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adolescent\tgradually\tresume\tcontrol\tover\teating\tagain.\tPhase\t3\tbegins\tonce\tthe\tadolescent\tis\table\tto\nmaintain\ta\tstable\tweight\t≥95%\tof\tideal\tbody\tweight\t(IBW)\tindependently.\tAt\tthis\tpoint,\tthe\tfocus\tof\ntreatment\n\tshifts\ttoward\tthe\testablishment\tof\ta\thealthy\tadolescent\tidentity,\tincreased\tadolescent
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autonomy,\tand\tthe\tdevelopment\tof\tappropriate\tparental\tboundaries.\tIt\tis\tnoteworthy\tthat\tFBT\ncertification\tis\tlimited\tto\tlicensed\tmental\thealth\tprofessionals\tand\tthat\tthe\tRDN\tplays\tno\tformal\trole\nin\tthe\tFBT\tprocess.\nIf\tFBT\tis\tcontraindicated,\tthen\tenhanced\tcognitive\tbehavioral\ttherapy\t(CBT-E)\tmay\tbe\tan\teffective
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alternative\tfor\tadolescents,\tand\ta\tgood\toption\tfor\tadults\twith\tAN\t(\nFairburn,\t2008\n).\tTwo\tversions\tof\nCBT-E\tare\tavailable:\tfocused\t(the\tcore\ttreatment)\tand\tbroad\t(includes\tclinical\tperfectionism,\tcore\nlow\tself-esteem,\tand\tinterpersonal\tdifficulties\tmodules).\tTreatment\tintensities\tinclude\ta\t20-session
|
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] |
version\tfor\tpatients\twith\ta\tBMI\t>17.5\tand\ta\t40-session\tversion\tfor\tpatients\twith\ta\tBMI\tbetween\t15.0\nand\t17.5.\tCBT-E\tis\ta\tmanualized\ttherapy\tprovided\tby\tpsychotherapists\ton\tinpatient\tunits\tas\twell\tas\nin\toutpatient\tsettings.\tCBT-E\ttypically\tincludes\tthe\tself-monitoring\tof\tfood\tintake\tand\teating
|
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] |
behaviors\t(binge\teating,\tpurging,\trestricting).\tThe\trole\tof\tthe\tRDN\tin\tCBT-E\tis\tminimal\tand\twill\tvary\nwith\tthe\ttreatment\tsetting\t(i.e.,\tgreater\tinvolvement\ton\tinpatient\tunits).\tOn\tan\toutpatient\tbasis,\nconsultation\n\twith\ta\tnutritionist\tmay\tbe\tlimited\tto\tpatients\twith\tcomplicated\tdiet\tissues\t(e.g.,\tdiabetes
|
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] |
mellitus,\tCD,\tvegan\tdiet)\tand\tchallenging\twork/sleep\tschedules\t(e.g.,\tindividuals\twho\twork\tovernight\nshifts).\nClassic\t\ncognitive\tbehavioral\ttherapy\t(CBT)\n\tis\ta\t20-session\tstructured\ttherapy\tthat\tincludes\nbehavioral\tand\tcognitive\tinterventions.\tCBT\tdirects\tthe\tclient\ttoward\tmodifying\tdysfunctional\nthinking\n\tand\tbehavior\t(see\t\nChapter\t13
|
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] |
thinking\n\tand\tbehavior\t(see\t\nChapter\t13\n).\tCurrent\tdata\tsuggest\tthat\tCBT\tis\tthe\trecommended\ntreatment\tfor\tBN\tand\tBED,\twith\tinterpersonal\ttherapy\t(IPT)\tconsidered\ta\tstrong\ttreatment\nalternative\t(\nGurr\tet\tal,\t2018\n).\tCBT\tconsists\tof\tthree\tdistinct\tand\tsystematic\tphases\tof\ttreatment:\t(1)
|
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establishing\ta\tregular\teating\tpattern,\t(2)\tevaluating\tand\tchanging\tbeliefs\tabout\tshape\tand\tweight,\nand\t(3)\tpreventing\trelapse.\n\tSimilar\tto\tCBT-E,\tclassic\tCBT\tis\tmanualized\tpsychotherapeutic\nintervention\tprovided\tby\ta\ttrained\tpsychotherapist.\tThe\trole\tof\tthe\tRDN\tis\tlimited\tto\tpatients\twith
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] |
comorbid\tmedical\tdiagnoses\tand\teating\tissues\tthat\trequire\tmore\tadvanced\tnutrition\ttraining.\nDialectical\tbehavioral\ttherapy\t(DBT),\ta\tskill-based\ttherapy\tthat\tfocuses\ton\tmindfulness,\tdistress\ntolerance,\temotion\tregulation,\tand\tinterpersonal\n\teffectiveness,\tmay\tbe\thelpful\tin\tBN\tcases\tin\twhich
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] |
effectiveness,\tmay\tbe\thelpful\tin\tBN\tcases\tin\twhich\ncomorbid\tpsychiatric\tdisorders\t(e.g.,\tdepression\tand\tmood\tdisorders,\tpersonality\tdisorders,\tand\nsubstance\tabuse\tdisorders),\tself-injurious\tbehaviors\t(e.g.,\tcutting),\tand\tgreater\timpulsivity\tare\nmanifested\t(\nBerg\tand\tWonderlich,\t2013\n).\tIn\tsome\tinstances,\tan\tantidepressant\tmedication\t(typically
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).\tIn\tsome\tinstances,\tan\tantidepressant\tmedication\t(typically\na\tselective\tserotonin\treuptake\tinhibitor\t[SSRI]\tsuch\n\tas\tfluoxetine)\tis\tprescribed\tadjunctive\tto\npsychotherapy.\nTechnology-based\tassessments\tand\tinterventions\tare\tbeing\ttested\tin\tpatients\twith\tEDs\t(\nEllison\tet\nal,\t2016\n).\tSmartphone\t“apps”\tlike\t\nRecovery\tRecord
|
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] |
Ellison\tet\nal,\t2016\n).\tSmartphone\t“apps”\tlike\t\nRecovery\tRecord\n\tand\tRise\tUP\t+\tRecover\thave\tbeen\tspecifically\ndeveloped\tto\tcomplement\tface-to-face\tpsychotherapy\tand\tmedical\tnutrition\ttherapy\t(MNT)\tfor\tEDs\n(\nBox\t21.2\n).\nBOX\t21.2\nRecovery\tApps\nNew\ttechnology\n\toffers\teating\tdisorder\trecovery\tfocused\ttools\tin\tthe\tform\tof\tapplications\tor
|
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“apps.”\tThe\tdistinction\tbetween\ta\t“fitness\tapp”\tand\tan\teating\tdisorder\trecovery\tapp\tis\tsignificant\nfor\tthe\ttreatment\tof\tthose\twith\teating\tdisorders.\tWhile\tthey\tmay\tboth\tfocus\ton\tlogging\tand\nrecording,\teating\tdisorder\tapps\tdiscourage\tthe\ttracking\tof\tcalories\tand\tactivity\tand\trather\npromote\tthe\tself-monitoring\tof\tthoughts
|
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] |
promote\tthe\tself-monitoring\tof\tthoughts\n\tand\tfeelings\taround\tfood\tintake.\tUtilizing\ta\tself-\nmonitoring\tplatform\ton\ta\tsmart\tphone\toffers\tseveral\tadvantages\tover\tpaper\tmonitoring\tas\tmany\npeople\tkeep\ttheir\tphones\ton\tthem\tmajority\tof\tthe\ttime.\tUsing\tthe\tapps\tmay\tbe\tmore\tconvenient
|
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] |
which\tlends\titself\tto\treal-time\tmonitoring,\taccuracy,\tand\tmore\tconsistency\tin\trecords.\nThe\tfollowing\tapps\tprovide\thelpful\ttools\tto\tsupport\tthe\tefforts\tof\teating\n\tdisorder\trecovery:\n1.\t\nRecovery\tRecord:\tThis\tapp\tallows\tyou\tto\tconnect\twith\tmultiple\ttreatment\tteam\tmembers
|
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that\tallows\tfor\nrecording\tof\tintake,\temotions,\tand\t“target\tbehaviors”\tsuch\tas\tbingeing\tand\tpurging.\tIt\ndoes\tnot\tallow\tfor\tan\tinteractive\texperience\twith\tyour\ttreatment\tteam,\tbut\tyou\tcan\texport\nmeal\tdata\tand\tshare\twith\tothers\tthrough\temail.\tUsers\tcan\talso\tshare\tmotivational\tquotes,\nimages,\tand\taffirmations.
