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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
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
Managing Purging
Purging, especially self-induced vomiting, is a difficult behavior to extinguish. Patients usually agree when we say that purging is the eating-disorder (ED) behavior that is most addicting. We respectfully acknowledge that purging may seem like a logical solution to a number of problems. Besides an ersatz weight-management tool, purging provides short-term relief of anxiety, resulting in relaxation, exhilaration, and even a sense of \"purity.\" To be effective with patients who purge, we find that we must be sympathetic, tolerant, and understanding of each patient's difficulties, particularly his or her embarrassment about purging. We keep in mind that correcting purging behaviors takes much effort on the patient's part and constant encouragement and help with problem-solving on our part. In this chapter, we define and describe purging behaviors (see Chapter 1: Clinical Features of Eating Disorders, pp. 3-31) and then devote the rest of the chapter to describing approaches we use to help patients become free of the compulsion to purge.
Book Chapter
Restoring Weight
We begin this chapter by defining weight restoration and by describing the well-documented metabolic and physical challenges to weight restoration. Next, we discuss the four phases of the weight restoration protocol we have developed over the course of years of clinical practice. We also include a detailed section on the art and science of setting weight goals. The chapter concludes with a discussion of weight restoring food planning based on the rule of threes food plan [(RO3s) detailed in Chapter 5: Food Planning] and other approaches that support weight restoration.
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
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
Managing Exercise
In this chapter we provide strategies and protocols for managing exercise, definitions of \"healthy activity\" (of benefit for all patients), and its antithesis, \"compulsive/excessive exercise.\" Permitting exercise during weight restoration may reinforce weight gain, but it can also increase health risks and portray exercise or sports participation as more important than recovery. In eating disorders (EDs), exercise is used to regulate mood, weight, and shape, but only rarely are patients aware that excessive exercise can jeopardize health. In this regard, we discuss the clinical features of the \"female athlete triad\" and review the health consequences associated with excessive exercise.
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