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Fuller S, Sheridan E, Hudson LD, Nicholls D. Nasogastric tube feeding under physical restraint of children and young people with mental disorders: a comprehensive audit and case series across paediatric wards in England. Arch Dis Child 2024; 109:649-653. [PMID: 38649256 DOI: 10.1136/archdischild-2024-327039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To estimate the number of patients on paediatric wards in England who received nasogastric tube (NGT) feeding under physical restraint from April 2022 to March 2023, identify the demographics and clinical characteristics of these patients, and which personnel facilitated the restraint. DESIGN Audit and anonymous case series SETTING: Paediatric wards in England. PATIENTS Children and young people receiving this intervention in a 1-year period. OUTCOME MEASURES An online survey was sent to all paediatric wards in England, with the option of submitting anonymous case studies. RESULTS 136/143 (95.1%) acute paediatric units responded. 144 young people received this intervention across 55 (38.5%) paediatric units. The predominant diagnosis was anorexia nervosa (64.5%), age range 9-18 years (M=14.2, SD=2.1). The duration of NGT feeding under restraint ranged from 1 to 425 days, (M=60.2, SD=80.4). Numerous personnel facilitated the restraints, including mental health nurses, paediatric nurses, security staff, healthcare assistants and parents/carers. CONCLUSION NGT feeding under restraint is a relatively common intervention in acute paediatric units in England. Understanding the demographics of those receiving this intervention may highlight where additional support is needed. Further research is needed to understand when this intervention transitions from a lifesaving intervention to ongoing management.
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Affiliation(s)
- Sarah Fuller
- Child and Adolescent Mental Health, Northamptonshire Healthcare NHS Foundation Trust, Northampton, Northamptonshire, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Emerie Sheridan
- Department of Brain Sciences, Imperial College London, London, UK
| | - Lee D Hudson
- Population, Policy & Practice Research Programme, UCL Institute of Child Health, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London, London, UK
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Fuller SJ, Tan J, Nicholls D. Nasogastric tube feeding under restraint: understanding the impact and improving care. BJPsych Bull 2024; 48:163-167. [PMID: 37485906 PMCID: PMC11134022 DOI: 10.1192/bjb.2023.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/26/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Nasogastric tube feeding under physical restraint is an intervention that clinicians working in specialist mental health in-patient units may need to implement. AIMS To examine the impact of this intervention on people with lived experience, carers and staff. METHOD People with lived experience and parents and/or carers were recruited via UK eating disorder charity Beat. Clinicians were recruited via the British Eating Disorders Society's research forum. Qualitative semi-structured interviews were conducted and transcribed, and the results were thematically analysed. RESULTS Thirty-six participants took part, and overlapping themes were identified. All participants spoke in relation to four themes: (a) the short-term impact on the patient; (b) the impact on those around the patient; (c) the long-term impact; and (d) the positive impact. Subthemes were identified and explored. CONCLUSION This lifesaving intervention can also negatively affect patients, parents and carers, peers and staff. Further research is needed to understand how interactions and environmental modifications can mitigate the negative impacts.