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images,\tand\taffirmations.\nFairburn\tCG,\tRothwell\tER:\tApps\tand\teating\tdisorders:\ta\tsystemic\tclinical\tappraisal,\t\nInt\n\tJ\tEat\tDisord\n48:1038,\t2015.\t\nJuarascio\tAS,\tManasse\tSM,\tet.\tal.\tReview\tof\tsmartphone\tapplications\tfor\tthe\ttreatment\tof\teating\ndisorders.\t\nEur\tEat\tDisord\tRev\n\t23:1,\t2014.
|
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] |
disorders.\t\nEur\tEat\tDisord\tRev\n\t23:1,\t2014.\nValidated\tinstruments\tand\tquestionnaires\tare\tavailable\tfor\tscreening\tand\tdiagnosis\tof\tpatients\twith\nEDs.\tThe\tEating\tDisorder\tExamination\t-\t17.0D\t(\nFairburn\tet\tal,\t2014\n)\tis\ta\tstructured\tinterview\tthat\ntakes\tapproximately\t1\n\thour\tto\tadminister\tby\ta\ttrained\tclinician;\tit\tcan\tbe\tused\tto\tdiagnose\tDSM-5
|
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] |
AN,\tBN,\tBED,\tand\tOSFED\tin\tindividuals\tages\t14\tand\tup.\tThe\tEating\tDisorder\tAssessment\tfor\tDSM-5\n(EDA-5)\tis\tan\tinterview-based\tsemistructured\tinterview\tthat\ttakes\tapproximately\t15\tminutes\tto\nadminister\tby\ta\tclinician\twith\tmodest\ttraining;\tit\tcan\tbe\taccessed\tat\t\nwww.eda5.org\n\tto\tdiagnose\tDSM-\n5\tAN,\tBN,\tBED,\tARFID,\tOSFED,\tpica,
|
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] |
Questionnaire\t(\nAPA,\t2006\n).\tThe\tSCOFF\t(\nMorgan\tet\tal,\t1999\n),\ta\tbrief\tand\teffective\tscreening\ttool\tthat\nis\teasy\tto\tadminister\tand\tscore,\tis\thighlighted\tin\t\nBox\t21.3\n.\nBOX\t21.3\nThe\tSCOFF\tQuestionnaire\n*\n1.\t\nDo\tyou\tmake\tyourself\tsick\tbecause\tyou\tfeel\tuncomfortably\tfull?\n2.\t\nDo\tyou\tworry\tyou\thave\tlost\tcontrol\tover\thow\tmuch\tyou\teat?\n3.
|
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] |
2.\t\nDo\tyou\tworry\tyou\thave\tlost\tcontrol\tover\thow\tmuch\tyou\teat?\n3.\t\nHave\tyou\trecently\tlost\tmore\tthan\tone\tstone\t(14\tlb)\tin\ta\t3-month\tperiod?
|
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] |
4.\t\nDo\tyou\tbelieve\tyourself\tto\tbe\tfat\twhen\tothers\tsay\tyou\tare\ttoo\tthin?\n5.\t\nWould\tyou\tsay\tthat\tfood\tdominates\tyour\tlife?\n*Two\tor\tmore\t“yes”\tanswers\n\tsuggest\tthe\tpresence\tof\tan\teating\tdisorder.\t\nFrom\tMorgan\tJF,\tReid\tF,\tLacey\tJH:\t\nBMJ\n\t4:1467,\t1999.\nNutrition\tmanagement
|
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0.011143921874463558,
0.11797642707824707,
0.07172547280788422,
0.030372437089681625,
-0.009148161858320236
] |
BMJ\n\t4:1467,\t1999.\nNutrition\tmanagement\nRoles\tand\tresponsibilities\tof\tthe\tRDN\tin\tthe\ttreatment\tof\tindividuals\twith\tEDs\tinclude\tassessment,\nintervention,\tmonitoring,\tevaluation,\tand\tcare\tcoordination.\tAlthough\tAN,\tBN,\tand\tBED\thave\ndifferent\tpresenting\tfeatures,\tsimilarities\texist\tin\tthe\tassessment\tand\tmanagement\n\tof\tthese\ndisorders.
