Eating Disorders
The positive outcomes of using dietetic services on patients with eating disorders are outlined within two case studies below:
Case study 1
Jennifer had a body mass index of 16kg/m2. She was eating only 800 calories per day and losing weight. She was seen by a therapist, and given a standardised eating plan to promote weight gain. However, Jennifer felt unable to follow this as it did not fit with her busy family’s meal preferences, or routine. Both Jennifer and her mum struggled to implement the eating plan, often with the emergence of rows around the plan, and with Jennifer using this as a reason to then not eat. Her therapist spent a lot of time each session negotiating food issues with Jennifer, which distracted them from addressing the underlying psychopathology that maintained the disordered eating.
Jennifer was seen by the dietitian, who tailored an individual eating plan to suit Jennifer’s preferences and her family’s busy timetable. They explored Jennifer’s beliefs around food, particular macronutrients and body weight. The dietitian was able to explain in detail what happens when food is restricted, and help Jennifer to understand why she feels anxious and cold, and respond to Jennifer’s concerns about her body weight, with a scientific explanation of how the body uses food to restore weight and repair the malnourished body. They also discussed the process of finding the body’s set point weight as opposed to using meaningless target weights. This helped to reassure Jennifer that her weight would not get “out of control” with eating more. With an eating plan agreed, the therapist was able to stop addressing issues related to food, and focus instead on Jennifer’s relationship with her family.
The dietitian supported Jennifer to slowly change her diet and increase her weight in a way that felt achievable. They worked with Jennifer and her mum to rebuild skills around planning, shopping and portioning food, as well as challenging their beliefs around food using graded exposure to more distressing foods and behavioural experiments. Jennifer was successfully discharged 8 months later at a normal weight, having gained the skills and knowledge to maintain a healthy weight and a healthy diet.
Case study 2
Ben had been restricting his food intake for the past 5 years, in order to keep his weight in tight control. He also had type 1 diabetes. He collapsed at work and was admitted to hospital with low blood glucose, and low potassium, where he admitted to vomiting daily after meals. He was depressed, self-harming, and had not engaged with his diabetes team for many years. He was referred to a therapist within the mental health team. Ben’s therapist worked with him to look at the factors causing his current difficulties, but struggled to advise Ben on what to eat, and how to manage his low potassium, or blood sugars.
The Dietitian explored Ben’s beliefs and attitudes to food and weight control, and helped him to understand the physiology and biochemistry of starvation, as well as the detrimental impact of vomiting on his general health, and the control of his diabetes. The Dietitian worked alongside the diabetes specialist nurse to agree the most suitable insulin regimen that suited his eating patterns and lifestyle. With the support of the dietitian, Ben began to experiment with eating more, and found he was able to stabilise his weight without restricting his food intake. Slowly his HbA1c and blood sugar monitoring improved, and he required no further hospital admissions. His knowledge and understanding of diabetes management increased, and he began to engage with his diabetes team again. He returned to favourite past-time, sport, and even ran a half marathon last year.
