Food, to the healthy body, functionsto nourish, restore, sustain, satisfy andheal. It is a basic, natural element oflife that occurs without anguish. Incontrast, to someone with an eatingdisorder, foodis alien, some-thing to con-trol, restrict,abuse, purge,distrust andeven fear.Helping to

re-shape apatient’s per-ception offood is just one of many goals of eatingdisorder treatment. Eating disordersare complex mental health disordersremarkable for their nutrition andmedical-related problems, some ofwhich are life-threatening. Nutritionintervention, including nutritionalcounseling by a registered dietitian isan essential component of the teamtreatment of patients with anorexianervosa, bulimia nervosa, and othereating disorders during assessment andtreatment across the continuum of care.(JADA, 2006)Physical manifestations of eating dis-

orders are numerous and can be life-threatening. These can includechanges in cardiovascular response,heart mass, gastrointestinal tract, brainmass, and bone mass. At the sametime, eating disorders have emotional,mental and behavioral components.Food restriction and starvation dramat-ically alter thought patterns, depressmood, interfere with thinking, and canpose a barrier to effective treatment.

Nutritional intervention and weightrestoration is typically the first step torecovery of medical and psychologicalhealth. Besides the many physical ben-efits, healthy nutrition restores the

brain to fullfunct ioning,upon whichpsychologicalt r e a t m e n tdepends.Early inter-

vention, closeto the onset ofeating disor-der symptoms,

can minimize damage and maximizethe recovery process. The urgency oftreatment in adolescents should beunderscored due to the potentially irre-versible effects of an eating disorder onthe young person’s physical and psy-chological development. Nutritional rehabilitation is thus

essential not only to re-nourish thebody, but is critical to the patient’sability to succeed in other facets oftreatment. Specifically, nutrition inter-vention involving structured foodintake, attention to food perceptions,modification of eating behaviors andregulation of weight are important ele-ments within a comprehensive treat-ment program, such as our EatingDisorders Intensive OutpatientProgram (ED IOP). Nutritional components of the ED

IOP assist the patient to normalize eat-ing patterns, plan meals in advanceand practice with food items. The IOPprogram includes utilization of the fol-lowing:

Spring 2009 Volume 2 Issue 1

A FOODDIARY

The food diaryis introduced tothe patient onadmission andserves as amu l t i - f a c e t edtool that is used by all members of thetreatment team. All IOP participantskeep a food diary. Keeping a record ofintake promotes accountability, aware-ness of actual intake and its associatedfeelings, and the identification ofpotential “triggers” to eating disor-dered behavior. The diary also servesas an assessment tool for the dietitianto gauge nutritional adequacy.Accurate diaries benefit both patientand clinician to assess progress towardgoals.

An individualized meal plan creat-ed by both the dietitian and patientprovides a schedule to normalize eat-ing. Following the plan enables thepatient to restore nutrient and fluidbalance, normalize eating, trust thebody’s utilization of foods for nourish-ment and achieve weight goals.Within this plan, nutritional require-ments are incorporated and made user-friendly by describing nutritionalneeds in terms of food groups and por-tion sizes.

The therapeutic meal session is adaily element of the IOP schedule.

Continued on Page 2

“Nutrition Intervention in Eating Disorders”by Maiya Ingram, MS, MPH, RD, LD

Maiya IngramWe are indeed much more thanwhat we eat, but what we eatcan nevertheless help us to bemuch more than what we are.

– Adelle Davis, nutrition pioneer (1904-1974)

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THE INDIVIDUALIZEDMEAL PLAN

THE THERAPEUTIC MEAL

16216 Baxter Rd., Ste. 399Chesterfield, MO 63017

For more information, call (636)532-9188 or www.slbmi.com

This meal includes a pre- and post-meal questionnaire for patients toidentify current thoughts and emo-tions, acknowledge current foodbehaviors, determine barriers to eatinggoals, and assess adherence to theirmeal plan. The group setting enablespatients to eat together, to process,and to communicate with each otherand the clinician in a safe and moni-tored setting. Patients are supportedand reinforced to practice with fooditems and adhere to the individualizedmeal plan.

Periodically, after progressing suffi-ciently, participants will participate in

Nutrition Intervention in Eating Disorders continued from front page

• Intensive Outpatient Program• 6-day (day/evening/weekend IOP)• 4-day (evening/weekend IOP)

• Weekly Therapy Groups• Anorexia Nervosa and Bulimia Nervosa Therapy Group

• Compulsive Eaters Group

• Nutritional Counseling• Individual Psychotherapy• Expressive Therapy for Body Image Issues

All groups are facilitated by a licensed clinician. We accept many insurance plans.

Eating Disorder Services

meal outing, e.g. eating at a restaurant,going on a picnic, grocery shoppingand preparing a meal. These are activ-ities that participants are likely to con-front but may have been avoided in thepast or represent a high risk situationfor unhealthy eating.The goals of nutritional intervention

in all phases of treatment are to providestrategies to normalize eating and tofurther the patient’s practical applica-tion of nutrition education. While patients can use the IOP to

establish a solid nutritional foundation,ongoing consultation with a nutritionistis the best way to continue to progresstowards full recovery.

Maiya Ingram, MS,MPH,RD,LD, pro-vides nutrition intervention for eating dis-order patients through SLBMI’s IntensiveOutpatient Treatment program. She alsoprovides nutrition education for childrenthrough adults for weight managementand medical needs.

References:Position of the American Dietetic Association:

Nutrition Intervention in the Treatment of AnorexiaNervosa, Bulimia Nervosa, and Other EatingDisorders, Journal of the American DieteticAssociation. December 2006 (Vol. 106, Issue 12,Pages 2073-2082).American Journal of Clinical Nutrition, Vol. 86,

No. 1, 92-99, July 2007.

The National Eating DisordersAssociation (NEDA) will hold its firstannual walk in St. Louis and in hundreds of other cities around thecountry to raise awareness and much needed funding to battleAnorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder.

The NEDA Walk in St. Louis will take place on April 18, 2009 at TowerGrove Park at the Sons of Rest Shelter. To find out how to register,sponsor a walker, or donate to NEDA, visit our website atwww.slbmi.com/eating_disorders/index.htm. For additional infor-mation, contact Kate Evett 314-968-1900 ext. 13.

NEDA to Hold Walkon April 18in Tower Grove Park

4)MEAL OUTINGS