|
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] |
of\tthese\ndisorders.\nNutrition\tassessment\nNutrition\tassessment\tshould\tinclude\ta\tthorough\tdiet\thistory,\tas\twell\tas\tthe\tevaluation\tof\tbiochemical,\nenergy\tmetabolism,\tand\tanthropometric\tmarkers\tof\tnutritional\tstatus.\nDiet\thistory\nThe\tdiet\thistory\tshould\tinclude\tassessment\tof\tenergy;\tmacronutrient,\tmicronutrient,\tand\tfluid
|
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intakes;\tenergy\tdensity;\tdiet\tvariety;\tand\tan\tevaluation\tof\teating\tattitudes,\n\tbehaviors,\tand\thabits\t(see\nChapter\t4\n).\tPatients\twith\ta\tshorter\tduration\tof\tillness\tshould\tbe\tqueried\tabout\ttheir\tpremorbid\tdiet\nand\teating\thabits\tas\tthis\tmay\tbe\ta\tuseful\tbenchmark\tby\twhich\tto\tgauge\trecovery.\nAnorexia\tnervosa
|
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] |
Anorexia\tnervosa\nPatients\twith\trestricting\ttype\tAN\ttypically\teat\tfewer\tthan\t1200\tkcal/day.\tPatients\twith\tbinge-purge\ntype\tAN\thave\tmore\tvariable\tdiet\tpatterns,\tand\tenergy\tintake\tshould\n\tbe\tassessed\tacross\tthe\tspectrum\nof\trestriction\tand\tbinge\teating.\tAlthough\tthe\tearly\tliterature\toften\tdescribed\tAN\tpatients\tas\ncarbohydrate\t“phobic”\t(\nRussell,\t1967
|
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carbohydrate\t“phobic”\t(\nRussell,\t1967\n),\tmore\trecent\tstudies\tsuggest\tgreater\tdietary\tfat\tavoidance\n(\nForbush\tand\tHunt,\t2014\n).\tPercent\tof\tcalories\tcontributed\tby\tprotein\tmay\tbe\tin\tthe\taverage\tto\nabove-average\trange,\tbut\tadequacy\tof\tprotein\tintake\tbecomes\tmarginalized\tas\tcaloric\n\tintake
|
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] |
intake\ndecreases.\tA\tvegetarian\tor\tvegan\tdiet\tmay\tnot\tcontain\tadequate\thigh-biologic\tvalue\tprotein\tin\tthe\npresence\tof\tlow\tcalorie\tintake.\nInadequate\tcalories,\tlimited\tdiet\tvariety,\tand\tpoor\tfood\tgroup\trepresentation\tincrease\trisk\tfor\ndeficient\tmicronutrient\tintakes.\tIn\tgeneral,\tmicronutrient\tintake\tparallels\tmacronutrient\tintake,\tand
|
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] |
AN\tpatients\twho\tconsistently\trestrict\tdietary\tfat\tare\tat\tgreater\n\trisk\tfor\tdiets\tthat\tare\tdeficient\tin\nessential\tfatty\tacids\tand\tfat-soluble\tvitamins.\tBased\ton\ta\t30-day\tdiet\thistory,\tHadigan\tet\tal\t(2000)\nfound\tthat\tmore\tthan\t50%\tof\t30\tAN\tpatients\tfailed\tto\tmeet\trecommended\tdietary\tallowances\t(RDA)\nfor\tvitamin\tD,\tcalcium,\tfolate,\tvitamin\tB\n12
|
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] |
for\tvitamin\tD,\tcalcium,\tfolate,\tvitamin\tB\n12\n,\tmagnesium,\tcopper,\tand\tzinc\t(see\tinside\tcover\tfor\tdietary\nreference\tintake\t[DRIs]).\tAbnormal\tfluid\tintake\tis\tcommon,\tand\n\tthe\tdiet\thistory\tshould\tquery\npatients\tabout\ttypes,\tamounts,\tand\trationale\tfor\tfluid\tconsumption.\tSome\tindividuals\trestrict\tfluid
|
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intake\tbecause\tthey\tfind\tit\tdifficult\tto\ttolerate\tfeelings\tof\tfullness\tafterward;\tothers\tdrink\texcessive\namounts\tto\tfeel\tfull\tand\tsuppress\tappetite.\tExtremes\tin\tfluid\trestriction\tor\tingestion\tmay\trequire\nmonitoring\tof\turine\tspecific\tgravity\tand\tserum\telectrolytes.\tMany\n\tAN\tpatients\tconsume\texcessive
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] |
AN\tpatients\tconsume\texcessive\namounts\tof\tartificially\tsweetened\tbeverages\tand\tartificial\tsweeteners.\tUse\tof\tthese\tproducts\tshould\nbe\taddressed\tduring\tthe\tcourse\tof\tnutrition\ttherapy.\nBulimia\tnervosa\nChaotic\teating,\tranging\tfrom\trestriction\tto\tnormal\teating\tto\tbinge\teating,\tmakes\tit\tdifficult\tto\tassess
|
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total\tenergy\tintake\tin\tBN.\tThe\tcaloric\tcontent\tof\ta\tbinge,\tthe\tdegree\tof\tcaloric\tabsorption\n\tafter\ta\npurge,\tand\tthe\textent\tof\tcalorie\trestriction\tbetween\tbinge\tepisodes\tmust\tbe\tevaluated.\tPatients\twith\nBN\tassume\tthat\tvomiting\tis\tan\tefficient\tmechanism\tfor\teliminating\tcalories\tconsumed\tduring\tbinge
|
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] |
episodes;\thowever,\tthis\tis\ta\tcommon\tmisconception.\tIn\ta\tstudy\tof\tthe\tcaloric\tcontent\tof\tfoods\ningested\tand\tpurged\tin\ta\tfeeding\tlaboratory,\tit\twas\tdetermined\tthat,\tas\ta\tgroup,\tBN\tsubjects\nconsumed\n\ta\tmean\tof\t2131\tkcal\tduring\ta\tbinge\tand\tvomited\tonly\t979\tkcal\tafterward\t(\nKaye\tet\tal,\n1993
|
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Kaye\tet\tal,\n1993\n).\tAs\ta\trule\tof\tthumb,\tRDNs\tcan\testimate\tthat\tabout\t50%\tof\tenergy\tconsumed\tduring\ta\tbinge\tis\nretained.\nIn\ta\tsimilar\tmanner,\tpatients\tmisusing\tlaxatives\tbelieve\tthat\tcatharsis\twill\tprevent\tthe\tabsorption\nof\tfood\tand\tcalories;\thowever,\tlaxatives\tdo\tnot\tact\ton\tthe\tsmall\tintestine,\twhere\tthe\tmajority\tof\nabsorption
|
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] |
absorption\n\toccurs.\tIn\ta\tlaboratory\tstudy\tthat\twas\tconducted\tby\tBo-Linn\tet\tal\t(1983),\ttwo\tBN\nparticipants\tate\ta\tstandardized\tdiet\tand\ttook\ttheir\tregular\tdaily\tdose\tof\tlaxatives\t(35\tand\t50\ttablets,\naccordingly).\tResults\tindicated\tthat\tdespite\toutputs\tof\t4\tto\t6\tL\tof\tdiarrhea\tper\tday,\tthese\tparticipants
|
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] |
decreased\tcalorie\tabsorption\tby\tonly\t12%.\tBecause\tof\tday-to-day\tvariability,\ta\t24-hour\trecall\tis\tnot\ta\nparticularly\n\tuseful\tassessment\ttool.\tTo\tassess\tenergy\tintake,\tit\tis\thelpful\tto\testimate\tdaily\tfood\nconsumption\tover\tthe\tcourse\tof\ta\tweek\tusing\tthe\tmethod\toutlined\tin\t\nBox\t21.4\n.\nBOX\t21.4
|
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] |
Box\t21.4\n.\nBOX\t21.4\nDetermination\tof\tAverage\tDaily\tEnergy\tIntake\tin\tthe\tIndividual\nwith\tBulimia\tNervosa\t(BN)\n1.\t\nKeep\ta\trecord\tof\tpatient\tintake\tfor\t7\tdays.\n2.\t\nOut\tof\tthe\t7\tdays,\tdetermine\tthe\tnumber\tof\tnonbinge\tdays\t(which\tmay\tinclude\n\trestrictive
|
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0.0524987131357193,
0.03205211088061333,
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0.06381525099277496,
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0.007332521956413984,
0.09078213572502136,
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0.06047848239541054,
0.11864272505044937,
0.05404416099190712,
-0.007022134494036436
] |
and\tnormal\tintake\tdays).\n3.\t\nApproximate\tthe\ttotal\tcaloric\tcontent\tfor\tthe\tweek.\n4.\t\nDetermine\tthe\tnumber\tof\tbinge\tdays.\n5.\t\nDetermine\tthe\tapproximate\tcaloric\tcontent\tof\tthe\tbinge\tdays\tand\tthen\tdeduct\t50%\tof\tthe\ncaloric\tcontent\tof\tbinges\tthat\tare\tpurged\t(vomited).\n6.