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Affiliation(s)
- Sarah J. Fuller
- Imperial College London, UK
- Northamptonshire Healthcare NHS Foundation Trust, UK
| | - Jacinta Tan
- Oxford Health NHS Foundation Trust, UK
- University of Oxford, UK
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Martini M, Longo P, Di Benedetto C, Delsedime N, Panero M, Abbate-Daga G, Toppino F. Nasogastric Tube Feeding in Anorexia Nervosa: A Propensity Score-Matched Analysis on Clinical Efficacy and Treatment Satisfaction. Nutrients 2024; 16:1664. [PMID: 38892597 PMCID: PMC11174568 DOI: 10.3390/nu16111664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
The choice of a refeeding strategy is essential in the inpatient treatment of Anorexia Nervosa (AN). Oral nutrition is usually the first choice, but enteral nutrition through the use of a Nasogastric Tube (NGT) often becomes necessary in hospitalized patients. The literature provides mixed results on the efficacy of this method in weight gain, and there is a scarcity of studies researching its psychological correlates. This study aims to analyze the effectiveness of oral versus enteral refeeding strategies in inpatients with AN, focusing on Body Mass Index (BMI) increase and treatment satisfaction, alongside assessing personality traits. We analyzed data from 241 inpatients, comparing a group of treated vs. non-treated individuals, balancing confounding factors using propensity score matching, and applied regression analysis to matched groups. The findings indicate that enteral therapy significantly enhances BMI without impacting treatment satisfaction, accounting for the therapeutic alliance. Personality traits showed no significant differences between patients undergoing oral or enteral refeeding. The study highlights the clinical efficacy of enteral feeding in weight gain, supporting its use in severe AN cases when oral refeeding is inadequate without adversely affecting patient satisfaction or being influenced by personality traits.
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Affiliation(s)
| | | | | | | | | | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 11, 10126 Turin, Italy; (M.M.); (P.L.); (C.D.B.); (N.D.); (M.P.); (F.T.)
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Fuller SJ, Tan J, Nicholls D. The importance of individualised care, good communication and trust for reducing nasogastric tube feeding under physical restraint: qualitative multi-informant study. BJPsych Open 2024; 10:e86. [PMID: 38629302 PMCID: PMC11060075 DOI: 10.1192/bjo.2024.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/18/2023] [Accepted: 02/06/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Nasogastric tube (NGT) feeding against a patient's consent is an intervention that clinicians working in specialist mental health in-patient units may need to implement from time to time. Little research has explored clinician, patient and carer perspectives on good practice. AIMS To use qualitative data from people with lived experience (PWLE), parents/carers and clinicians, to identify components of best practice when this intervention is required. METHOD PWLE and parents/carers were recruited via BEAT UK's eating disorder charity. Clinicians were recruited via a post on The British Eating Disorders Society's research page. Semi-structured interviews were administered, transcribed and thematically analysed. RESULTS Thirty-six interviews took place and overlapping themes were identified. Participants spoke in relation to three themes: first, the significance of individualised care; second, the importance of communication; third, the impact of staff relationships. Sub-themes were identified and explored. CONCLUSIONS Good care evolved around positive staff relationships and individualised care planning rather than standard processes. The centrality of trust as an important mediator of outcome was identified, and this should be acknowledged in any service that delivers this intervention.
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Affiliation(s)
- Sarah J. Fuller
- Division of Psychiatry, Imperial College London, UK
- Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Jacinta Tan
- Retired Consultant Child and Adolescent Psychiatrist, Swansea, UK
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Fuller SJ, Tan J, De Costa H, Nicholls D. Nasogastric tube feeding under physical restraint: comprehensive audit and case series across in-patient mental health units in England. BJPsych Bull 2023; 47:322-327. [PMID: 37165785 PMCID: PMC10694691 DOI: 10.1192/bjb.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/02/2023] [Indexed: 05/12/2023] Open
Abstract
AIMS AND METHOD To identify the clinical characteristics of patients receiving nasogastric tube (NGT) feeding under physical restraint. Clinicians participated via professional networks and subsequent telephone contact. In addition to completing a survey, participants were invited to submit up to ten case studies. RESULTS The survey response rate from in-patient units was 100% and 143 case studies were submitted. An estimated 622 patients received NGT feeding under restraint in England in 2020-2021. The most common diagnosis was anorexia nervosa (68.5-75.7%), with depression, anxiety and autism spectrum disorder the most frequent comorbidities. Patients receiving the intervention ranged from 11 to 60 years in age (mean 19.02 years). There was wide variation in duration of use, from once to daily for 312 weeks (mode 1 week; mean 29.1 weeks, s.d. = 50.8 weeks). CLINICAL IMPLICATIONS NGT feeding under restraint is not uncommon in England, with variation in implementation. Further research is needed to understand how the high comorbidity and complexity contribute to initiation and termination of the intervention.
