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iaedp™ The International Association of Eating Disorders Professionals Foundation

Medical Management Professionals

in Eating

Disorders Care

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MedicalManagementProfessionalsin

EatingDisorderCareiaedptmNutrition/HealthManagementCommitteeIntroduction:The iaedptm Foundation provides a wide scope ofeducational opportunities for professionals to acquiretheknowledge, skills, and confidence to recognize andtreat eating disorders. Eating disorders are complexbiopsychosocial disorders that require specializedtreatment by a multidisciplinary team. The team isethically bound to treatwithin a scope of competenceandeachtreatingclinicianmustunderstandtheirroletosupporttheteamandprovidetheirexpertiseeffectively.Disclaimer:This document, created by the Association of EatingDisorderProfessionals’NutritionHealthManagement Committee, is intended as a resource to promoterecognition of the medical healthcare professionalcontributionstotheeatingdisordertreatmentteam.Itisnotacomprehensiveclinicalguidefortreatment.Everyattemptwasmade to include current evidenced‐basedreferencesandclinicalpracticestandards.Accordingly,theCommitteehasreliedonpeer‐reviewedsources and clinical expertise that reflects evidenced‐based approaches from a variety of eating disorderprofessionalsandresearchconductedwithintheUnitedStates and Internationally. Thus, the content of thisdocumentreflectscurrentknowledgeandstandardsof

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eatingdisordersmanagement.However, credentials aswellasthespecificrolesofprofessionalsoutsideoftheUnited States may differ according to local standards,practices,andhealthcaredelivery.TheiaedptmNutritionHealthManagementCommitteeChair:KarenBeerbower,MS,RDN,CEDRD,LD,F.iaedpMembers:TammyBeasley,RDN,CEDRD,CSSD,LDJessikaBrown,MS,RDN,CSSD,CEDRD,ACEBrianCook,PhDMaryDye,MPH,RDN,CEDRD,KathrynFinkMartinez,MS,RDN,CEDRD,LDValerieMurrayHoughton,RDN,LDJoelJahraus,MD,FAED,CEDS,F.iaedpAnnaLutz,MPH,RDN,CEDRD,LDThereseS.WaterhousPhD,RDN,CEDRD,LD

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TABLEOFCONTENTSIntroduction,Disclaimer&iaedptm

NutritionHealthManagementMembers......................1

MultidisciplinaryTeamApproach:EDTeamModels................................................................4‐6

MedicalProfessionalCredentials:WhatDoTheyMean?.......................................................6‐8

TeamReimbursement.................................................9‐10

MedicalCareProviderRole&Responsibilities............................................................10‐11

MedicalCareProviderSummaryofContributionsandTherapeuticInterventions..11‐13

LevelofCarePracticeConsiderations..................13‐21

HighRiskPopulations&TreatmentInterventions..........................................22‐25

References......................................................................26‐28

Appendix1.....................................................................29‐31

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MultidisciplinaryTeamApproach:EDTeamModelsEating disorders (ED) are one of the most difficultillnesses to treat since these disorders includementalhealth aspects as well as medical and nutritionalcomplications.Whilemultidisciplinaryteamtreatmentisconsideredbestpractice,considerablevariationexistsinteam compositiondepending on treatment setting andstageof illness.TheEDteamiscomprisedofadiverseselection of licensed health professionals such asphysiciansandnursepractitioners,whoarecertifiedtopracticemedicine (i.e. diagnosing amedical condition,prescribingdrugs,orderinglaboratorytests),aswellasclinical care experts like registered nurses, registereddietitians and psychotherapists who collaborate as ateam to address a variety of medical and behavioralissuesofthepatient.The scope of practice for each licensed healthcareprofessional is clearly defined in state and federalmedicalboardguidelinesand shouldbeincluded in allstandardsofcaredocumentswithintheorganization.Itisimportanttoidentifyrolesandresponsibilities,withineachmultidisciplinaryteamasskillsandknowledgewilloftenhaveoverlappingcompetencies.The team may also utilize “consultants” who provideexpertisewhenrequiredbutmaynotactasapermanentpartof themultidisciplinary team.Understandingeachhealth professional’s contribution to the ED team isessential andwill require leadership decisions to bestutilize various skill sets of teammembers. In treatingpatients with eating disorders, the psychiatrist may

