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Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders ABSTRACT
POSITION STATEMENT
It is the position of the American Die- tetic Association that nutrition inter- vosa, individuals lack a sense of control vention, including nutritional counsel- ing, by a registered dietitian is an essential component of the team treat- ment of patients with anorexia nervosa, bulimia nervosa, and other eating dis- (eg, vomiting, excessive exercise, alter- orders during assessment and treat- ment across the continuum of care. Eating disorders are considered
fective treatment of eating disorders.
ing patterns and nutritional status.
level of expertise in the field of eating disorders and related complications.
tion text revision of the Diagnostic and Statistical Manual of Mental Disorders 2006 by the American Dietetic Association Journal of the AMERICAN DIETETIC ASSOCIATION ADA REPORTS
COMORBID ILLNESS AND EATING
DISORDERS
EPIDEMIOLOGIC AND INFLUENCING
time period before clinical detection.
industrialized, developed countries.
ROLE OF THE TREATMENT TEAM
records for the period of 1984 to 1998.
selor, or a master’s level counselor.
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needs for care and site of treatment.
used as an adjunct to psychotherapy.
choice, it is critical that the RD’s mes- MEDICAL CONSEQUENCES AND
INTERVENTION IN EATING DISORDERS
in the patient’s thought processes, be- ANOREXIA NERVOSA
December 2006 ● Journal of the AMERICAN DIETETIC ASSOCIATION ADA REPORTS
Clinical signs
Anorexia nervosa
Bulimia nervosa
Hypotension; irregular, slow pulse; orthostasis; sinus Cardiac arrhythmias; palpitations; weakness Abdominal pain; bloating; constipation; delayed gastric emptying; feeling of fullness; vomiting dysmotility; early satiety; esophagitis;flatulence; gastroesophageal refluxdisease; gastrointestinal bleeding hypercholestrolemia; hypoglycemia; menstrual Protein–energy malnutrition; various micronutrient Bone pain with exercise; osteopenia; osteoporosis; Dental caries; erosion of the surface of the Figure. Nutrition-related clinical signs commonly associated with anorexia nervosa and bulimia nervosa. These signs will vary depending on the
weight-losing or purging behaviors and degree of malnutrition. (Data adapted from references and
Statistical Classification of Diseases Revision (ICD-10) systems identify ADA REPORTS
BULIMIA NERVOSA
ues to be the “drug of choice” for an- “bad” set up a system of dieting that tend to have “all or none” cognitions ness may trigger the person to purge.
December 2006 ● Journal of the AMERICAN DIETETIC ASSOCIATION ADA REPORTS
weight fluctuations may be occurring.
OTHER EATING DISORDERS
instrument that guides goal setting.
seling can influence the “all or none” plication resulting from the disorder.
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therefore, to overweight or obesity.
rather than weight loss, at any cost.
EMERGING ISSUES
December 2006 ● Journal of the AMERICAN DIETETIC ASSOCIATION ADA REPORTS
tors for eating disorders. Acta Psy- chiatr Scand. 2001;104:122-130.
CONCLUSIONS
10. H.R. 873, 108th Cong., 1st Sess.
disorder intervention and treatment.
References
Int J Eat Disord. 2001:30:69-74.
ADA REPORTS
limia nervosa. Am J Psychiatry.
ders: The state of the art. Pediat- treatment of eating disorders. Can J Psychiatry. 2002;47:227-234.
J Eat Disord. 2004;36:224-228.
delusionality of body image. Int J multisite study. Am J Psychiatry.
18. Kinoy BP. Eating Disorders. 2nd Ther. 1999;37(suppl 1):S79-S95.
descriptive study. J Behav Med.
Int J Obesity. 2000;24:404-409.
controlled trial. Am J Psychiatry.
21. Miller WR, Rollnick S. Motiva- site study. Int J Eat Disord. 1993; Int J Eat Disord. 2005;37:52-59.
December 2006 ● Journal of the AMERICAN DIETETIC ASSOCIATION ADA REPORTS
dence. Obes Rev. 2001;2:37-45.
Disord. 2003;34(suppl 1):S74-S88.
experiment. Int J Eat Disord.
Psychiatry. 2003;160:973-978.
patients’ status post-gastric by-pass for obesity. Obes Surg. 2001:11:464-468.
ADA position adopted by the House of Delegates on October 18, 1987, and reaffirmed on September 12, 1992; September 28, 1998; and May 25, 2005.
The update will be in effect until December 31, 2010. The ADA authorizes republication of the position, in its entirety, provided full and proper credit The Practical Guide: Identification, is given. Requests to use portions of this position must be directed to ADA Headquarters at 800/877-1600, ext. 4835, or Overweight and Obesity in Adults.
Authors: Beverly W. Henry, PhD, RD (Northern Illinois University, DeKalb, IL); Amy D. Ozier, PhD, RD (Northern Illinois University, DeKalb, IL).
Reviewers: Academy for Eating Disorders (Jillian Croll, PhD, RD, MPH, The Emily Program, St Paul, MN); Melanie Brede, MHSE, RD (University of Florida Student Health Care Center, Gainesville, FL); Kathryn Fink, MS, RD (Timberlawn Mental Health System, Dallas, TX); Mary H. Hager, PhD, RD, FADA and Jennifer Weber, MPH, RD (ADA Government Relations, Washington, DC); Rebekah Frandsen Mardis, RD (Real World Nutrition, Int J Obes Relat Metab Disord.
Los Angeles, CA); Esther Myers, PhD, RD, FADA (ADA Scientific Affairs, Chicago, IL); Pediatric Nutrition dietetic practice group (Barbara C. York, MS, RD, Children’s Hospital and Regional Medical Center, Seattle, WA).
Association Positions Committee Workgroup: Christine Palumbo, MBA, RD (chair); Dianne Polly, RD, JD; Jessica Setnick, MS, RD (content advisor).

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