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Affiliation(s)
- Sarah J. Fuller
- Imperial College London, UK
- East London NHS Foundation Trust, UK
| | - Jacinta Tan
- Oxford Health NHS Foundation Trust, UK
- University of Oxford, UK
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Fuller SJ, Thomson S, Tan J. Nasogastric tube feeding under restraint: practical guidance for children's nurses. Nurs Child Young People 2023; 35:18-23. [PMID: 36408588 DOI: 10.7748/ncyp.2022.e1457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/22/2022]
Abstract
The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.
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Affiliation(s)
- Sarah J Fuller
- child and adolescent mental health, East London NHS Foundation Trust, Bedford, England
| | - Sharon Thomson
- child and adolescent mental health, East London NHS Foundation Trust, Bedford, England
| | - Jacinta Tan
- child and adolescent mental health, Oxford Health NHS Foundation Trust, Bedford, England
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Fuller SJ, Tan J, Nicholls D. Decision-making and best practice when nasogastric tube feeding under restraint: multi-informant qualitative study. BJPsych Open 2023; 9:e28. [PMID: 36721889 PMCID: PMC9970178 DOI: 10.1192/bjo.2022.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Clinicians working in mental health in-patient settings may have to use nasogastric tube feeding under physical restraint to reverse the life-threatening consequences of malnutrition when this is driven by a psychiatric condition such as a restrictive eating disorder. AIMS To understand the decision-making process when nasogastric tube feeding under restraint is initiated in mental health in-patient settings. METHOD People with lived experience of nasogastric tube feeding under restraint and parents/carers were recruited via the website of the UK's eating disorder charity BEAT. Eating disorder clinicians were recruited via an online post by the British Eating Disorders Society. Semi-structured interviews were administered to all participants. RESULTS Themes overlapped between the participant groups and were integrated in the final analysis. Two main themes were generated: first, 'quick decisions', with the subthemes of 'medical risk', 'impact of not eating' and 'limited discussions'; second, 'slow decisions', with subthemes of 'threats', 'discussions with patient', 'not giving up' and 'advanced directives'. Benefits and harms of both quick and slow decisions were identified. CONCLUSIONS This research offers a new perspective regarding how clinical teams can make best practice decisions regarding initiating nasogastric feeding under restraint. In-patient mental health teams facilitating this clinical intervention should consider discussing it with the patient at the beginning of their admission in anticipation of the need for emergency intervention and in full collaboration with the multidisciplinary team.
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Affiliation(s)
- Sarah J Fuller
- Division of Psychiatry, Imperial College London, London, UK; and East London NHS Foundation Trust, Bedford, UK
| | | | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
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Fuller SJ, Chapman S, Cave E, Druce-Perkins J, Daniels P, Tan J. Nasogastric tube feeding under physical restraint on paediatric wards: ethical, legal and practical considerations regarding this lifesaving intervention. BJPsych Bull 2022; 47:105-110. [PMID: 35249576 PMCID: PMC10063984 DOI: 10.1192/bjb.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Eating disorders have the highest mortality rate of any psychiatric condition. Since the COVID-19 pandemic, the number of patients who have required medical stabilisation on paediatric wards has increased significantly. Likewise, the number of patients who have required medical stabilisation against their will as a lifesaving intervention has increased. This paper highlights a fictional case study aiming to explore the legal, ethical and practical considerations a trainee should be aware of. By the end of this article, readers will be more aware of this complex issue and how it might be managed, as well as the impact it can have on the patient, their family and ward staff.
