates many of the nutrition counseling techniques we have used over the years, namely: educating about weight and ED symptoms; weekly weighing; realtime monitoring of eating behaviors; reducing evaluation of shape and weight on self-value; establishing a regular eating pattern; and maintaining and preventing relapse (Fairburn et al., 2009; Karbasi, 2010; Wagner & MacCaughelty, 2011; Wonderlich, 2009).
Book Chapter
Assessing Weight
In this chapter we outline how to estimate a patient's biologically appropriate weight (BAW), how to talk about weight issues, how to use body mass index (BMI) categories, and how to appropriately monitor weights throughout treatment. This information provides a framework for the following chapters on restoring weight, managing weight and managing bingeing, purging, and exercise behaviors. Although all team members address weight issues, usually it is the nutrition counselor's responsibility to assess and monitor weights and to educate patients about the biological facts that influence body weight. Weight monitoring is a helpful gauge of the adequacy of a particular food plan and it can reassure patients who worry that improving eating patterns will cause undesired changes in weight.
Book Chapter
Treating Binge Eating
Binge eating is defined as eating unusually large amounts of food while experiencing a lack of control over eating. Loss of control is assessed by asking, \"Did you have a sense of loss of control at the time?\" \"Could you have stopped eating once you had started?\" \"Could you have prevented the episode from occurring?\" (Wolfe, Baker, Smith, and Kelly-Weeder, 2009). Patients who binge eat may have a diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED). Some are overweight or obese and some not. Entrenched AN, especially if the body mass index (BMI) is less than 17.5, almost always includes bouts of binge eating (Lowe et al., 2011). It is important to note that binge eating is found in over 60% of AN patients and is known to delay or inhibit full recovery in AN (Tenconi, Lunardi, Zanetti, Santonastaso, & Favaro, 2006).
Book Chapter
Clinical Features of Eating Disorders
Eating disorders (EDs) are biologically-based mental disorders classified and defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 2000). This chapter relies on the DSM-IV and the soon to be published next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We conclude this chapter with a discussion of the most significant of the proposed DSM-5 criteria for EDs.
Book Chapter
Working with Families
This chapter describes our Parent-Assisted Meals and Snacks (PAMS) approach, a nutrition-counseling approach derived from the family-based treatment (FBT) research first conducted at the Maudsley Hospital in London in the 1980s and 1990s. Beginning in the mid-1990s, Stanford University launched a research initiative on FBT also known as the Maudsley approach or the Maudsley method. Published studies demonstrate the effectiveness of FBT for anorexia nervosa (AN) in children and adolescents, with full remission at both 12 months and 5 years (Lock, Le Grange, Agras, Moye, Bryson, & Jo, 2010). Recent studies show that the most powerful aspects of FBT lie in the parents taking control, being united, not criticizing the patient, and externalizing the ED (Ellison et al., 2012). The publication of several FBT treatment manuals for AN and bulimia nervosa (BN; Lock, Le Grange, Agras, & Dare, 2001; Le Grange & Lock, 2007) led to the establishment of FBT programs in university centers in the United States, Canada and Australia. FBT is a based on the five tenets listed in Box 13.1 (Lock, 2011, p. 232).
Book Chapter
The Process of Counseling
Nutrition counselors who treat patients with eating disorders (EDs) benefit from understanding the dynamics of counseling this complex population. As an overview, we have included the Academy of Nutrition and Dietetics position statement's outline of the clinical responsibilities of nutrition counselors who treat patients with EDs (see Box 3.1; Ozier & Henry, 2011). The rest of this chapter 60delves deeply into the counseling process, highlighting the ethics of counseling and the management of psychotherapeutic issues that often arise during the nutrition counseling process. We offer guidelines about co-morbid illnesses that frequently affect patients with EDs and how these illnesses impact nutrition counseling. Finally, we include a section on body-image disturbance, as this feature is a diagnostic criterion of EDs and is intertwined with the food, weight, and shape issues that are in the scope of practice for the nutrition counselor.
Box 3.1
Code of Ethics for Nutrition Counselors
The dietetics practitioner conducts himself/herself with honesty, integrity, and fairness.
The dietetics practitioner supports and promotes high standards of professional practice.
The dietetics practitioner accepts the obligation to protect patients, the public, and the profession by upholding the Code of Ethics for the Profession of Dietetics and by reporting perceived violations of the Code through the processes established by ADA and its credentialing agency, CDR.
Note: Fundamental principles of the code of ethics for nutrition counselors. Reprinted from \"American Dietetic Association/Commission on Dietetic Registration Code of Ethics for the Profession of Dietetics and Process for Consideration of Ethics Issues,\" by American Dietetic Association, 2009, Journal of the American Dietetic Association, 109, p. 1461. Copyright 2009 by American Dietetic Association. Reprinted with permission.
Book Chapter