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assume the leadership role within a program or teamthatincludesotherphysicians,psychologists,registereddietitians and psychotherapists, or may workcollaborativelyonateamledbyothers.The American Psychiatric Association (APA) hasestablished themost recognized practice guideline forthe treatment of eating disorders but other guidelinessuchastheNationalInstituteforHealthandCare(NICEguidelines for eating disorders treatment are alsohelpful. Additional guidelines from other licensing orcredentialing agencies such as Joint Commission forAccreditationofHospitalOrganizations(JCAHO),Agencyfor Health Care Administration (AHCA), etc. dictatestandardsof compliance such as the credentials of theprovider and the minimum requirements of medicalinterventionrequiredtotreatthevariouslevelsofcarewithinthepopulation.TwoexamplesofanEDteamaredepicted in the following diagrams: Core andComprehensive.

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MedicalProfessionalCredentials:WhatDoTheyMean?Understanding thecredentialsandscopeofpracticeofthe variousmedical professionals thatmay participateon the ED treatment team is necessary to meet thespecificneedsofyourfacilityand/orestablishateamofhighlyskilledprofessionalscapableofservingtheneedsofyourcommunity.WhenorganizingtheEDcareteam,themedicalneedsofthepatientmaybemanagedbyoneorseveralmedicalprofessionals. A primary medical provider should beestablished for each patient to ensure a clear line ofmedical leadership is understoodwithin the ED team.This is also dependent on the availability of trained

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professionalswithinanenvironmentorregion.Detailsregarding education and scope of practice for theseprofessionalscanbefoundinAppendix1ofthisbooklet.Notethatonlythoseprofessionalswithaminimum ofafour‐year degree are listed and can obtain iaedptmcertification.

DoctorofMedicine(MD)DoctorofOsteopathicMedicine(DO)PhysicianAssistant(PA)DoctorofPhilosophyinNursing(PhD)DoctorofNursingPractice(DNP)MasterofScienceinNursing(MSN)NursePractitioner(NP)RegisteredNurse(RN)BachelorofScienceinNursing(BSN,BN)

Certified Eating Disorders Specialist (CEDS),Certified Eating Disorders Registered Dietitian(CEDRD), Certified Eating Disorders RegisteredNurse(CEDRN),CertifiedEatingDisordersCreativeArtsTherapist(CEDCAT)andiaedptm:In 2002 the iaedptm leadership and its membersforecasted that the rate of individuals diagnosed witheatingdisorderswouldsurpassthenumberofqualifiedhealthcare professionals available to deliver therequired care. To help address this potential criticalshortage of qualified, knowledgeable treatmentproviders iaedptm began offering an advancedCertification Program to promote standards ofexcellence within the field of eating disorders. Sinceinception iaedptm has been continually committed to

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strengtheningandupdatingevidenced‐basedtreatmentstandardstomaintainitsstrongreputationasaleaderofclinicalpractice in thementalhealth field. It is iaedp’smission to promote excellence in competencyassessmentforprofessionalsintheeatingdisordersfieldthrough offering a rigorous set of criteria for theevaluation of education, training, knowledge andexperience.Registered dietitians, registered nurses, nursespecialists,physicians,physicianassistants,creativeartstherapists, and psychotherapists with iaedptmcertification are experienced clinicians who have metextensive educational and skill requirements, haveaccumulatedaminimumnumberofhoursofqualifyingwork experience, have made a commitment to stayabreast of current developments in the field throughContinuingEducation,andhaveagreedtocomplywiththe Association's Ethical Principles. Certification isevidence that both the healthcare professional andiaedptmarediligentinseekingadvancementintraining,education, research and competency in addressing thecomplexities involved in the treatment of eatingdisorders. In addition, both are united in theircommitmenttotheadvancementofmentalhealthparityand advocacy for individuals strugglingwith an eatingdisorder.

