Navigating the Complexities of Significant Weight Restoration

Ward, Jessica

Thursday, February 7, 2019: 3:45 PM-5:15 PM

Desert Salon 1/2 (JW Marriott Desert Springs Resort and Spa)

Background: Weight restoration, especially significant weight restoration, is a complicated process physically, emotionally, and behaviorally. Many patients have never been “normal” body weight, and the weight restoration process can be daunting. Emaciation and thin body type may have become the norm, and patients and families may no longer see the risks. Helping patients and families navigate the weight restoration process is an important step toward recovery. In this workshop, we’ll talk about the medical, nutritional, and therapeutic aspects of significant weight restoration and how they work together to successfully move the patient toward recovery.

Objectives:

Upon completion of this workshop, participants will be able to list 3 common lab abnormalities during weight restoration and describe how to respond.
Upon completion of this workshop, participants will name at least 4 topics that are helpful to navigate with families and support people.
Upon completion of this workshop, participants will describe at least 2 strategies for helping patients continue to move through weight restoration in spite of discomfort.

Navigating the Complexities of Significant Weight Restoration Outline

I. What makes weight restoration complicated and scary?

a. Medical complications

i. Labs: abnormalities and risks, management, monitoring

1. AST

2. ALT

3. Glucose

4. Phosphorus

5. Cholesterol

6. Others

ii. Vitals: abnormalities and risks, management, precautions

1. Heart rate

2. Blood pressure

iii. Edema: prevention and management, working with the patient

b. Nutrition

i. Food preferences: what is eating disorder, what is real and how do you know?

ii. ED rules: assignment and how it helps

iii. Fullness: preparation and management

iv. Digestive discomfort: what to expect, how to manage it, communication

c. Emotional complications

i. Being in treatment

ii. Managing “down time” and learning to rest

iii. Loss of identity

iv. Body Image

d. Family complications

i. Emaciation as “normal”

ii. Managing home without the patient

iii. Changing family roles

II. Overcoming ambivalence about weight restoration

a. Role of RD

b. Role of Therapist with client

c. Role of Family therapist

d. Role of Medical/Nursing

e. Tying it all together/working as a team

III. Managing the Process

a. Vitals – how to manage normalization

b. Labs – monitoring and managing, revisited

c. Communicating when it isn’t going well

d. Communicating when it is going well and the eating disorder twists it all around

e. Medications

f. Nutritional choices

g. Changing Body and subsequent body image changes – how to talk about it, when to talk about it

h. Managing family and friends and their comments

IV. Staying the Course

a. Keeping the patient committed

b. Giving options to keep it interesting; creating challenges when appropriate

c. Tying in family

d. Managing fullness

V. Preparing for weight maintenance

a. Changing the meal plan

b. Managing expectations

i. Patient

ii. Family

c. Physical activity and movement

i. Changing the definition

ii. Making it fun

iii. Building relationship

iv. Goals for the future

d. Family understanding and support

e. Body image

f. Stoplight Assignment

Significant weight restoration can be a challenging and sometimes scary proposition not only for the patient, but also for their family and even clinicians. The potential for physical complications of weight restoration is real and needs careful monitoring and management. Understanding which abnormalities to watch for as well as becoming more comfortable with how and when to respond to abnormal values is important. Interpreting those changes for patients and families in a way that conveys seriousness without alarm is where art mixes with science. Weight restoration also directly confronts many disordered eating patterns and behaviors creating a minefield clinicians must navigate to keep the patient engaged. Physical changes and symptoms create discomfort that can be difficult to tolerate and may reinforce some eating disorder beliefs. Add to those things, the emotions of treatment and weight restoration, family dynamics that necessarily change, and the process of treatment and weight restoration becomes a challenge not for the faint of heart. Each member of the eating disorder treatment team (medical, nutritional, therapeutic) plays an important role and how they work together with patient and family is key. We’ll walk through this progression from managing the initial step into treatment, overcoming potential ambivalence, and then managing all the things that happen during the process including medical complications, physical symptoms, emotional changes, and helping the patient and family look at patterns and roles that may need to change for lasting recovery. We’ll wrap up with ideas and strategies to prepare for the next phase of recovery once weight restoration is complete.

Primary Presenter:

Jessica Ward, MS, RD, CD, CEDRD

Jessica Ward received her Bachelor of Science in Dietetics from Gannon University and Master of Science in Wellness Management from Ball State University. She is the Director of Therapeutic Services for Selah House developing Selah House’s program and leading the team of dietitians, therapists, chaplain, equine staff, and education staff. Jessica serves as faculty for the eating disorders course at Anderson University and has authored the eating disorder section of the Indiana Diet Manual in two revisions. She is an active member of several eating disorder dietitian groups nationally and active in the Indiana Eating Disorder Task Force

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