Dietary advice... where to start?

Transcription

1 Dietary advice... where to start?

2 Content The New Eatwell Guide & nutritional knowledge the basics Where to start... dietary advice Common ED dietary problems Meal Plan Food goals... normal eating and mechanical eating Laxatives.. advice with reducing these Fluid intake Exercise levels in ED patients Management of ED patient on general psychiatric ward Refeeding Syndrome & mineral and vitamin supplementation Binge Eating disorder.. Some tips Where to seek advice Resources

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5 There is no such thing as a good food or a bad food, you either have a good diet or bad diet

6 Common ED dietary problems Avoidance of carbohydrates and fats Small portions Food avoidance & very little variety Little or no social eating Obsessional calorie checking Weighing of foods Excessive fluid intake Calorie limits Obsessional use of diet & fitness apps.. i.e. My Fitness Pal & Fitbit Excessive energy expenditure Distorted views on food and weight

7 Normal Eating Breakfast Snack Lunch Snack Evening Meal Supper 3 Meals and 3 snacks Mechanical eating... due to distortion in hunger and fullness sensations

8 Example Meal Plan B - 2 x weetabix with 200 mls semi skimmed milk 1 x slice of toast with spread S - banana L Tuna, mayo and sweetcorn sandwich non diet fruit yoghurt S - digestives x 2/ scone with spread/ large pancake with spread milky drink/ fruit juice (250mls) EM-balanced evening meal ( e.g. spaghetti bolognaise, chicken fajitas) S - milky drink and 1 x slice of toast

9 Dietary goals Be specific......can you increase your cereal...could we look at adding on one whole weetabix this week at breakfast time Expectations: be mindful of what one small dietary change can mean to a patient with an ED guide on what might be better options to eat

10 Outpatients Initial Aims.. in anorexia, prevent further weight loss Get starchy carbohydrates in at each meal Regular eating Assess fluid intake and advise Non diet approach Identity and work on abnormal eating behaviours Diary keeping food & thoughts Involve family where possible

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13 Over exercise Can be more of a issue than restricted diet Be mindful of energy intake v expenditure Will hinder weight gain Replacing high intensity exercise with non activity Education on metabolism and BMR Assess daily activity some patients find it even difficult to sit down Exercise apps discourage

14 Laxatives Education on water loss Advice on gradual reduction

15 Refeeding Syndrome Highly unlikely to occur in ED outpatients Majority of patients would be too anxious to make extreme changes to their eating habits Be aware of it Should be more cautious about it in an inpatient setting during process of refeeding. Monitoring of K, Mg and in particular PO4

16 Diabetes Need Diabetic Services involved- highly complex and life threatening

17 ED patients on a general psychiatric ward Difficult to manage Good Communication is vital (including the catering department) All ward staff need clear guidance from ED staff and dietitian e.g.. what is the meal plan, when to eat, who supports, do they need supervision, how much exercise are they allowed, when to be weighed etc May require one to one nursing support: particularly with meals Boundaries are a MUST e.g.. No deviation from meal plan and fluid requirements, supervision during and after meals Detailed record keeping... food and fluid intake charts If Nasogastric feeding is required.. likely require 24 hour observation depending on patient compliance

18 Meal times Set times All patients initially supervised by staff Must adhere to meal plan prescribed by a dietitian Must eat everything on their plate ( some exceptions if genuinely struggling in the first few days of admission) No likes or dislikes (within reason)

19 After Meals All patients initially supervised Helps break purging behaviours Reduces exercise levels Patients learn about distraction Support Cannot access the toilet, if urgently requiring the toilet, there must be supervised toilet visit

20 Vitamin and mineral supplementation Guided by dietitian Forceval? Calcium and vitamin d Refeeding- thiamin, vitamin B Co Strong (-14 days) May require potassium supplementation if vomiting

21 Binge Eating... tips BED patients... Mainly overweight and obese Non diet approach... do not suggest a diet! Main focus of treatment is NOT weight loss ( weight loss may be a side affect of eating better) Many restrict most of the day and binge eat at night Aim is to eating regularly ensuring is eating adequate at each meal... include starchy carbohydrates Must continue with next planned meal after a binge 3 meals and three snacks Distraction.. delaying the binge...

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24 Resources Centre for Clinical Intervention Australian Website B-eat DWED Diabetics with Eating Disorders MBEEDS- Men and Boys Eating & Exercise Disorders NEEDS (North East Eating Disorder Support), Aberdeen and Dundee GEDS (Gerbera Eating Disorder Services, Glasgow)

25 Dietetic Support Dietetic department Local ED services