|
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] |
caloric\tcontent\tof\tbinges\tthat\tare\tpurged\t(vomited).\n6.\t\nFinally,\taverage\tthe\tcaloric\tintake\tover\tthe\t7-day\tperiod.\tDetermination\tof\tthis\taverage\nenergy\tintake,\tas\twell\tas\n\tthe\trange\tof\tintake,\twill\tbe\tuseful\tinformation\tfor\tthe\tassessment\nprocess.\nNutrient\tintake\tin\tpatients\twith\tBN\tvaries\twith\tthe\tcycle\tof\tbinge\teating\tand\trestriction,\tand\tit\tis
|
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] |
likely\tthat\toverall\tdiet\tquality\tand\tmicronutrient\tintake\tis\tinadequate.\tA\t14-day\tdietary\tintake\tstudy\nof\t50\tBN\tpatients\trevealed\tthat\tat\tleast\t50%\tof\tparticipants\tconsumed\tless\tthan\ttwo\tthirds\tof\tthe\nRDA\tfor\tcalcium,\n\tiron,\tand\tzinc\ton\tnonbinge\tdays.\tFurthermore,\t25%\tof\tparticipants\thad\tinadequate
|
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] |
intakes\tof\tzinc\tand\tiron\twhen\toverall\tintake\t(i.e.,\tbinge\tand\tnonbinge\tdays)\twas\tassessed\t(\nGendall\tet\nal,\t1997\n).\tEven\twhen\tthe\tdiet\tappears\tadequate,\tnutrient\tloss\toccurs\tsecondary\tto\tpurging,\tthus\nmaking\tit\tdifficult\tto\tassess\ttrue\tadequacy\tof\tnutrient\tintake.\tUse\tof\tvitamin\tand\tmineral\nsupplements\talso\tshould\tbe
|
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] |
supplements\talso\tshould\tbe\n\tdetermined\tbut,\tonce\tagain,\tretention\tafter\tpurging\tmust\tbe\tconsidered.\nEating\tbehavior\nCharacteristic\tattitudes,\tbehaviors,\tand\teating\thabits\tseen\tin\tAN\tand\tBN\tare\tshown\tin\t\nBox\t21.5\n.\nFood\taversions,\tcommon\tin\tthis\tpopulation,\tinclude\tred\tmeat,\tbaked\tgoods,\tdesserts,\tfull-fat\tdairy
|
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products,\tadded\tfats,\tfried\tfoods,\tand\tcaloric\tbeverages.\tPatients\twith\tEDs\toften\tincorrectly\tregard\nspecific\n\tfoods\tor\tgroups\tof\tfoods\tas\tabsolutely\t“good”\tor\tabsolutely\t“bad.”\tIrrational\tbeliefs\tand\ndichotomous\tthinking\tabout\tfood\tchoices\tshould\tbe\tidentified\tand\tchallenged\tthroughout\tthe\ntreatment\tprocess.\nBOX\t21.5
|
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treatment\tprocess.\nBOX\t21.5\nAssessment\tof\tEating\tAttitudes,\tBehaviors,\tand\tHabits\n1.\t\nEating\tattitudes\nA.\n\tFood\taversions\nB.\n\tSafe,\trisky,\tforbidden\tfoods\nC.\n\tMagical\tthinking\nD.\n\tBinge\ttrigger\tfoods\nE.\n\tIdeas\n\ton\tappropriate\tamounts\tof\tfood\nF.\n\tRefusal\tto\teat\ta\tfood\titem\tthat\tdoes\tnot\thave\ta\tnutrition\tfacts\tlabel\n2.\t\nEating\tbehaviors\nA.
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] |
2.\t\nEating\tbehaviors\nA.\n\tRitualistic\tbehaviors\nB.\n\tUnusual\tfood\tcombinations\nC.\n\tAtypical\tuse\tof\tcondiments\t(e.g.,\tmustard,\tlemon\tjuice,\tvinegar)\tand\tseasonings\t(e.g.,\nblack\tpepper)\nD.\n\tAtypical\tuse\tof\teating\tutensils\tand\tuse\tof\tutensils\tto\tconsume\ta\tfinger\tfood\t(e.g.,\nusing\ta\tknife\tand\tfork\n\tto\teat\ta\tmuffin)\nE.
