Medical Nutrition Therapy for Eating Disorders
What is Medical Nutrition Therapy in Eating Disorder & Malnutrition Treatment?
Medical nutrition therapy (MNT) is an evidence-based, individualized treatment that uses nutrition interventions to treat both long-term and acute medical conditions. MNT is administered by a registered dietitian nutritionist and can be utilized for a variety of conditions, including refeeding patients with eating disorders or severe malnutrition.
Medical nutrition therapy helps patients address the numerous medical complications of their condition through refeeding as dietitians:
- Assess eating practices and related factors
- Develop individualized plans for appropriate nutrition intervention
- Assist patients with implementing their meal plans
The role of nutrition
The importance of utilizing medical nutrition therapy in the treatment process for eating disorders and malnutrition cannot be overstated. MNT is vital to treating malnutrition and achieving medical stabilization because all the building blocks for the body that facilitate healing and function require energy obtained via carbohydrates, proteins and fats. Without them, the body’s organs, muscles and tissues are unable to replenish, heal and perform.
Goals of medical nutrition therapy
MNT is a major vehicle for medical stabilization, with its goals consisting of weight restoration, restored function and improved outcomes.
Weight restoration
One of the primary goals of nutrition therapy is weight restoration. Weight restoration plays a vital role in the refeeding process by supporting function and healing. Weight restoration is linked to improved short- and long-term outcomes for those with eating disorders and can improve physical complications of eating disorders like:
- Osteopenia and osteoporosis
- Cardiac complications
- Electrolyte abnormalities
- Menstrual function
Restoring function
Nutrition therapy reintroduces energy that helps restore basic functions of the body. Things like cognitive processing, temperature regulation, fluid balance and breathing all require energy. Adequate nutrition can restore these basic functions and ultimately allows for more complex activities like walking or holding conversations. Throughout their stay, many patients experience improved:
- Vital signs
- Cognitive functioning
- Bowel function
- Overall functional status
Improved outcomes
Weight restoration during the early stages of refeeding improves outcomes in patients with eating disorders. Patients who are sufficiently weight restored are less likely to experience a worsening of eating disorder symptoms. Proper nutrition and refeeding during medical stabilization treatment helps patients reach the physical and emotional state necessary to engage at lower levels of care.
FAQ
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Will I be automatically tube fed if I’m admitted with an eating disorder?
No. The dietitian will meet with you to meet with you to assess the safest and most effective way to refeed you, including oral nutrition, supplements, nutrition support or a combination of any of these.
Incorporating Nutrition
Oral nutrition
Oral refeeding is when nutrition is provided via oral intake without the use of parenteral or enteral nutrition.
Parenteral refeeding
Parenteral nutrition is the process of delivering nutrition intravenously (through a vein) to bypass the gut and support nutritional rehabilitation. Nutrition is delivered via formula that is customized to the patient’s specific nutritional requirements.
For most patients, parenteral refeeding is a short-term measure. Some examples of these conditions that require temporary parenteral refeeding include:
- Ileus
- Bowel obstruction
- Short bowel syndrome
Enteral refeeding
Enteral nutrition, known as tube feeding, is delivered through a feeding tube that is placed bedside through the nose and can be fed into the stomach or the small intestine, or a surgical feeding tube indicated for more long-term nutrition support.
The use of tube feeding is rare, with the vast majority of patients at ACUTE receiving oral nutrition.
What to expect from nutrition therapy
Assessment
Upon admission, the patient meets with a registered dietitian specializing in eating disorders to perform a nutrition-focused physical exam, which evaluates numerous body systems, including:
- Muscle and fat wasting
- Weight changes or weight loss
- Nutrient intake prior to arrival
- Muscle weakness
- Hair, skin and nails
- Signs of edema
Together, dietitian and patient will also discuss weight history, comorbidities, food preferences and food allergies. The dietitian may also inquire about discomfort, the patient’s diagnosis and how it has affected their food preferences.
For patients with non-eating disorder malnutrition, dietitians assess for chronic conditions, what their eating history was like before their weight loss, how it impacts ability to eat and how it prevents weight gain.
For patients who report difficulty swallowing or eating, the dietitian can ask for a consult from a speech therapist.
Education
Learning about the importance and function of nutrition is an essential part of medical nutrition therapy. The refeeding process can be very complex and confusing, so dietitians encourage patients to ask questions about foods and the refeeding process.
Dietitians will also engage patients in discussion on a variety of topics patients are curious about, like how the body is using the nutrition, what a hypermetabolic state is, how the gut microbiome works or how the brain and gut are related via the brain-gut axis.
Skilled interventions
MNT and meal plans are customized to support the nutritional needs of each patient and are designed to meet patients where they are at in their recovery journey. Patients meet 1:1 with the dietitian, who considers the patient’s food preferences, challenge foods and metabolic demand to design their meal plan.
Over time, a healthy rapport with a dietitian can also help patients feel empowered to try new foods.
- Meal planning
- Calculating nutrition needs
- Calculating nutrition support like tube feeding, formula, and supplementation
- Formulas for parenteral nutrition
- Ensuring macro and micronutrient goals are met
- Weening patients off feeding tubes, when applicable
Who does ACUTE treat?
ACUTE accepts patients who are too medically complex for lower levels of care.
- 15+ years of age
- All gender expressions
- <70% of ideal body weight (IBW)
- BMI <14.5
Severe medical complications associated with severe eating disorders or malnutrition
Get connected to care
Our admissions specialist can help assess your needs and determine the appropriate level of care.
Even if ACUTE isn’t right for you, our experienced admissions team can connect you with other programs that meet your needs.