By: Rachel Scott, RD, CD, CNSD
Inpatient treatment for individuals with eating disorders is an important time for receiving adequate therapy, working on underlying issues, changing relationships with food, and establishing healthy eating behaviors. It can be more cost-effective than intensive outpatient treatment alone1. However, 80% of women who receive treatment for their eating disorder do not get the intensity of treatment they need to sustain recovery2. Many patients leave inpatient treatment prematurely for financial or personal reasons. With this in mind, it is shocking to see that one study shows individuals with eating disorders average 79 months to achieve full recovery3. Outpatient follow-up after inpatient care is imperative for full recovery. A key to success of outpatient care is continuing to see a registered dietitian in order to help support the new eating behaviors in a less structured environment.
The transition from inpatient residential treatment to a home environment can be harder than most people expect it to be. Some eating disorder behaviors resurface with less structure. Many individuals are triggered by returning to the environment they were in before inpatient treatment. A dietitian can help the patient remember the changes the patient has made and what the patient is capable of accomplishing. A dietitian can also help the patient to see how to apply what they learned, as an inpatient, to their new home setting.
Individuals receiving follow-up care after inpatient treatment need continued nutrition education. While much education is provided in an inpatient setting, there is still more for the patient to learn. Also, the material taught in the inpatient setting needs to be consistently presented to the patient as repetition is key to replacing old eating disorder beliefs about food. These individuals may not have been as ready to receive accurate nutrition knowledge when it was presented in an inpatient setting but may be more willing to accept it as an outpatient when they are further along in their recovery.
Meeting with a dietitian can be an opportunity for continued improvement and support. Individuals leaving an inpatient setting still have some eating disorder behaviors and food beliefs that they need to continue to work on. Regular nutrition counseling sessions can offer the individual a chance to voice concerns about what they’re seeing in their eating behaviors and have an opportunity for objective feedback. In a world of misconceptions about food and body image, these individuals need to hear and be reminded of how to maintain a healthy relationship with food. A dietitian can be a voice of support and encouragement needed for the recovering individual to continue her newly established eating behaviors.
It is important for the registered dietitian to have a background working with eating disorder patients. Dietitians who are not experienced with eating disorders can unintentionally say things that trigger the negative mind and exacerbate harmful eating behaviors. Communication between the inpatient and outpatient dietitian is important for continuity of care for the patient. Some items to discuss include: eating disorder behaviors at the beginning and end of treatment, anthropometrical data, and current goals for the patient.
Continuing to visit with an outpatient dietitian can be beneficial in sustaining recovery. It can help to solidify behaviors that were learned in an inpatient setting as well as serve as a support in a less structured environment. Follow-up sessions with a dietitian can offer continued nutrition education and advice in changing eating-disordered behaviors. In general, the registered dietitian plays a key role in, but is only part of, the outpatient treatment team.
Deep-Soboslay A, Sebastiani LM, Kaye WH. Weight gain with Anorexia Nervosa. Am J Psychiatry 157:1526.
http://www.state.sc.us/dmh/anorexia/statistics.htm accessed April 11, 2005
Strober M. Long-term outcome in Anorexia Nervosa: survival analysis of recovery, relapse, and outcome predictors in a 10-15 year prospective. Neuropsychiatric & Hospital, UCLA School of Medicine.