|
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] |
using\ta\tknife\tand\tfork\n\tto\teat\ta\tmuffin)\nE.\n\tExcessive\tuse\tof\tartificial\tsweeteners\n3.\t\nEating\thabits\nA.\n\tIntake\tpattern\n(1)\n\tNumber\tof\tmeals\tand\tsnacks\n(2)\n\tTime\tof\tday,\tincluding\ttimes\twhen\teating\tmay\tbe\trestricted\t(e.g.,\tpatients\twill\nnot\tpermit\tthemselves\tto\teat\tbefore\tor\tafter\ta\tcertain\ttime\tin\tthe\tday).\n(3)\n\tDuration\tof\tmeals\tand\tsnacks\n(4)
|
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] |
(3)\n\tDuration\tof\tmeals\tand\tsnacks\n(4)\n\tEating\tenvironment—where\tand\twith\twhom\n(5)\n\tHow\tconsumed—sitting\tor\tstanding\n\tor\twhile\tlooking\tat\ta\tscreen\nB.\n\tFood\tgroup\tavoidance;\tparticularly\tthose\twith\thigher\tenergy\tdensity\nC.\n\tDiet\tvariety\tfrom\tall\tfood\tgroups,\tincluding\tthose\twith\ta\tlow\tenergy\tdensity\tcontent\nD.\n\tFluid\tconsumption:
|
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] |
D.\n\tFluid\tconsumption:\nRestricted\tvs.\texcessive\nTypes:\tcaloric,\tnoncaloric,\tbeverage\twater,\talcohol\nIn\tcomparison\tto\thealthy\tindividuals,\tpatients\twith\tAN\texhibit\tcharacteristic\tmealtime\tbehaviors\nthat\tinclude\tstaring\tat\tfood,\ttearing\tfood,\tnibbling/picking,\tdissecting\tfood,\tnapkin\tuse,\tinappropriate
|
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] |
utensil\tuse,\thand\tfidgeting,\teating\tlatency,\tand\tnibbling/picking\tlatency\t(\nGianini\tet\tal,\t2015\n).\tIn\tthe\nassessment\tprocess,\tthe\tRDN\tmay\tdiscover\tunusual\tor\tritualistic\tbehaviors\tthe\tpatient\tpractices,\nunusual\tfood\tcombinations,\tand\texcessive\tuse\tof\tspices,\tvinegar,\tlemon\tjuice,\tand\tartificial
|
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sweeteners.\tMeal\tspacing\tand\tlength\tof\ttime\tallocated\tfor\ta\tmeal\talso\tshould\tbe\tdetermined.\tMany\npatients\tsave\ttheir\tself-allotted\tfood\tration\tuntil\tlate\tin\tthe\tday;\tothers\tare\tfearful\tof\teating\tpast\ta\ncertain\ttime\tof\tday.\tAN\tpatients\toften\teat\tin\tan\texcessively\tslow\tmanner.\tThis\tmay\tbe\ta\ttactic\tto
|
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avoid\tfood\tintake,\tbut\tit\talso\tmay\tbe\tan\teffect\tof\tstarvation\t(\nKeys,\t1950\n).\tTime\tlimits\tfor\tmeal\n\tand\nsnack\tconsumption\tfrequently\tare\tincorporated\tinto\tbehavioral\ttreatment\tplans\tand\tFBT.\nMany\tBN\tpatients\teat\tquickly,\treflecting\ttheir\tdifficulties\twith\tsatiety\tcues.\tIn\taddition,\tBN\tpatients
|
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] |
approach\tto\t“trigger”\tfoods.\tAlthough\tthe\tpatient\tmay\tprefer\tavoidance,\tassistance\twith\nreintroduction\n\tof\tcontrolled\tamounts\tof\tthese\tfoods\tat\tregular\ttimes\tand\tintervals\tis\thelpful.\nPatients\tmay\tfeel\ta\tsense\tof\tshame\tabout\tparticular\tfood\tand\teating\tpractices,\tso\tthese\tbehaviors
|
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] |
may\tnot\tbe\tidentified\tduring\tthe\tinitial\tassessment\tperiod.\tThe\tassessment\tprocess\tcontinues\tduring\nsubsequent\tmeetings\tand,\tin\tsome\tcases,\twill\tnot\tbe\tcomplete\tuntil\tthe\tRDN\thas\tobserved\tthe\npatient\tduring\ta\tmeal\ttime.\nBiochemical\tassessment\nThe\tmarked\tcachexia\tof\tAN\tmay\tlead\tone\tto\texpect\tmany\tbiochemical\tindices\tof\tmalnutrition\t(see\nChapter\t5
|
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] |
Chapter\t5\n),\tbut\tthis\tis\trarely\tthe\tcase.\tCompensatory\tmechanisms\tare\tremarkable,\tand\tlaboratory\nabnormalities\tmay\tnot\tbe\tobserved\tuntil\tthe\tillness\tis\tfar\tadvanced.\nSignificant\talterations\tin\tvisceral\tprotein\tstatus\tare\tless\tcommon\tthan\texpected\tin\tAN.\tIndeed,\nadaptive\tphenomena
|
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adaptive\tphenomena\n\tthat\toccur\tin\tchronic\tstarvation\tare\taimed\tat\tthe\tmaintenance\tof\tvisceral\nprotein\tmetabolism\tat\tthe\texpense\tof\tthe\tsomatic\tcompartment.\tAlthough\tserum\talbumin\tis\tusually\nnormal\t(\nMehler\tet\tal,\t2018\n;\t\nBarron\tet\tal,\t2017\n;\t\nAchamrah\tet\tal,\t2017\n),\twhen\thypoalbuminemia\tdoes\noccur,\tit\tis\tassociated\twith\ta\tpoorer\tprognosis\t(
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] |
occur,\tit\tis\tassociated\twith\ta\tpoorer\tprognosis\t(\nWinston,\t2012\n).\tPrealbumin\tis\ta\tmore\tsensitive\nmarker\tof\tmalnutrition,\tand\ta\tlow\n\tserum\tprealbumin\tlevel\tmay\tbe\tassociated\twith\tthe\tdevelopment\nof\tserious\tcomplications\tof\trefeeding\t(i.e.,\thypophosphatemia\tand\thypoglycemia)\tin\textremely\nunderweight\tindividuals\t(\nGaudiani\tet\tal,\t2014\n)\t(see
|
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] |
underweight\tindividuals\t(\nGaudiani\tet\tal,\t2014\n)\t(see\t\nAppendix\t12\n).\nDespite\ttypical\tconsumption\tof\ta\tvery\tlow-fat,\tlow-cholesterol\tdiet,\tmalnourished\tAN\tpatients\toften\nmanifest\televated\ttotal\tcholesterol,\tlow-density\tlipoprotein\t(LDL)\tcholesterol,\n\tand\thigh-density\nlipoprotein\t(HDL)\tcholesterol\tlevels\t(\nWinston,\t2012
|
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] |
lipoprotein\t(HDL)\tcholesterol\tlevels\t(\nWinston,\t2012\n).\tAlthough\tthe\tcause\tis\tunclear\tand\ncardiovascular\trisk\tis\tuncertain,\tthe\tbulk\tof\tavailable\tevidence\tsuggests\tthat\tlipid\tabnormalities\nimprove\tor\tnormalize\tafter\trecovery\tand\ta\tlow-fat,\tlow-cholesterol\tdiet\tis\tnot\twarranted\tduring\tthe
|
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] |
