Clinician and patient characteristics and cognitions that influence weighing practice in cognitive-behavioral therapy for eating disorders

Management of eating disorders during pregnancy: A survey of Australian dietitians in clinical practice

BACKGROUND

Eating disorders (EDs) are estimated to affect 5.2%-7.5% of pregnant women, equating to 15,800-23,000 births in Australia annually. In pregnancy, an ED increases the risk of complications for both mother and child. Heightened motivation and increased utilisation of healthcare services during pregnancy present an opportunity to identify and commence ED treatment. Dietetic management of EDs differs from nutrition guidelines for pregnancy. This study aimed to assess current practice, confidence and training needs of dietitians to manage EDs in pregnancy.

METHODS

A cross-sectional survey of Australian dietitians with past year exposure to ED and/or antenatal fields was completed using Microsoft Forms between November 2022 and January 2023.

RESULTS

One hundred and seventeen responses were analysed. Confidence was less for assessment of a woman with an active ED in pregnancy than a pregnant woman with a history of an ED, pregnancy or an ED alone (p < 0.001). Greater than 5 years of experience as a dietitian, but without recent exposure to the patient population, was associated with increased confidence (p < 0.01). Almost half provided descriptions of treatments and interventions used to treat a pregnant woman with an ED, some of which conflict with ED or antenatal guidelines. Dietitians were more likely to weigh a person with an ED in pregnancy. Most respondents indicated further training (93%) and guidelines (98%) would be helpful.

CONCLUSION

This is the first investigation into the dietetic management of EDs in pregnancy, and it highlights a need for guidelines and training for dietitians.

Impact of patient characteristics on clinicians' decisions to involve dietitians in eating disorder treatment

BACKGROUND & AIMS

Dietetic involvement in eating disorder (ED) treatment is often initiated by other members of a patient's treating team. This study aimed to examine the impact of patient characteristics on clinicians' decisions to involve a dietitian in a patient's ED treatment, as well as the influence of clinician characteristics on their decision-making.

METHODS

ED clinicians were recruited to complete an online survey, which used case vignettes to assess their likelihood of referring patients to a dietitian or consulting with a dietitian for guidance. Questions were also included measuring clinician anxiety, beliefs about the therapy they deliver, beliefs about dietitians and views on evidence-based practice, to determine if these were related to their responses to case vignettes.

RESULTS

Fifty-seven clinicians completed the survey, with the largest group being clinical psychologists (n=22, 39%). ED diagnosis, weight status, medical co-morbidities and progress in treatment were all shown to be influential on whether clinicians involved dietitians in ED treatment. Clinician characteristics and their beliefs about dietitians were generally not correlated with the likelihood of seeking dietetic input.

CONCLUSIONS

This study indicates that clinicians' decisions to involve dietitians in ED treatment are systematic rather than random decisions influenced by individual clinician characteristics. Clinicians require further education on the potential for malnutrition regardless of patients'ED diagnosis or weight status, and the dietitian's role in addressing this. This article is protected by copyright. All rights reserved.

New developments in cognitive-behavioural therapy for eating disorders (CBT-ED)

PURPOSE OF REVIEW

This review summarizes recent developments in cognitive-behavioural therapy for eating disorders (CBT-ED). More specifically, the past five years were covered, with the latest UK and Dutch guidelines for eating disorders as a starting benchmark, and with special consideration of the past 18 months.

RECENT FINDINGS

The new research can be divided into findings that have: (1) reinforced our existing understanding of CBT-ED's models and impact; (2) advanced our understanding and the utility of CBT-ED, including its application for the 'new' disorder Avoidant/Restrictive Food Intake Disorder (ARFID); (3) suggested new directions, which require further exploration in clinical and research terms. These include learning from the circumstances of the COVID-19 pandemic.

SUMMARY

CBT-ED has developed substantially in the past 5 years, with consolidation of its existing evidence base, further support for real-life implementation, extension of methods used, and the development of new approaches for working with younger people - particularly in the form of treatments for ARFID. Over the past 18 months, even more promising changes in delivery occurred in response to the COVID19 pandemic, showing that we can adapt our methods in order to work effectively via remote means. Challenges remain regarding poor outcomes for anorexia nervosa.