Medical nutrition therapy for eating disorder recovery

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What is medical nutrition therapy?

Medical nutrition therapy (MNT) is an evidence-based treatment option for eating disorders that is applied in clinical settings for disease management and requires a physician referral. MNT is more intensive than traditional nutrition therapy.

 Like nutrition therapy, MNT also involves setting goals, developing a nutrition plan, and providing support for an individual. But MNT is necessary when nutrition needs are more complicated due to a disease, such as diabetes, or an eating disorder, and medical intervention is required to stabilize and monitor health in a hospital or outpatient setting. Medical interventions typically include IV or tube feeding and frequent monitoring of vital signs to help manage medical complications, as well as a psychiatric component to help manage the eating disorder and other mental health disorders that often co-occur with eating disorders. 

MNT can be effective for people with eating disorders to help them better understand the relationship between nutrition, diet, and overall health from a medical perspective and how improperly nourishing the body with what it needs to function can have life-threatening consequences. The primary goal of MNT is to change a person's long-term eating habits to improve their health. This is done through nutritional assessment, diagnosis, intervention, monitoring, and evaluation. (1)

How to treat eating disorders with medical nutrition therapy 

MNT is more than a nutritional plan. MNT as an eating disorder treatment focuses on an individual's behaviors concerning their eating. It's about understanding why a person with an eating disorder eats the way they do or why they avoid certain foods. A dietitian can develop a care plan and help the person with the eating disorder learn new eating habits. 

People with an eating disorder may receive MNT through a hospital or in an outpatient clinic. Some medical professionals also offer tele-health or virtual options. Part of MNT is about nutritional education, or understanding how certain foods affect the body to help someone achieve their health goals. When treating someone with an eating disorder such as anorexia nervosa (AN), a dietitian may explain what foods are the most effective for building solid bones or powering organs and what happens to the body when it doesn’t get proper nourishment. A person with avoidant restrictive food intake disorder (ARFID) may learn benefits about the foods they're avoiding and why the body needs them to function properly. A person with binge eating disorder (BED) may learn how neurotransmitters in the brain and hormones in the body respond to restricting and how restricting can lead to binging because of these chemical reactions.

In addition to educating individuals on their nutritional decisions, MNT also helps people set goals, deconstruct current behaviors, and build new habits. An added piece of MNT as an eating disorder treatment includes the psychodynamics of eating disorders. (2) A person with an eating disorder often has mental or emotional forces that encourage their relationship to food. To help someone with an eating disorder change their food-related behaviors, a dietitian will also understand the motivations behind a person's behavior. 

What to expect in medical nutrition therapy?

MNT starts with a registered dietitian performing a comprehensive nutrition assessment of a person with an eating disorder. During the evaluation, the dietitian learns about the individual's eating habits and behaviors and assesses emotional factors, such as how they feel about their appearance or anxiety about food. The dietitian will then create a care plan with goals for the person to work toward. 

A care plan for a person with anorexia may focus on building their caloric intake and mapping out what to eat at a specific time each day. Their goals may be to increase their calories by a certain number each week or to include certain nutritional foods in their diet they may have avoided. A care plan for someone with a binge eating disorder may focus on spreading their meal portions throughout the day to avoid eating everything at once and practicing mindful eating, or paying close attention to how they feel before, during, and after eating. They may have goals around how many times to eat each day. 

Once a care plan is put into place, the person with the eating disorder is expected to continue working with a dietitian to monitor and evaluate progress. Through monitoring, the dietitian can ensure the person with the eating disorder understands and is following their care plan. The evaluation process allows for the dietitian to assess the individual's progress toward their goals. The evaluation may include food intake, weight gain, mood assessment, and the individual's overall physical and mental well-being. As the person's eating behaviors change, a dietitian will adjust their care plan to include new goals and actions.

Evaluating medical nutrition therapy as an effective eating disorder treatment

MNT is a vital component in treating eating disorders and is encouraged during a person's entire treatment. (3) Through MNT, a person can better understand their body, their relationship to food, how different foods impact their brain and body, and how to build healthier eating behaviors. 

What are the benefits of medical nutrition therapy?

MNT as an eating disorder treatment can provide various physical and mental benefits, including:

  • Personalization: Each person's MNT journey is unique to address their specific dietary needs. A person with an eating disorder is not receiving generalized advice on how to best eat for anorexia, bulimia nervosa (BN), binge eating disorder (BED), or another eating disorder, but how to develop a diet that best works for them and their health. 
  • A better understanding of the body and nutrition: MNT is education about the relationship between food and the body. Through MNT, individuals can learn more about what their bodies need to properly function and what specific foods work best to fuel and nourish their bodies. 
  • Reduce or manage health risks: MNT can reduce a person's chance of developing health concerns, like diabetes, heart disease, or organ failure, or help manage health conditions, if they’re already present, as disordered eating can lead to serious health challenges. 

Efficacy of medical nutrition therapy in healing eating disorders

A dietitian is a critical part of a treatment team for someone with an eating disorder and is vital to a successful healing process. Dietitians working with individuals who live with eating disorders possess the specialized skills and knowledge base to promote behavioral changes in eating patterns. And through behavioral changes, people who have eating disorders can develop healthier eating habits. Research finds MNT to successfully change behaviors in those with anorexia and bulimia in inpatient and outpatient settings. (4)

Medical nutritional therapy at Within Health

Our care team at Within Health offer guidance for nutrition, including nutritional counseling, and weekly nutrition groups. At this time we do not provide the more medically-intensive aspects of nutritional therapy, as we are not an inpatient medical facility. We will, however, work with our clients to help with weight restoration, or stabilization as needed. Our nutritionists map out meal plans, and unique nutritional goals for each client to pursue during treatment, and in recovery from their eating disorder. Our care team has established a comprehensive, clinically-superior approach to treatment, which treats the eating disorder in its home environment. Call us now if you’d like to learn more about our eating disorder treatment programs, or find out about first steps for starting treatment.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Novaković B;Jovicić J;Pavlović LT;Grujicić M;Torović L;Balać D; (2010). Medical nutrition therapy planning. Medicinski pregled. Retrieved November 29, 2021, from https://pubmed.ncbi.nlm.nih.gov/21553460/.
  2. Ozier, A. D., & Henry, B. W. (2011). Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Eating Disorders. Eat Right. Retrieved November 29, 2021, from https://www.jandonline.org/article/S0002-8223(11)00712-7/fulltext.
  3. Reiter, C. S., & Graves, L. (2010, April 22). Nutrition therapy for eating disorders. American Society for Parenteral and Enteral Nutrition. Retrieved November 29, 2021, from https://aspenjournals.onlinelibrary.wiley.com/doi/abs/10.1177/0884533610361606.
  4. Whisenant, S. L., & Smith, B. A. (2003, May 8). Eating disorders: Current nutrition therapy and perceived needs in dietetics education and research. Journal of the American Dietetic Association. Retrieved November 29, 2021, from https://www.sciencedirect.com/science/article/pii/S0002822395003010.

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