weight\trestoration\tprocess.\tIf\thyperlipidemia\tpredates\tthe\tdevelopment\tof\tAN,\tor\ta\tstrong\tfamily\nhistory\tof\thyperlipidemia\tis\tidentified,\tthe\tpatient\tcan\tbe\treassessed\tafter\tnutritional\trehabilitation.\nLipid\tprofiles\troutinely\tare\tincluded\tin\tlaboratory\tassessments;\thowever,\ta\tfasting\tlipid\tprofile\tis\tnot
|
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] |
warranted\tuntil\tthe\tpatient\tis\trestored\tto\ta\thealthy\tand\tstable\tbody\tweight.\nIndividuals\twith\tBN\talso\tmay\thave\televated\tlipid\tlevels,\tbut\tthe\tvalidity\tof\tthe\ttest\tmust\tbe\nquestioned\tif\n\tthe\tpatient\tis\tactively\tbinge\teating.\tFurthermore,\tsome\tBN\tpatients\tcannot\tcomply\twith
|
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] |
the\tabstinence\tperiod\trequired\tfor\ta\tfasting\tlipid\tprofile.\tPatients\twith\tBN\teat\tchaotically,\tconsuming\na\thigh-fat,\thigh-calorie\tdiet\tduring\tbinge\tepisodes,\tand\ta\tlow-fat,\tlow\tcalorie\tdiet\tduring\tintermittent\nperiods\tof\trestriction.\tAn\tinaccurate\tlipid\tprofile\tmay\tlead\tto\tthe\tunnecessary\tprescription\tof\ta\nrestricted
|
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] |
restricted\n\tdiet,\twhich\tin\tturn\tmay\texacerbate\tbinge\teating\tepisodes\tand\treinforce\tan\tall-or-nothing\napproach\tto\teating.\tIf\thyperlipidemia\tpredates\tthe\tdevelopment\tof\tBN,\tor\tif\ta\tstrong\tfamily\thistory\tof\nhyperlipidemia\tis\tidentified,\tthe\tpatient\tshould\tbe\treassessed\tafter\teating\tbehavior\tand\tdiet\tare\nstabilized\t(see\t\nChapter\t32\n).
|
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] |
stabilized\t(see\t\nChapter\t32\n).\nHypoglycemia\tresults\tfrom\ta\tdeficit\tof\tprecursors\tthat\tare\tneeded\tfor\tgluconeogenesis\n\tand\tglucose\nproduction.\tPatients\twith\tmild\thypoglycemia\tare\toften\tasymptomatic;\thowever,\tsevere\thypoglycemia\nis\tassociated\twith\tincreased\trisk\tof\tthe\trefeeding\tsyndrome\t(\nGaudiani\tet\tal,\t2014\n)\tand\thospitalization
|
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] |
Gaudiani\tet\tal,\t2014\n)\tand\thospitalization\nmay\tbe\twarranted\t(\nWinston,\t2012\n;\tsee\t\nChapter\t12\n).\nVitamin\tand\tmineral\tdeficiencies\nDespite\tobviously\tdeficient\tdiets,\tsurprisingly\tfew\tstudies\taddress\tbiochemical\tmarkers\tof\nmicronutrient\n\tstatus\tin\tpatients\twith\tEDs.\tLaboratory\tvalues\tare\tnot\talways\taccurate\tin\tassessing
|
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] |
degree\tof\tprotection\n\tin\tlow\tweight\tpatients;\thowever,\tthe\tshift\tfrom\tcatabolic\tto\tanabolic\tprocesses\nmay\tprecipitate\tmicronutrient\tdeficiencies\tduring\trefeeding\tand\tweight\trestoration\n.\n\tStudy\tfindings\nconflict,\tbut\tzinc,\tcopper,\tvitamin\tC,\tvitamin\tA,\tvitamin\tD,\triboflavin,\tfolate,\tand\tvitamin\tB\n6\ndeficiencies\thave\tbeen\treported\tin\tAN\t(
|
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] |
6\ndeficiencies\thave\tbeen\treported\tin\tAN\t(\nMehler\tet\tal,\t2018\n;\t\nBarron\tet\tal,\t2017\n;\t\nAchamrah\tet\tal,\n2017\n).\tThiamin\tdeficiency,\n\tprevalent\tamong\tlow-weight\tAN\tpatients,\tmay\tbe\texacerbated\tby\nincreased\tcarbohydrate\tintake\tduring\trefeeding,\tand\ta\tthiamin\tsupplement\tmay\tbe\twarranted\n(\nWinston,\t2012
|
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] |
(\nWinston,\t2012\n).\tGiven\tthat\tassays\tfor\tsome\tvitamins\tand\ttrace\telements\tmay\tnot\talways\tbe\treadily\navailable,\tand\tthat\tthe\trelationship\tbetween\tblood\tconcentrations\tand\twhole-body\tstatus\tis\tunclear,\nit\tmay\tbe\tmore\tpractical\tto\tprescribe\ta\tprophylactic\n\tvitamin/mineral\tsupplement\tduring\trefeeding\nand\tweight\trestoration\t(\nWinston,\t2012\n).
|
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] |
and\tweight\trestoration\t(\nWinston,\t2012\n).\nHypercarotenemia,\tattributed\tto\tmobilization\tof\tlipid\tstores,\tcatabolic\tchanges\tcaused\tby\tweight\nloss,\tand\tmetabolic\tstress,\tmay\toccur\tin\tAN;\texcessive\tdietary\tintake\tof\tcarotenoids\tis\tless\tlikely\n(\nWinston,\t2012\n).\tHypercarotenemia\tresolves\tduring\tweight\trestoration\tand\tmeasurement\tof\tserum
|
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] |
carotene\tlevels\tis\tunnecessary.\nIron\trequirements\tare\tdecreased\tin\tAN\tsecondary\tto\tamenorrhea\tand\tthe\toverall\tcatabolic\tstate.\nAt\ttreatment\tonset,\tthe\themoglobin\tlevel\tmay\tbe\tfalsely\televated\tas\ta\tresult\tof\tdehydration\tresulting\nin\themoconcentration.\tMalnourished\tpatients\tmay\talso\thave\tfluid\tretention,\tand\tassociated
|
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] |
hemodilution\tmay\tfalsely\tlower\tthe\themoglobin\tlevel.\nLow\tzinc\tlevels\tin\tpatients\twith\tAN\thave\tbeen\treported\n\tby\tsome\tinvestigators\t(\nBarron\tet\tal,\t2017\n)\nbut\tnot\tby\tothers\t(\nAchamrah\tet\tal,\t2017\n).\tZinc\tdeficiency\tmay\tresult\tfrom\tinadequate\tenergy\nconsumption\tand\ttransition\tto\ta\tvegetarian\tdiet.\tAlthough\tzinc\tdeficiency\tmay\tbe\tassociated\twith
|
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-0.011601924896240234
] |
altered\ttaste\tperception\tand\tweight\tloss,\tthere\tis\tno\tevidence\tthat\tdeficiency\tcauses\tor\tperpetuates\nsymptoms\tof\tAN.\tSupplemental\tzinc\tis\tpurported\tto\tenhance\tfood\n\tintake\tand\tweight\tgain\tin\tAN\npatients,\tbut\tthere\tis\tlimited\tevidence\tto\tsupport\tthis\tclaim\t(\nLock\tand\tFitzpatrick,\t2009\n).
