Guide to Medical Nutrition Therapy for Eating Disorders

Eating disorders are biological, psychological, and social disorders that wreak havoc on the body, mind, and lives of those that struggle with them. 28.8 million individuals in the United States will struggle with one of these disorders in their lifetime and these numbers are only increasing [1].

Those in the eating disorder field have researched and developed numerous effective methods of treatment to eradicate these devastating disorders. These evidence-based practices must focus not only on the psychology behind the behaviors but their physical impact on them. Medical Nutrition Therapy was developed to address this aspect of treatment.

diet planning

What is Medical Nutrition Therapy (MNT)?

Medical Nutrition Therapy (MNT) is established on the foundational understanding that physical health conditions worsen due to malnutrition. Ethical nutrition therapy is provided by a Registered Dietitian and involves this professional creating a meal plan customized for the individual being treated. This plan considers the medical, dietary, psychological, and social aspects of the individual.

The American Dietetic Association specifies that “key nutrition therapies require expertise in nutritional requirements for the life stage of the affected individual, nutritional rehabilitation treatments, and modalities to restore normal eating patterns [2].”

MNT is used in the treatment of numerous mental and medical illnesses such as diabetes, gastrointestinal disorders, cardiovascular disease, renal disorders, and numerous cancers.

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What is the Goal of Medical Nutrition Therapy?

The primary goal of nutrition therapy is to empower the individual being treated through psychoeducation and individualized understanding of what nutrition allows their bodies to be nourished and function optimally. Individuals that are simply told what to do are more at-risk for reverting back to concerning nutritional behaviors once on their own again.

MNT prioritizes education and self-management training with the understanding that the individual must be empowered and enabled to improve their nutrition for themselves and by themselves using intuitive eating, self-awareness, and an understanding of the importance of appropriate treatment for medical health and wellness.

diet plan

Medical Nutrition Therapy for Eating Disorders

MNT is an important component of eating disorder treatment, as the nutritional impact of eating disorder behaviors makes nutrition education, awareness, and change crucial to recovery. This makes Registered Dietitians a key member of the treatment team, their role is “to work with the recovering person to change food-and-weight-related behaviors. Dietitians must be able to address (ie, recognize and take into consideration) the psychological components and the nutritional aspects of these disorders and in most cases work closely with a clinical psychologist or psychiatrist [3].”

The American Dietetic Association outlines 5 specific duties of Dietitians that are part of an eating disorder treatment team:

  1. Nutrition Assessment: Identify nutrition problems that relate to medical or physical condition, including eating disorder symptoms and behaviors [2].”
  2. Nutrition Intervention: “Calculate and monitor energy and macronutrient intake to establish expected rates of weight change, and to meet body composition and health goals. Guide goal setting to normalize eating patterns for nutrition rehabilitation and weight restoration or maintenance as appropriate [2].”
  3. Nutrition Monitoring and Evaluation: Monitoring nutritional intake and adjusting as required.
  4. Care Coordination: Providing coordinated care and education for other treatment team members.
  5. Advanced Training: “Seek specialized training in other counseling techniques” that are effective in treating disorders and utilizing this in combination with nutritional work to support patients [2].

The education and guidance provided will depend on each individual’s unique combination of beliefs and behaviors.

Medical Nutrition Therapy for Anorexia Nervosa

Individuals struggling with Anorexia Nervosa engage in severe restriction of nutritional intake motivated by a desire to alter their body due to distorted body image. MNT for these individuals will involve support not only in educating about the importance of sufficient and effective nutrition but also in creating the required meal plan for medical stabilization and weight restoration. The RD would also provide an exploration of the internalized thin ideals and challenging body distortions to combat disordered beliefs.

planning a meal

Nutrition Therapy and Binge Eating Disorder

Binge Eating Disorder (BED) is characterized by individuals engaging in binge-eating episodes, which involve eating an atypically large amount of food in a short period of time. These behaviors are often associated with feelings of loss of control during the binge as well as guilt and shame afterward. To support these individuals in their recovery, Registered Dietitians would provide support in creating a meal plan based on appropriate nutritional requirements as well as supporting the individual in learning to listen to hunger and fullness cues and engage in intuitive eating. The RD would likely work with the therapist on the treatment team to explore the emotional aspects behind binges and find ways to more effectively cope with these.

Bulimia and Nutrition Therapy

Bulimia Nervosa involves individuals engaging in binge episodes as described above and subsequently using compensatory behaviors such as vomiting, exercise, and/or laxative/diuretic use to purge what was consumed during the binge. Medical Nutrition Therapy for those struggling with Bulimia Nervosa would involve the same work on binge eating episodes as described above as well as educational support on the impacts of these compensatory behaviors on health and the body. The Registered Dietitian would likely also explore with the individual and their Therapist the limiting or false beliefs behind their behaviors and how they can rewrite these beliefs and replace them with more nutritionally sound and effective, recovery-focused beliefs around food and nutrition.

Benefits of Nutrition Therapy for Eating Disorder Recovery

Regardless of the eating disorder, Medical Nutrition Therapy will always involve a component of nutritional, medical, and emotional education and self-management skills. Registered Dietitians that are part of an eating disorder team must be nutritionally-minded while also being clinically minded in order to support the team and their patient in addressing all aspects of the eating disorder. Additionally, plans and interventions will always focus on health-centered approaches rather than weight-centered approaches.

All of these aspects lead to Nutrition Therapy being a crucial and effective aspect of eating disorder treatment. This component of treatment allows individuals to challenge the false beliefs and nutrition facts they have been taught or developed, provides re-education, emphasizes the exploration of how the emotional lends to nutrition decisions and beliefs and supports the implementation of recovery-focused beliefs and behaviors that center on health rather than weight, societal expectations, or maladaptive coping.

Without addressing this aspect of treatment, individuals may gain therapeutic insight or weight restoration while in treatment but would be unlikely to continue these changes or implement these understandings once returning to their daily lives.

Medical Nutrition Therapy combines education and autonomy in the nutritional aspects that are key to the eating disorder treatment and recovery process.

Resources

[1] Sonneville, K. R., Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders.

[2] Unknown (2011). Position of the American Dietetic Association: Nutrition intervention in the treatment of eating disorders. Journal of the American Dietetic Association, 111.

[3] Whisenant, S. L. (1995). Eating disorders: current nutrition therapy and perceived needs in dietetic education and research. Journal of the American Dietetic Association, 95:10.

Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed and Approved By: Jacquelyn Ekern, MS, LPC / 12.2.21