Unit
- Anorexia nervosa: Characterized by significantly low body weight due to restrictive eating, intense fear of weight gain, and disturbance in body weight or shape experience. Subtypes include restricting and binge-eating/purging. Onset typically in adolescence, with higher prevalence in females.
- Bulimia nervosa: Involves recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, laxative misuse, or excessive exercise. Body weight is often within normal range, making detection challenging. Purging behaviors carry serious electrolyte and dental risks.
- Binge-eating disorder: The most common eating disorder, marked by recurrent binge eating without compensatory behaviors. Associated with obesity and metabolic syndrome. Episodes involve loss of control and distress, often leading to guilt and shame.
- Avoidant/restrictive food intake disorder (ARFID): A eating or feeding disturbance resulting in persistent failure to meet nutritional needs, without body image disturbance. Common in children and those with sensory sensitivities or fear of choking.
- Other specified feeding or eating disorder (OSFED): Includes atypical anorexia, purging disorder, and night eating syndrome. These individuals meet many criteria but not full thresholds, yet still experience significant impairment.
- Pica and rumination disorder: Pica involves persistent eating of non-nutritive substances; rumination disorder involves repeated regurgitation of food. Both require specialized nutritional and behavioral interventions.
- Prevalence and demographics: Eating disorders affect approximately 9% of the population globally, with higher rates in athletes, LGBTQ+ communities, and those with trauma history. Early detection improves outcomes significantly.
- DSM-5 criteria importance: Accurate diagnosis using DSM-5 criteria ensures appropriate treatment planning and insurance reimbursement. Clinicians must differentiate between disorders as nutritional strategies vary substantially.
- Medical complications: Eating disorders can lead to critical health issues including cardiac arrhythmias, osteopenia, gastrointestinal motility disorders, and endocrine disturbances. These complications guide the dietitian's monitoring priorities and underscore the need for medical stabilization before intensive nutritional rehabilitation begins.
- Refeeding syndrome: A potentially fatal metabolic complication occurring when malnourished individuals receive aggressive nutrition. It involves dangerous electrolyte shifts, particularly hypophosphatemia. Dietitians must implement slow, monitored refeeding protocols with electrolyte supplementation and close medical oversight to prevent adverse outcomes.
Scope of Practice
Role: Registered Dietitian in Outpatient Eating Disorder Clinic
Within scope:
- Conducting comprehensive nutritional assessments and diagnosing malnutrition using standard criteria.
- Developing individualized meal plans that address medical stability and psychological readiness.
- Providing nutrition education on energy balance, micronutrient needs, and weight restoration.
- Collaborating with therapists and physicians to coordinate care and adjust interventions.
- Monitoring labs, vital signs, and eating behaviors during refeeding.
Outside scope:
- Diagnosing eating disorders independently (requires qualified mental health professional).
- Prescribing psychotropic medications or ordering medical tests without physician authorization.
- Providing psychotherapy or trauma processing without specialized license.
- Mandating weight gain without client assent and collaborative agreement.
- Managing medical emergencies such as severe electrolyte imbalances alone.
Quick Revision
- Major eating disorder categories include anorexia, bulimia, binge-eating disorder, and ARFID, each with distinct behavioral and nutritional profiles.
- Accurate diagnosis using DSM-5 criteria is critical for selecting appropriate nutritional interventions.
- Dietitians work within a multidisciplinary team and must recognize their scope boundaries, especially in diagnosis and medication management.
- Early detection and referral improve prognosis; dietitians play a key role in screening and initial assessment.