|
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] |
Lock\tand\tFitzpatrick,\t2009\n).\nLow\t25-hydroxy\tvitamin\tD\t(25[OH]D)\tlevels\thave\tbeen\treported\tin\tlow-weight\tAN\tpatients\t(\nMehler\net\tal,\t2018\n;\t\nModan-Moses\tet\tal,\t2014\n).\tAlthough\tvitamin\tD\tand\tcalcium\tcontribute\tto\thealthy\tbone
|
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] |
development,\tthere\tis\tno\tevidence\tto\tsuggest\tthat\tcalcium\tor\tvitamin\tD\tsupplementation\n\tincreases\nBMD\tin\tAN\t(\nRobinson\tet\tal,\t2017\n).\tNevertheless,\tsome\tresearchers\tsuggest\troutine\tassessment\tof\n25(OH)D\tlevels\t(\nMehler\tet\tal,\t2018\n;\t\nModan-Moses\tet\tal,\t2014\n).\tTo\tdate,\tadequate\tenergy\tintake\tand
|
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] |
;\t\nModan-Moses\tet\tal,\t2014\n).\tTo\tdate,\tadequate\tenergy\tintake\tand\nnormalization\tof\tbody\tweight\tare\tthe\tprimary\tagents\tof\tbone\thealth\tin\tAN.\tSupplements,\tlike\tcalcium\nand\tvitamin\tD,\tare\tvariably\tprescribed\tamong\ttreatment\tprograms\tand\tclinicians.\nFluid\tand\n\telectrolyte\tbalance
|
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] |
Fluid\tand\n\telectrolyte\tbalance\nVomiting\tand\tlaxative\tand\tdiuretic\tuse\tcan\tresult\tin\tsignificant\tfluid\tand\telectrolyte\timbalances\tin\npatients\twith\tEDs\t(\nTrent\tet\tal,\t2013\n).\tBaseline\tpotassium,\tchloride,\tsodium,\tand\tCO\n2\n\tlevels\tshould\tbe\nobtained\tin\tpatients\twith\tpurging\tand\trestricting\tbehaviors,\twith\tmonitoring\tbased\ton\nsymptomatology.
|
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] |
symptomatology.\nUrine\tconcentration\tis\tsometimes\tdecreased,\tand\turine\toutput\tincreased\n\tin\tsemistarvation.\tEdema\ncan\toccur\tin\tresponse\tto\tmalnutrition\tand\trefeeding.\tAn\tincrease\tin\textracellular\twater\tfrequently\noccurs\tin\tAN\tpatients\twith\ta\tBMI\tless\tthan\t15\tto\t16\tkg/m2\t(\nRigaud\tet\tal,\t2010\n).\tAlthough\tfluid
|
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] |
Rigaud\tet\tal,\t2010\n).\tAlthough\tfluid\nretention\tusually\tdissipates\twith\trefeeding,\tlimiting\tsodium\tintake\tto\t2\tg/day\tmay\tbe\thelpful\t(\nRigaud\net\tal,\t2010\n).\tDepletion\tof\tglycogen\tand\tlean\ttissue\tis\taccompanied\tby\tobligatory\n\twater\tloss\tthat\nreflects\tcharacteristic\thydration\tratios.\tFor\texample,\tthe\tobligatory\twater\tloss\tassociated\twith
|
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] |
glycogen\tdepletion\tmay\tbe\tin\tthe\trange\tof\t600\tto\t800\tmL.\tVarying\tdegrees\tof\tfluid\tintake,\tranging\nfrom\trestricted\tto\texcessive,\tmay\taffect\telectrolyte\tvalues\tin\tpatients\twith\tEDs\t(see\t\nChapter\t3\n).\nEnergy\texpenditure\nMetabolic\tadaptation\tto\tstarvation\toccurs\tin\tmalnourished\tAN\tpatients\n\t(\nKosmiski\tet\tal,\t2014\n)\tand
|
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] |
(\nKosmiski\tet\tal,\t2014\n)\tand\nresults\tin\treduced\tresting\tenergy\texpenditure\t(REE)\tin\tthe\trange\tof\t50%\tto\t93%\tof\tpredicted\tvalues\n(\nHaas\tet\tal,\t2018b\n).\tWeight\tloss,\tdecreased\tlean\tbody\tmass,\tenergy\trestriction,\tlow\tT\n3\n,\tand\ndecreased\tleptin\tlevels\thave\tbeen\timplicated\tin\tthe\tpathogenesis\tof\tthis\thypometabolic\tstate.\tAt\tthe
|
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] |
completion\tof\trefeeding,\tREE\treportedly\tincreases\tto\t94%\tto\t119%\tof\tpredicted\n\tvalues\t(\nHaas\tet\tal,\n2018b\n).\tIn\taddition\tto\tincreased\tREE,\tAN\tpatients\toften\texhibit\texaggerated\t\ndiet-induced\nthermogenesis\t(DIT)\n\tin\tresponse\tto\trefeeding\tand\tthis\tmetabolic\tresistance\tto\tweight\tgain\tmay
|
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] |
contribute\tto\tthe\thigh\tcalorie\tprescriptions\tneeded\tduring\tnutritional\trehabilitation\t(\nKosmiski\tet\tal,\n2014\n).\tFindings\ton\tREE\tin\tBN\tpatients\tare\tcontradictory,\twith\tinvestigators\tfinding\treduced\n\tlevels,\nnormal\tlevels,\tand\televated\tlevels\tof\tREE\tat\tbaseline\t(\nde\tZwaan\tet\tal,\t2002\n).\tProposed\tcauses\tof\ta
|
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] |
de\tZwaan\tet\tal,\t2002\n).\tProposed\tcauses\tof\ta\ndecreased\tREE\tinclude\tmetabolic\tadaptation\tto\tintermittent\tperiods\tof\tdietary\trestraint\tand\tfasting\ninterfaced\twith\tbinge\teating\tand\tpurging,\tas\twell\tas\ta\thistory\tof\tweight\tsuppression.\tIncreased\tREE\nmay\tbe\tcaused\tby\ta\tpreabsorptive\trelease\tof\tinsulin\tthat\tactivates\tthe\tsympathetic\tnervous\n\tsystem
|
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] |
Mehler\tet\tal,\t2010\n),\taccess\tto\tindirect\tcalorimetry\nequipment\tis\toften\tlimited.\tHandheld\tcalorimeters\tare\treadily\tavailable,\tbut\tdata\ton\ttheir\n\taccuracy\nin\tthis\tpatient\tpopulation\tare\tlimited\t(\nHipskind\tet\tal,\t2011\n;\tsee\t\nChapter\t2\n).\nAnthropometric\tassessment
