Background: This program will explore combining the art and science of determining concrete nutrition restoration goals for eating disorder patients. It will combine knowledge from neurobiology, medicine and nutrition literature as well as professional experience to formulate weight goals and discuss nutritional challenges for both adolescents and adults that suffer from eating disorders. Practice based audience interaction and discussion of brand new research elucidating fMRI changes seen in individuals after nutritional restoration will round out the session.
Objectives:
- Identify all of the tools used to set weight goals.
- Understand medical and neurobiological changes that occur with malnutrition and with nutrition rehabilitation.
- Understand factors to consider when setting weight goals for both adolescent and adults and across the eating disorder spectrum.
- Weight Ranges
- Importance of Nutritional Rehab and achieving weight goal prior to discharge
- Study
- No common standard in the field
- Not an exact science
- Restoration process
- IP vs OP
- Combo of fat, muscle, organ, bone
- Labs and vitals
- How functioning cognitively
- Medications appear more affective
- Set Point Theory
- Importance of Nutritional Rehab and achieving weight goal prior to discharge
- Methods to determine weight range
- Ideal Body Weight
- How it is used
- Why not helpful
- Body Mass Index
- How it is used
- Ratio of height and weight
- What each category means
- Why not helpful
- Doesn’t take into consideration body composition
- Not an indicator of health
- Not accurate for growing children
- Insurance using this as a standard/DSM-V
- How it is used
- Hormone levels and other labs
- Menses, sex drive
- LH, Estradiol, FSH
- Family History/Genetics
- Meet their parents and siblings
- Growth charts
- Where to obtain this information
- CDC
- How to use
- Show an example
- Adult vs Adol
- Adult vs Adolescent Ranges
- Adult: Can be set more specifically
- Adol: Moving target as they grow
- Weight goals across Eating Disorder spectrum
- Atypical Anorexia
- Bulimia Nervosa
- Binge Eating Disorder
- State criteria in Anorexia
- Distinction from traits in the illness.
- Importance of malnutrition
- Impact in treatment and relapse prevention.
- Neurobiological changes of Malnutrition
- Impact on Neurons and connections
- Impact on chemical messengers
- Impact on neuronal circuits
- Nutritional and Medical Physiology
- Bone Health
- Cardiovascular Health
- Endocrine Health
- Neurologic/Psychological Health
- Nutrition and psychopharmacology
- SSRI’s, serotonin and nutrition
- Antipsychotic side effects and weight gain during and after weight restoration
- Folate and antidepressant response
- New research into impact of weight restoration on functional imaging and neural circuits
- BOLD signal changes in individuals pre-post weight restoration
- Functional connectivity changes in neural systems pre-post weight restoration
- Ideal Body Weight
- Interactive session to test what is learned:
- Have audience members list out 8-10 factors of a potential patients to have open discussion of how to determine weight range and how to follow it over time.
In this presentation a pragmatic dietitian’s view of working with individuals with different presentations and diagnoses will be used in order to set real and achievable nutrition and weight goals during the course of treatment. Medical data concerning nutritional health including discussion of bone health, endocrine changes, cardiovascular health as well as neurobiology will be covered as well. This includes new fMRI data that looks at important changes that occur in the brain during the course of nutritional restoration in Anorexia Nervosa. Finally, utilizing audience participation, the team of doctor and dietitian will create a case discussion based on challenges face by clinicians in their daily practice.
Dr. Moseman attended medical school at Texas A&M University and completed adult residency at the University of Arizona. He went on to do a fellowship in Child and Adolescent Psychiatry at Western Psychiatric Institute and Clinic where he served as chief fellow. Since completing fellowship in 2004, he has worked at the Laureate Eating Disorders Program on both an inpatient and outpatient basis and is currently Medical Director of the eating disorders program. Dr. Moseman is also an investigator at the Laureate Institute of Brain Research where he participates in studies using functional imaging to investigate eating related illnesses.
Claire Gish has been a clinical dietitian for the Laureate Eating Disorders Program since 2011. She served as dietitian for Magnolia House, Laureate’s independent living home for adults in early recovery from eating disorders, for six years. She earned both a bachelor and master of sciences degree in nutritional sciences and dietetics from Oklahoma State University. Claire enjoys working in both the inpatient and outpatient setting on nutritional goal setting and application of skills to effectively manage eating disorder symptoms. Claire uses an “All Foods Fit” approach, which legalizes all food groups and allows for flexibility and trust.