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Affiliation(s)
- Sarah J Fuller
- Advanced Specialist Eating Disorders Dietitian, East London NHS Foundation Trust and Child; and Child and Adolescent Mental Health Department, Imperial College London, UK
| | - Simon Chapman
- Consultant in Paediatric and Adolescent Medicine, Department of Paediatrics, King's College London, UK
| | - Emma Cave
- Professor of Healthcare Law, Department of Paediatrics, Durham University, UK
| | - James Druce-Perkins
- Highly Specialist Dietitian, Child and Adolescent Mental Health Department, Aneurin Bevan University Health Board
| | | | - Jacinta Tan
- Consultant Child and Adolescent Psychiatrist, Oxford Health NHS Foundation Trust; and Senior Clinical Research Fellow, Department of Psychiatry, Oxford University, UK
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Cooper M, Collison AO, Collica SC, Pan I, Tamashiro KL, Redgrave GW, Schreyer CC, Guarda AS. Gastrointestinal symptomatology, diagnosis, and treatment history in patients with underweight avoidant/restrictive food intake disorder and anorexia nervosa: Impact on weight restoration in a meal-based behavioral treatment program. Int J Eat Disord 2021; 54:1055-1062. [PMID: 33973254 DOI: 10.1002/eat.23535] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Gastrointestinal (GI) concerns are often presumed to complicate nutritional rehabilitation for restrictive eating disorders, yet their relationship to weight restoration outcomes is unclear. This retrospective chart review examined GI history and weight-related discharge outcomes in primarily adult, underweight inpatients with anorexia nervosa (AN, N = 107) or avoidant/restrictive food intake disorder (ARFID, N = 22) treated in a meal-based, behavioral eating disorder program. METHOD Lifetime GI symptomatology, diagnoses, diagnostic tests, and procedures were abstracted from medical records. Generalized linear models examined associations of GI diagnoses, tests, and procedures with discharge BMI and rate of weight gain. RESULTS Ninety-nine percent of patients reported GI symptomatology and 83% had one or more GI diagnoses; with constipation and GERD most common. GI diagnoses (p <.01) and testing (p <.001) were more common in ARFID than AN. Average inpatient weight gain (1.59 kg/week), and discharge BMI (18.5 kg/m2 ), did not differ by group. Slower weight gain in patients with (1.3 kg/week), versus without (1.7 kg/week), history of tube feeding (p = .02), accounted for a main effect of GI procedures on inpatient rate of gain (p = .01). DISCUSSION Despite ubiquitous GI symptomatology, meal-based weight restoration achieved average weekly weight gain above recommended APA guidelines for hospitalized patients with an eating disorder. History of tube feeding was associated with slower mean weight gain, which remained, however, within recommended APA guidelines.
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Affiliation(s)
- Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amira O Collison
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sarah C Collica
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Isabella Pan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kellie L Tamashiro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Cook N, Collins J, Goodwin D, Porter J. A systematic review of food waste audit methods in hospital foodservices: development of a consensus pathway food waste audit tool. J Hum Nutr Diet 2021; 35:68-80. [PMID: 34060673 DOI: 10.1111/jhn.12928] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To understand, monitor and compare the scope of food waste in hospital foodservices, it is essential to measure food waste using a standardised method. The aims of this systematic review were to: (i) describe and critique the methodological features of waste audits used in hospital foodservice settings that measure aggregate food and food-related waste and (ii) develop a consensus tool for conducting a food waste audit in a hospital foodservice setting. METHODS Seven electronic databases were searched for peer reviewed literature, and 17 Google Advanced searches located grey literature that described food waste audit methods previously used or developed for hospital foodservices. Study selection and quality assessment occurred in duplicate. Data describing the audit method, its feasibility, and strengths and limitations were extracted and synthesised to develop a consensus tool. RESULTS Eight peer reviewed and nine grey literature documents describing a variety of food waste audit methods were found. The most common practices were 2-week data collection (n = 5), foodservice staff collecting data (n = 6), measuring food waste only (n = 11), measuring food waste at main meals (n = 5) and using electronic scales to measure waste (n = 12). A consensus tool was developed that proposes a method for preparing, conducting and analysing data from a food waste audit. CONCLUSIONS This review used published evidence to develop the first ever food waste audit consensus tool for hospital foodservices to use and measure food and food-related waste. Future research is needed to apply and test this tool in practice.