|
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] |
Hipskind\tet\tal,\t2011\n;\tsee\t\nChapter\t2\n).\nAnthropometric\tassessment\nPatients\twith\tAN\thave\tPEM,\tcharacterized\tby\tsignificantly\tdepleted\tadipose\tand\tsomatic\tprotein\nstores\tbut\ta\trelatively\tintact\tvisceral\tprotein\tcompartment.\tThese\tpatients\tmeet\tthe\tcriteria\tfor\ta\ndiagnosis\tof\tsevere\tPEM.\tA\tgoal\tof\tnutritional\trehabilitation\tis\trestoration\tof\tbody
|
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fat\tand\tfat-free\nmass.\tAlthough\tthese\tcompartments\tdo\tregenerate,\tthe\textent\tand\trate\tvary.\nBody\tcomposition\tstudies\tof\teating\tdisordered\tpatients\thave\tutilized\tunderwater\tweighing,\tdual-\nenergy\tx-ray\tabsorptiometry\t(DEXA)\tequipped\twith\tbody\tcomposition\tsoftware,\tand\tskinfold
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0.05112212523818016,
0.07762932777404785,
0.06570729613304138,
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] |
thicknesses.\tImaging\ttechniques\tsuch\tas\tcomputed\ttomography\t(CT)\tand\tmagnetic\tresonance\nimaging\t(MRI)\talso\thave\tbeen\tused\n\tto\tobtain\tdetailed\tmeasurements\tof\tspecific\tregions\tor\ttissues\n(e.g.,\tvisceral\tadipose\tfat)\tor\tfat\tinfiltration\tof\ttissues.\tTotal\tbody\tprotein\tassessment\tusing\tin\tvivo
|
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] |
neutron\tactivation\tanalysis\t(IVNAA)\thas\trecently\tbeen\tdescribed\tin\tadolescents\twith\tAN\t(\nHaas\tet\tal,\n2018a\n).\tMost\tbody\tcomposition\tmethodologies\tare\tlimited\tto\tthe\tresearch\tsetting.\tBioelectrical\nimpedance\tanalysis\t(BIA)\tis\tmore\n\tclinically\tavailable,\tbut\tshifts\tin\tintracellular\tand\textracellular\tfluid
|
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compartments\tin\tpatients\twith\tsevere\tEDs\tmay\taffect\tthe\taccuracy\tof\tbody\tfat\testimate\t(see\t\nChapter\n5\n\tand\t\nAppendix\t11\n).\nCareful\tassessment\tof\theight\tand\tweight\tare\tessential\tcomponents\tof\tclinical\tmanagement\tin\tall\nED\tdiagnostic\tgroups.\tIn\tAN\tand\tARFID,\tweight\trestoration,\tfollowed\tby\tweight\tmaintenance\n(adults)\tor\tage-appropriate
|
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] |
(adults)\tor\tage-appropriate\n\tweight\tgain\t(children/adolescents),\tis\tcritical\tfor\trecovery.\tIn\tBN,\ncessation\tof\tbinge/purge\tepisodes\twith\tconcurrent\tweight\tmaintenance\tis\tthe\tprimary\ttreatment\ngoal.\tIn\tBED,\tcessation\tof\tbinge\teating\talong\twith\tweight\tstabilization\t(size\tacceptance)\tor\tweight\nloss\tmay\tbe\trecommended\t(\nGrilo,\t2017\n).
|
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loss\tmay\tbe\trecommended\t(\nGrilo,\t2017\n).\nIn\thospitalized/residential\ttreatment,\tan\tearly\tmorning,\tpreprandial,\tgowned\tbody\tweight\nmeasurement\n\tis\trecommended.\tThe\tpatient\tshould\tbe\tadvised\tto\tempty\tbowel\tand\tbladder\tbefore\nweight\tassessment.\tUrine\tspecific\tgravity\tcan\tbe\tchecked\tif\twater\tloading\tis\tsuspected.\tPatients\tmay
|
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] |
resort\tto\tdeceptive\ttactics\t(water\tloading,\thiding\theavy\tobjects\tlike\trolls\tof\tcoins\tand\tmarine\tdiving\nweights\ton\ttheir\tperson,\tand\tholding\turine\tand\tbowel\tcontent)\tto\treach\ta\tmandated\tweight\tgoal.\nFrequency\tof\n\tweight\tchecks\tvaries\tamong\ttreatment\tprograms\tbut\tis\ttypically\tevery\t1\tto\t3\tdays;
|
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] |
known\tversus\tblind\tweight\tprotocols\talso\tvary.\tOn\tan\toutpatient\tbasis,\ta\tgowned\tweight\tshould\tbe\nobtained\ton\tthe\tsame\tscale,\tat\tapproximately\tthe\tsame\ttime\tof\tday,\tat\tleast\tonce\ta\tweek\tin\tearly\ntreatment.\tIf\tthe\tpatient\tis\tseeing\tmultiple\thealth\tcare\tprofessionals,\tonly\tone\tshould\tbe\tweighing\nthe\tpatient.\nBody\tweight,
|
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the\tpatient.\nBody\tweight,\n\tas\ta\tmetric\tfor\tassessment\tand\ta\tgoal\tfor\trecovery,\tis\tmeasured\tand\tmonitored\nthroughout\ttreatment.\tHowever,\t“healthy”\tor\t“ideal”\treference\tweights,\tlike\tthe\tMetropolitan\tLife
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] |
Insurance\tCompany\ttables\tand\tthe\tHamwi\n*\n\tmethod,\tprovide\twidely\tvarying\tand\tempirically\nunsupported\tresults.\tDue\tto\tthese\tlimitations,\tBMI\thas\tbecome\tincreasingly\taccepted\tin\tthe\nmanagement\tof\tED\tpatients\t(see\t\nChapter\t5\n\tand\n\t\nAppendix\t11\n).\tIn\tAN,\tfour\tcategories\tof\tBMI\tseverity
|
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] |
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