Balancing nutrition management and the role of dietitians in eating disorder treatment
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(2020) 8:64
COMMENTARY
Open Access
Balancing nutrition management and the role of dietitians in eating disorder treatment Shane Jeffrey1,2,3 and Gabriella Heruc1,4,5* Abstract The symptoms of starvation and dietary restriction are often the subject of targeted intervention in evidence-based treatments across eating disorder diagnoses and treatment models. Despite the level of attention given to these symptoms of clinical malnutrition, they are often treated by health professionals with no nutritional qualifications and in a non-clinical manner in the outpatient setting, with dietitians having no defined role in manualised treatment models. Recently the Australia & New Zealand Academy for Eating Disorders (ANZAED) published practice and training standards for dietitians to help characterise their role in eating disorder treatment. Since malnutrition, secondary to dietary restriction, is a clinically significant nutritional diagnosis that co-occurs in eating disorder presentations, this commentary proposes that dietitians are ideally-positioned to assess and advise on the clinical aspects of malnutrition as a key member of the multidisciplinary team. Food is a central focus in eating disorder treatment, suggesting that nutritional care needs to be addressed by a dietitian alongside the psychological aspects of care that are addressed by a mental health professional. Keywords: Dietetic, Dietitian, Eating disorder, Malnutrition, Nutrition, Treatment
Main text While it is widely accepted that improved nutrition and eating behaviour are an integral aspect of eating disorder treatment, the role of the dietitian in treatment remains unclear. In support of the dietitian’s role, clinical practice guidelines [1, 2] and the clinical practice standards recently published in the Journal of Eating Disorders [3, 4] recommend dietetic involvement in the multidisciplinary eating disorder treatment team. Furthermore, a recent initiative of the Australian Government provided funding under the Medicare Benefits Scheme for eligible patients with an eating disorder diagnosis to access up to twenty sessions with a dietitian per year. However, the * Correspondence: [email protected] 1 Executive Committee, Australia & New Zealand Academy for Eating Disorders, Sydney, Australia 4 School of Medicine, Western Sydney University, Campbelltown, Australia Full list of author information is available at the end of the article
manualised, evidence-based treatment models of Family Based Therapy (FBT) [5] and Cognitive Behaviour Therapy – enhanced (CBT-e) [6] make no reference to the direct inclusion of a dietitian in treatment. A recent review of the nutritional content of treatment manuals for adults with an eating disorder found that while 91% of manuals contained some degree of nutritionally-focused content, only 36% of the manuals recommended a dietitian be consulted as part of the multidisciplinary treatment approach [7], suggesting that dietetic involvement is not being recommended for many patients undergoing evidence-based psy
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