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Affiliation(s)
- Nathan Cook
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.,Dietetics Departments, Eastern Health, Box Hill, VIC, Australia
| | - Denise Goodwin
- Monash Sustainable Development Unit, Monash University, Clayton, VIC, Australia.,BehaviourWorks, Clayton, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Kodua M, Mackenzie JM, Smyth N. Nursing assistants' experiences of administering manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa. Int J Ment Health Nurs 2020; 29:1181-1191. [PMID: 32578949 DOI: 10.1111/inm.12758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
Abstract
Manual restraint, a type of physical restraint, is a common practice in inpatient mental health settings linked to adverse physical and psychological staff and patient outcomes. However, little is known about the use of manual restraint for compulsory nasogastric feeding of patients with anorexia nervosa within inpatient eating disorder settings. The present phenomenological study aimed to explore nursing assistants' experiences of administering manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa. The study followed COREQ guidelines. Eight semi-structured interviews were conducted with eight nursing assistants from one UK inpatient child and adolescent eating disorder service. Interviews were transcribed verbatim and analysed using thematic analysis. Three themes were extracted: An unpleasant practice, importance of coping, and becoming desensitized and sensitized. Nursing assistants commonly experienced emotional distress, physical exhaustion, physical injury and physical aggression as a result of their manual restraint use. Nursing assistants appeared to cope with their distress by talking with colleagues and young persons who were further in their recovery, and by detaching themselves during manual restraint incidents. The findings highlight that the use of manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa in the UK is a highly distressing practice for nursing assistants. It is therefore important that sufficient supervision, support, and training are made available to staff working in these settings.
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Affiliation(s)
- Michael Kodua
- School of Social Sciences, Psychology, University of Westminster, London, UK
| | - Jay-Marie Mackenzie
- School of Social Sciences, Psychology, University of Westminster, London, UK
| | - Nina Smyth
- School of Social Sciences, Psychology, University of Westminster, London, UK
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McMaster CM, Wade T, Franklin J, Hart S. Development of consensus-based guidelines for outpatient dietetic treatment of eating disorders: A Delphi study. Int J Eat Disord 2020; 53:1480-1495. [PMID: 32662177 DOI: 10.1002/eat.23330] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To generate consensus-based guidelines for outpatient dietetic treatment of patients with an eating disorder (ED) using Delphi methodology. METHOD A modified Delphi method was used to develop consensus-based guidelines in several categories: referral to a dietitian; essential components of outpatient dietetic treatment; strategies to promote collaboration between dietitians and other healthcare professionals; and skills dietitians should possess if treating patients with an ED. Participants (n = 162) were coded into three panels: ED specialists (n = 79), non-ED specialists (n = 28), and consumers and carers with lived experience of an ED (n = 55). A total of 122 statements were rated across three rounds. RESULTS Eighty-one statements reached consensus level (66.4%). A high proportion of endorsed statements were consistent with current guidelines for ED treatment, though some statements for which evidence exists were not endorsed as essential components of dietetic treatment. Compared to consumers and carers, ED specialists were less likely to endorse assessment or involvement by a dietitian as a standard component of treatment, and a number of discrepancies between ED specialists and consumers and carers were observed regarding essential components of dietetic treatment. DISCUSSION This study provides consensus-based guidelines in the current absence of clinical practice guidelines for dietetic treatment of EDs. It also highlights the importance of further research into: (a) the effectiveness of different components of dietetic intervention in this population and (b) how dietetic assessment and intervention is best incorporated into outpatient treatment.
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Affiliation(s)
- Caitlin M McMaster
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
| | - Tracey Wade
- Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia
| | - Janet Franklin
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Susan Hart
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia.,Nutrition and Dietetics Department, St Vincent's Hospital, Sydney, New South Wales, Australia
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