Eating Recovery Center, a national, multisite treatment facility for patients with eating disorders, outlines strategies for using family-based treatment (FBT) practices with adolescents who are receiving inpatient care for an eating disorder. According to the organization’s paper published in the Journal of the Academy of Nutrition and Dietetics, FBT is designed as an outpatient treatment. However, its principles can apply to more intensive care.

Registered dietitian (RDs) are a critical component of inpatient FBT, the researchers state. At higher levels of care, the RD must communicate frequently with the patient’s parents or other caregivers. They discuss weight status and goals, growth, laboratory test results, vital signs, nutrition plans, and goals achieved.

When patients move to outpatient treatment, the responsibility of giving the child meals and snacks falls on the parents or caregivers. The RDs advise them on meal and menu planning, how to incorporate “challenge” foods, and strategies for redirecting disordered eating behaviors at mealtime.


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During inpatient care, caregivers are encouraged to join their child at mealtimes. Weekly trips to a restaurant are encouraged. During intensive outpatient treatment, caregivers are fully responsible for meal preparation and meal goals.

To further support caregivers, RDs provide weekly nutrition education. They must also work with caregivers to understand behavioral interventions and to explore family food beliefs. Balance, variety, and moderation are beneficial for recovery.

During inpatient and/or partial hospitalization, RDs support patients with meal-time coaching and check-ins. They do this while communicating and empowering caregivers.

In the beginning, patients are not involved in meal preparation and planning. As they progress through treatment, the facility gradually gives patients more autonomy.

“This paper may serve as a guide to other programs seeking to incorporate family-empowered care into their treatment, and to describe the important role of RDs in this novel treatment model,” the researchers conclude.

“Although the focus of this paper is on family-empowered care based on outpatient FBT, future research may seek to examine the efficacy of treatment facilities offering higher levels of care that focus on approaches other than FBT. For example, preliminary data support the use of the Unified Protocol in a residential program for eating disorders.”

Reference

Patterson J, Myers JL, Gallagher E, et al. Family-empowered treatment in higher levels of care for adolescent eating disorders: The role of the dietician. J Acad Nutr Diet. 2022;S2212-2672(22)00382-3. doi:10.1016/j.jand.2022.06.010