Nutritional Therapy aids in restoring a patient’s nutritional status.  This is vital in the treatment of eating disorders.  The patient’s treatment team is comprised of a dietitian, psychiatrist and physician—this interdisciplinary team assesses the patient’s nutritional patterns and the physiological components of the illness.  After an initial nutritional assessment, individualized meal plans and behavior program(s) are developed to support recovery.  Family and friend involvement and education are also encouraged to aid patient progress.

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Goals of Treatment

Nutrition therapy consultants intensive outpatient treatment program will provide family members with an
understanding and the tools necessary to manage and support the patient’s eating disorder at home. Family members and the patient are an integral part of the multidisciplinary treatment team as they are able to collaborate goals and establish a strong treatment team alliance. However, a collaborative approach to treatment should involve non-negotiable goals (i.e., weight gain and following a structured meal plan). Therefore, psycho-education will allow family members to gain a deeper understanding and empathy for what the patient may be experiencing. The development of a strong treatment team alliance is also imperative, as it will prevent the patient from splitting, especially when implementing feared treatment goals that are not negotiable. According to the research, family involvement in treatment increases treatment retention and strengthens family relationships (Agras & Robinson, 2005). An individual diagnosed with an eating disorder tends to have difficulty focusing on psychological and emotional process when in a state of starvation; therefore, psychological interventions to explore the psychological, interpersonal, and cultural factors that may have contributed to the onset of the eating disorder are generally ineffective initially. As a result, the program will provide an intensive nutritional rehabilitation during the initial stage of treatment to address the medical and cognitive effects of starvation; this will allow the patient to be more responsive to psychological interventions, subsequently, promoting a better prognosis for long-term recovery. This program assumes that change will occur for the patient with eating disorders when nutrition and weight are restored, allowing psycho-therapeutic interventions to be effectively utilized. The patient will be able to respond to stressful or emotional situations in his or her life with a wider range of coping skills without resorting to their eating disorder as a way of coping. As a result, the patient will be able to explore the etiology of the eating disorder, develop and utilize appropriate coping skills, and establish healthy relationships and boundaries with family members.Through the program, the patient and his or her family will gain knowledge and a deeper understanding about the complexity of eating disorders and obtain tools needed to manage the eating disorder on outpatient basis, consequently resulting in increased family cohesion and long-term recovery.

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Stages of Treatment

There are three stages of treatment in which the patient can stay or advance at different rates depending on
individual progress and level of care needed. The patient’s stage of treatment determines the amount of services that he or she is required to receive. The level of treatment is decreased when the patient is able to demonstrate the following: Nutrition and weight recovery and maintenance; participation in individual and group interventions; effective utilization of appropriate coping skills to deal with stressful events or situations; and independence and appropriate interpersonal boundaries.

Stage 1. The goal of this stage is to provide nutrition and weight restoration to reverse the cognitive and
physical impairments resulting from self-starvation. During this initial stage, the patient will participate assessments and interventions that include:

• Medical, psychiatric, nutritional assessments, and psychological that will be completed upon admission
• Primary care physician (1-2x/month)
• Individual nutrition therapy (1 hour, 1-3x/week)
• Individual psychotherapy (1 hour, 1x/week)
• Intensive nutrition therapy groups (2 hours, 2x/week)*
• Family therapy (1 hour, 2x/month)
• Support group (1.5 hours, 1x/month)
• Treatment team meeting (1x/month)

Stage 2. The focus of stage 2 is to increase the level of psycho-therapeutic interventions to address family
dynamics that may have contributed to the onset of the eating disorder. At this stage, nutritional interventions are decreased as the patient has demonstrated normalized eating behaviors and are maintaining his or her set-point weight. As autonomy is achieved, the patient is able to follow the meal plan outside of treatment without constant supervision. If appropriate, the patient is encouraged to add a balanced level of physical exercise (i.e., yoga or hiking).

• Individual nutrition therapy (1 hour, 2-3x/month)
• Individual psychotherapy (1 hour, 1x/week)
• Primary care physician (as needed to monitor client’s physical health)
• Process therapy group (1.5 hours, 1x/week)**
• Intensive nutrition therapy groups (2 hours, 1-2x/week)*
• Family therapy (1x/month)
• Support group (1x/month)
• Treatment team meeting (1x/month)

Stage 3 and 4. At these stages, the patient has demonstrated a consistent ability to maintain a healthy balanced lifestyle. He or she is able to effectively utilize positive coping skills without resorting to eating disorder behaviors. The patient continues to gain deeper understanding of him or herself and establishes healthy relationships and boundaries with family members. During stage 4, a relapse prevention plan is discussed; the patient is encouraged to continue individual nutrition and psychotherapy, as needed, until remission is achieved to prevent future relapse.

• Individual nutrition therapy (1 hour, 1-2x/month)
• Individual psychotherapy (1 hour, 2x/month)
• Primary care physician (as needed to monitor client’s physical health)
• Process therapy group (1.5 hours, 1x/week)**
• Intensive nutrition therapy groups (2-4x/month)*
• Family therapy (1x/month or as needed)
• Support group (1x/month)

Nutrition Therapy Groups*

Many patients come to the nutritional group (affectionately called ‘food group’) in the earlier phases of treatment; depending on a person’s individual needs, however, some continue to attend later into treatment.  The purpose of this group is to build comfort around food and practice the meal plan.  A meal is served at every food group meeting, and after the meal patients can talk about eating-related issues and struggles with fellow members.

Process Therapy Groups**

​Patients are invited into the process therapy group based on age and their need to develop basic skills needed to form and maintain relationships.  This group focuses on learning to build trust and camaraderie, and serves as an opportunity for patients to practice assertiveness skills.  Most importantly, they learn to share things that are going on in their lives and recognize the value of maintaining these interpersonal skills to prevent relapse