Jill Granneman RD,LD
I.
II.
III.
Goals of nutrition counseling
Differences between Anorexia and Bulimia
Nervosa
Learn about treatment approaches geared
towards normalizing eating patterns
 In
the US 20 million women and 10 million
men suffer from an eating disorder in their
lifetime
Wade, Keski-Rahkonen & Hudson, 2011
 Decreased
Metabolic rates
 Food Obsession
 Change in Eating Style
 Bulimia
 Excessive exercise
 Change in personality
 Nutrition
counseling is pragmatic with welldefined goals
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Correction of eating disorder behavior
Establishment of a normal, carefree approach to
eating and weight control
American Dietetic Association 1994
 “If
you cannot embrace the pain of learning
but must have instant gratification you
forfeit the greatest rewards in life.”
 Body
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Image issues
Body checking in the mirror
Comparison with others
Preoccupation with shape
Distorted body image
Self hate
 Dieting/Diet
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mentality
Lists of “good and bad” foods
Counting calories, fat grams, or carbs
Eating only “safe foods”
Eating only at certain times of the day
Pacifying hunger with diet drinks or coffee
 Concerns
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with current weight or gaining weight
Frequent scale weighing
Obsessive exercise
Body checking
Body bashing
 Diagnostic
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Criteria
Weight loss
Fears
Denial
Amenorrhea (females)
Restricting type
Binge-Eating/Purging Type
 D-20
year old male with restricting anorexia
nervosa
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Weight prior to onset: 160 lbs
Weight at first appt: 121.8 lbs
Height: 72”
Ideal body weight: 178 lbs +/- 10%
68.4% of ideal body weight
Diet hx: approx. 1100-1500 calories per day
Frequency of Scale weighing - 2x per day
 Interventions
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for D included
Meal planning
Self weighing limits
Snacks
Fear food reintroduction
 Weight
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up 21 lbs 5 months after treatment
Current wt: 142.6 lbs
Approx 79.7% of ideal body weight
 Behavioral
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Changes
Eating out
Enjoying all foods
Stopped calorie counting
 Diet
history
 Nutritional Adequacy
 Physical Activity Level
 Fluid intake
 Self weighing frequency
 Fear Foods
 Safe Foods
 Assess
readiness to change
 List potential food modifications
 Food behavioral goals
 Weight restoration goals
 Motivational Interviewing
 Weight
gain goals for weight restoration
 Caloric needs for weight restoration
 Food planning vs. counting calories
Breakfast
Lunch
 Calcium
 Calcium
 Complex
 Complex
Carbohydrates
 Fruit or vegetable
 Protein (optional)
 Fat (optional)
Carbohydrates
 Fruit or Vegetable
 Protein
 Fat
 “fun food”
 Snacks
 What
counts as one serving?
 List fear foods
 Reintroduce fear foods
 Diagnostic
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criteria
Recurrent episodes of binge eating which may
include the following
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Eating, in a discrete period of time, an amount of
food that is definitely larger than most people would
eat during a similar period of time and under similar
circumstances
A sense of lack of control over eating during the
episode
 Diagnostic
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Criteria continued
Recurrent inappropriate compensatory
behaviors
Frequency of binge eating/compensatory
behaviors
 H-20
year old female with Bulimia Nervosa
and hx of anorexia nervosa as well as bipolar
disorder
 Wt:98.4 lbs Ht:60”
 Purging behaviors
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2x/day
5-6 days/week
 Bingeing
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1 or more times per week
 Interventions
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for H included
Food planning
Consistent meal times
Prevention
Review the binge/deprive cycle
 Diet
History
 Nutritional Adequacy
 Physical activity level
 Assess fluid intake
 Self weighing frequency
 Fear foods vs. Safe foods
 Identify Triggers
 Regularly
Scheduled meals
 Detriments of purging
 Meal Planning
 Self Monitoring
Examples…
 “I will finish each bite of my meal”
 “I will not get fat”
 “This is part of getting better”
 “My meal has been prescribed”
 “I must take my meal like medication”
 “I need food to keep me healthy regardless
of what I feel”
 List
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potential enjoyable activities
Calling or emailing a friend
Using the computer
Journaling
Taking a bath
Going for a walk
 Benefits
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include
Detailed descriptions
Increased self awareness
Accuracy
 Blind
weighing
 Using a Gown
 What to share
 What not to share
 Hospitalization
may be recommended for the
following
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Rapid, progressive weight loss
Failure to gain weight or alter purging
behaviors
Severe metabolic abnormalities
Certain cardiac dysfunction
Psychomotor retardation
Inability to perform ADLs
Suicide risk
 Team
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Physician
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Involvement:
Not always specialized in eating disorders
Psychotherapist
Psychiatrist
Nutrition Counselor
 Benefits
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Pooled knowledge
Team support
Shared responsibility for patient care
A model of collaborative relationships for the patient
 C-24
year old male
 Starting weight:366 lbs
 Height:68” BMI:56.2(morbid obesity)
 Usual daily intakes
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chinese food
burgers and fries
Pizza
chips
 Eats
out 4x/week
 Food
choice changes
 Meal substitutions while eating out
 Weight
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gradually decreased by 25.6 lbs
Current wt: 340.4 lbs
7% loss of original body weight
 Behavioral
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Changes
Incorporated vegetarian options
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Veggie chick nuggets
Veggie burgers
Canned vegetables
 Obtain
detailed diet hx
 Assess current nutrition knowledge
 Eating/diet history
 Weight History
 Possible
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approaches
Portion control
Intuitive eating
Food planning
 Nutrition
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education topics
Food group requirements
Balanced eating
Nutrient density of foods
Food label reading
 Eating
food as close to nature as possible
 Nutrient dense food options
 Proteins, whole grains, heart healthy fats
 Key nutrients
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Vitamins
Minerals
 Functional
foods
 Dietary Guidelines for Americans
 Online food tracking
 Mixture
of protein, carbs, and fats for meals
is most effective in promoting feelings of
satiety
 Minimum serving requirements per day
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Grains: 6 servings
Fruits and Vegetables: 5 servings
Protein: 4 ounces
Beans: 3 servings per week
Dairy or Calcium rich: 2 servings
 Intuitive
eaters eat according to their inner
hunger signals, and eat whatever they choose
without experiencing guilt or an ethical
dilemma.
Intuitive eating, Evelyn Tribole
 Hunger
sensation
 Over hunger as a trigger
 The 5 hour rule
 Carbohydrate Storage Capacity of the Liver
 The
Ultimate Goal of Nutrition Counseling
 Not Perfect
 Variable
 Flexible
 Carefree
 Joyful
 “Knowing
what you like to eat, and believing
that you have the right to enjoy food, are
key factors in a lifetime of weight control
without dieting”
Evelyn Tribole- Intuitive eating