Nutrition Assessment
By Debra Johnston, RD, Culinary Services Manager at Remuda Ranch
Nutrition Therapy plays a very important role in the treatment of eating disorders. Properly nourishing the body and achieving a healthy body weight are both essential for physical and psychological health. Unless the body is well nourished, the brain does not function properly, making it difficult for the patient to fully engage in her treatment. Therefore, the foundation of eating disorder treatment at Remuda Ranch is nourishment. The Registered Dieticians make sure that every patient is receiving the correct meal plan with the accurate number of calories for her individual weight restoration or weight maintenance needs.
The first step in working toward proper nourishment is a thorough nutrition assessment and the development of an individualize plan of care. During the nutrition assessment, the RD learns the history of the eating disorder, including restricting, exercising, binging, and/or purging behaviors. It is during this meeting that the RD gets to know the patient and discovers her motivation for treatment and recovery.
Reaching a Healthy Weight
An important part of establishing a healthy goal weight is the patient’s weight history. This history includes the patients highest/lowest weight and what behaviors led to those particular weights. The patient’s “fear” weight helps the RD understand how much support and education will be needed as she progresses in weight restoration. A patient’s family weight history is also taken into account when establishing a goal weight as a consideration of the genetic component of body weight.
During the nutrition assessment process, body composition measurements are taken in the form of skinfold measurements using Lange skinfold calipers. These measurements, along with height, weight, frame size, and age are inserted into a scientifically developed formula, which calculates percent body fat and muscle mass. Based on these body composition values, the patient’s weight history, the family’s weight history, and any available growth charts, the dietitian is able to establish an Ideal Body Weight (IBW).
Based on the patient’s current weight, her IBW, her weight history, and her eating disorder behaviors, the RD will establish weight restoration and nutrition goals. When a patient has a significant amount of weight to restore, a goal of 2 – 3 pounds of weight gain per week is normal. By progressing at this rate, complications from re-feeding syndrome can be prevented. When a patient is at or close to her IBW, the main focus is the elimination of eating disorder behaviors and progression toward a normal relationship with food.
The RD establishes an individualized meal plan based on the patient’s daily intake immediately prior to admission and her weight restoration goals. When a patient has been restricting to less than 800 calories per day, or has been purging excessively, an initial caloric level of 800 to 1000 calories is appropriate. When restricting has been less severe, the patient may begin with a meal plan of 1500 to 1800 calories per day.
At Remuda Ranch, we find it beneficial to provide the patient’s maintenance calories by way of three balanced meals per day along with snacks. These meals and snacks teach the patient what her meal plan will look like as she continues recovery and maintains a healthy weight. The Remuda Ranch meal plan is based on servings from MyPyramid and provides 50 – 60% of calories from carbohydrates, 15 – 20% of calories from protein and 25 – 35% of calories from fat.
Weight gain calories are provided through medical nutrition supplements or nasogastric tube feeding. High calorie, nutrient dense supplements or tube feeding formula provide more nutrients and calories with a smaller volume. This makes it possible for the patient’s meals and snacks to continue to look like a maintenance meal plan.
Many times the patient’s main behavior is compulsive exercising. Since exercise is an important part of a healthy lifestyle, we teach the patients guidelines to help them enjoy exercise without abusing it. By following the guidelines of the American College of Sports Medicine and with the approval of the outpatient dietitian and under the supervision of her primary care provider, a patient can leave treatment able to participate in a healthy exercise program.
Nourishing the body and attaining a healthy body weight go hand in hand with helping the patient with an eating disorder progress through treatment and into recovery. A thorough and individualized nutrition assessment is the basis for providing adequate nutrition intervention.
We Are Here to Help
Recovery from an eating disorder or OCD is possible. It's happening every day at Remuda Ranch. For information about our treatment programs, please call 1-800-445-1900 or complete a Take the Next Step form and we will contact you with the information you need.
