Food, to the healthy body, functions to nourish, restore, sustain, satisfy and heal. It is a basic, natural element of life that occurs without anguish. In contrast, to someone with an eating disorder, food is alien, some- thing to con- trol, restrict, abuse, purge, distrust and even fear. Helping to re-shape a patient’s per- ception of food is just one of many goals of eating disorder treatment. Eating disorders are complex mental health disorders remarkable for their nutrition and medical-related problems, some of which are life-threatening. Nutrition intervention, including nutritional counseling by a registered dietitian is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. (JADA, 2006) Physical manifestations of eating dis- orders are numerous and can be life- threatening. These can include changes in cardiovascular response, heart mass, gastrointestinal tract, brain mass, and bone mass. At the same time, eating disorders have emotional, mental and behavioral components. Food restriction and starvation dramat- ically alter thought patterns, depress mood, interfere with thinking, and can pose a barrier to effective treatment. Nutritional intervention and weight restoration is typically the first step to recovery of medical and psychological health. Besides the many physical ben- efits, healthy nutrition restores the brain to full functioning, upon which psychological treatment depends. Early inter- vention, close to the onset of eating disor- der symptoms, can minimize damage and maximize the recovery process. The urgency of treatment in adolescents should be underscored due to the potentially irre- versible effects of an eating disorder on the young person’s physical and psy- chological development. Nutritional rehabilitation is thus essential not only to re-nourish the body, but is critical to the patient’s ability to succeed in other facets of treatment. Specifically, nutrition inter- vention involving structured food intake, attention to food perceptions, modification of eating behaviors and regulation of weight are important ele- ments within a comprehensive treat- ment program, such as our Eating Disorders Intensive Outpatient Program (ED IOP). Nutritional components of the ED IOP assist the patient to normalize eat- ing patterns, plan meals in advance and practice with food items. The IOP program includes utilization of the fol- lowing: Spring 2009 Volume 2 Issue 1 A FOOD DIARY The food diary is introduced to the patient on admission and serves as a multi-faceted tool that is used by all members of the treatment team. All IOP participants keep a food diary. Keeping a record of intake promotes accountability, aware- ness of actual intake and its associated feelings, and the identification of potential “triggers” to eating disor- dered behavior. The diary also serves as an assessment tool for the dietitian to gauge nutritional adequacy. Accurate diaries benefit both patient and clinician to assess progress toward goals. An individualized meal plan creat- ed by both the dietitian and patient provides a schedule to normalize eat- ing. Following the plan enables the patient to restore nutrient and fluid balance, normalize eating, trust the body’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 nutritional needs in terms of food groups and por- tion sizes. The therapeutic meal session is a daily element of the IOP schedule. Continued on Page 2 “Nutrition Intervention in Eating Disorders” by Maiya Ingram, MS, MPH, RD, LD Maiya Ingram We are indeed much more than what we eat, but what we eat can nevertheless help us to be much more than what we are. – Adelle Davis, nutrition pioneer (1904-1974) 1) 2) 3) THE INDIVIDUALIZED MEAL PLAN THE THERAPEUTIC MEAL