ANZAED eating disorder treatment principles and general clinical practice and training standards

Introduction: Eating disorders are complex to manage, and there is limited guidance around the depth and breadth of knowledge, skills and experience required by treatment providers. The Australia & New Zealand Academy for Eating Disorders (ANZAED) convened an expert group of eating disorder researchers and clinicians to define the clinical practice and training standards recommended for mental health professionals and dietitians providing treatment for individuals with an eating disorder. General principles and clinical practice standards were first developed, after which separate mental health professional and dietitian standards were drafted and collated by the appropriate members of the expert group. The subsequent review process included four stages of consultation and document revision: (1) expert reviewers; (2) a face-to-face consultation workshop attended by approximately 100 health professionals working within the sector; (3) an extensive open access online consultation process; and (4) consultation with key professional and consumer/carer stakeholder organisations. Recommendations: The resulting paper outlines and describes the following eight eating disorder treatment principles: (1) early intervention is essential; (2) co-ordination of services is fundamental to all service models; (3) services must be evidence-based; (4) involvement of significant others in service provision is highly desirable; (5) a personalised treatment approach is required for all patients; (6) education and/or psychoeducation is included in all interventions; (7) multidisciplinary care is required and (8) a skilled workforce is necessary. Seven general clinical practice standards are also discussed, including: (1) diagnosis and assessment; (2) the multidisciplinary care team; (3) a positive therapeutic alliance; (4) knowledge of evidence-based treatment; (5) knowledge of levels of care; (6) relapse prevention; and (7) professional responsibility. Conclusions: These principles and standards provide guidance to professional training programs and service providers on the development of knowledge required as a foundation on which to build competent practice in the eating disorder field. Implementing these standards aims to bring treatment closer to best practice, and consequently improve treatment outcomes, reduce financial cost to patients and services and improve patient quality of life

Normalised eating in the treatment of eating disorders : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Human Nutrition at Massey University, Manawatu campus, New Zealand

Background: Normalising eating behaviour is one of the primary goals for recovery from eating disorders. There is a lack of consensus or working definition about what normalised eating is. Investigation of eating patterns in recovered eating disorder patients has been limited. The assumption appears to be that normalised eating will automatically follow weight restoration. Aim: To describe normalised eating as a treatment goal for eating disorders among women aged 18 to 60 years using a sample of “expert opinions”. Methods: Mixed methods design, including an online survey and in-depth interviews to expand on findings from the survey. Participants were recruited through online and print advertising. The online survey asked respondents to assess the “normality” of a range of eating practices and to give examples of eating in a “normal day”. Nutrient analysis was carried out using FoodWorks and SPSS was used for statistical tests. Content analysis was used for depth interviews and qualitative data from the online survey. Results & Conclusion: Sixty-seven online surveys were completed by six women who had recovered from an eating disorder, 20 eating disorder dietitians, 15 other eating disorder clinicians and 26 healthy control women. A range of eating patterns and practices were described as normalised (e.g. 2-7 eating episodes in a day; cutting muffins in 1-4 pieces). While normalised eating is more likely to involve a specific set of actions (e.g. 3 meals and 2-3 snacks), reasons for eating seem to underpin normalised eating more than specific actions (e.g. “if hungry after dinner will have a piece of fruit”). Eating for a variety of reasons gives rise to flexibility. Flexibility within the confines of a nutritionally adequate diet was the central theme of normalised eating which emerged from this study

ANZAED practice and training standards for dietitians providing eating disorder treatment

Introduction: Dietitians involved in eating disorder treatment are viewed as important members of the multidisciplinary team. However, the skills and knowledge that they require are not well characterised. Therefore, as part of a broader project to identify the key principles and clinical practice and training standards for mental health professionals and dietitians providing eating disorder treatment, the Australia & New Zealand Academy for Eating Disorders (ANZAED) sought to identify the key practice and training standards specific to dietitians. An expert working group of dietitians was convened to draft the initial dietetic standards. After expert review, feedback on the revised standards was then provided by 100 health professionals working within the eating disorder sector. This was collated into a revised version made available online for public consultation, with input received from treatment professionals, professional bodies and consumer/carer organisations. Recommendations: Dietitians providing treatment to individuals with an eating disorder should follow ANZAED’s general principles and clinical practice standards for mental health professionals and dietitians. In addition, they should also be competent in the present eating disorder-specific standards based around the core dietetic skills of screening, professional responsibility, assessment, nutrition diagnosis, intervention, monitoring and evaluation. Conclusions: These standards provide guidance on the expectations of dietetic management to ensure the safe and effective treatment of individuals with an eating disorder. Implications for professional development content and training providers are discussed, as well as the importance of clinical supervision to support professional self-care and evidence-informed and safe practice for individuals with an eating disorder