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Team ReimbursementReimbursement for services provided by the medicalprofessional is based on the level of care where theprovision of services is administered; for example,whetherthetreatmentoccursinanoutpatientsettingorwithin an acute care facility. For ED facilities, medicalprofessionalsprovidingthetreatmentmaybeemployedby facility and act as part of themedical staff or theycouldbecontractedtoprovideservicesandbilltheclientor organization. While the medical coverage rate isvariable, typically the medical professional cansuccessfullybillforcareprovided.TheEDmedicalprofessionalmaybefunctioningwithina private practice setting as a member of an EDoutpatient team for various patients. In such casesreimbursement is conductedwith the standard billingpracticesofthatoffice.Attheoutpatientlevelofcare,dietitiansandtherapistsoperateeitherasafeeforserviceorsubmitchargeswithinsurance companies on behalf of the patient.When aclinician uses a fee for servicemodel, patientsmay beprovided with receipts that can be used to apply forreimbursement from insurance companies or undertheir flex spendingorhealthsavingsaccounts.Medicaldiagnosiscodesprovidedbythemedicalprofessionaltoalltheteammembersassistwiththebillingprocessandenhancetheopportunityforpatientreimbursement.Outpatientdietitianservicesfallundermedicalbenefitsand may require a prescriptive referral for MedicalNutrition therapy. Providing the dietitian with the

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patient’sdiagnosedconditions,labs,anddiagnosiscodeiscriticaltothebilling process.Psychotherapy services will be billed under mentalhealthorbehavioralhealthbenefitsofinsuranceplans.Inallcases,itisimperativethatthepatientunderstandsthe fee for service structure (i.e. major medical andmentalhealthtreatmentteambilling,whatservicesmaynotbereimbursed),thefinancialobligationsofservicesprovidedandtheroleofeachteammember.Thebottomline is that communication is critical for the team,patient,andfamily.MedicalCareProviderRole&ResponsibilitiesFor this educational document, the term “certifiedmedical provider” will be used to reference any teammemberprovidingdirectmedicalcaretothepatientandservingas themedical entityof theEDcare team.Thecertified medical provider has been approved by theorganization and meets all regulatory guidelinespertinenttotheorganizationprovidingtheservice.Thecertifiedmedicalprovidermaybethefirstpointofcontact forapatientseekinghelp foranED; therefore,this professional often becomes responsible forestablishing the treatment team and orienting thepatient to the care providers. It is important for anorganization to be knowledgeable of the trainedprofessionalswithin their communitywho are able tojoin the multidisciplinary team and provide the mosteffectivetreatment.Thecertifiedmedicalprovidermayalsoshareresponsibilitiesofmedicalmanagementwith

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the primary care physician or medical director of afacility. Within the course of treatment, a shift in theprioritization of therapeutic intervention often occursand may require a concurrent shift in the designated“team leader”. For instance, if the need for medicalstabilization is determined to be the number one carepriority, the certified medical provider would beresponsible for initiating treatment modalities anddirectingtheteamastohowandwhentoinitiatetheirtherapeutictreatment.Atothertimes,themedicalaspectmay not be as critical and another healthcareprofessionalsuchasatherapistcandirectthetreatmentplan. This underscores the need for all practitionersinvolvedinthetreatmentplantocommunicaterelevantfindingstodrivethemosteffectivehealthoutcome.MedicalCareProviderSummaryofContributionsandTherapeuticInterventionsIn summary, the medical care provider provides thefollowingcontributionsandtherapeuticinterventions:

Provides a strong therapeutic relationshipwiththepatient

Conducts a medical assessment to include ahistoryandphysicalexaminationwithattentiontopertinenteatingdisorderhistory(predictiveofspecific medical complications), history ofcomorbid illnesses, vital signs, and physicalassessment of cardiovascular and peripheralvascularfunction,gastrointestinalevaluationandevendermatologicalmanifestationsoftheeatingdisorder, including evidence of self‐injuriousbehaviors

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Monitors and interprets growth charts,laboratory data, bone density screening andelectrocardiogram

Works in collaborationwith the teammembersonrefeedingoptions(oral,enteralorparenteral),restoration of weight/nutrition, behavioral andpsychosocialchanges

Identifiesthemedicalcomplicationsoftheeatingdisorder

Understands pharmacotherapy pertinent to theindividual’streatment

Worksincollaborationwithotherteammemberstodiscussallmedicalissuesandestablishacareplanincludingappropriatelevelofcare

The treatmentcareplan includesanassessmentof thefollowing:

Medical/nutritionalstatus Co‐occurringmedicalandpsychiatricdiagnoses Levelofsupervisionrequired Availability of specialized programs within and

outsideofageographicalarea An understanding of underlying componentsof

recoveryincluding:o Thestagesofgriefo Thestagesofchangeandreadinessforchangeo Theindicatorsofrecovery

Assistswithpeerreviews,insuranceappealsandintheprovisionofinformationonmedicalstatusasappropriateforreimbursementchallenges

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Consults with or refers patients to otherphysicians, dentists or medical specialists asindicated

Communicates information regarding medicalstatusas related to theEDwithotherattendingphysicians or medical specialists involved withthecareofthepatient

Provides ED medical education to the staff,patientandfamily

Collaborates with the patient’s family andestablishesasupportiveenvironmenttopromoteweight/nutritional restorationwithin the familydynamics

LevelofCarePracticeConsiderationsContinuityofCareContinuity of care is imperative when a patient shiftsfromonelevelofcaretoanothertoavoidbacktrackingor splitting behaviors. From the patient or clients’perspective, a less restrictive treatment plan can beinterpretedashavingfullyrecoveredorvastlyimproved.Therealityisthatachangeinlevelofcareisrequiredforcontinuing treatment due to financial constraints.Regardlessofthereasonforthechange,itisimperativethattreatmentstaffmaintainahighqualityofcareandmakethetransitionasseamlessaspossiblefortheclient,toassistintheindividual’srecovery.CareEnvironmentLevelsAt all levels of care, the certified medical provider isexpected to carry out responsibilities according to theorganization’sstandardsofpractice and ethicsandinaccordancewiththeircredentialingagencyorlicensing

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guidelines. It is important to note that each of thefollowing healthcare environments require specificconsiderations formedical professional treatment andpossible reimbursement and that the intent of thefollowinginformationistoprovideageneraloutlineoftheroleofthecertifiedmedicalproviderateachlevelofcare.Itisalsonoteworthytoexpectthattheorganizationor practice delivering the caremust practice fiduciaryresponsibilityandbeheldaccountableforadministeringthe appropriate medical services to clients/patientsacross and within the healthcare spectrum. The listbelow provides a summary of suggested treatmentinterventions and objectives provided by the medicalcareproviderineachlevelofcare.AcuteCareThepatientishospitalizedbasedonmedical,psychiatricand behavioral factors, including but not limited to arapidorpersistentdeclineinoralintakeand/orweightandmedical/nutritionalinstability.Thegoalofthislevelofcareistoensurethesafetyofthepatientandprovidemedicalstabilization.Atthisstage,thepatientmaybeindenialoftheneedforcareandresistanttoparticipateinhis or her own care. Treatment interventions andobjectives at this level of care should include thefollowing:

Confirm that the symptoms exhibited areattributable to an ED based etiology andnotanotherillnessorcondition.

Initiatelabtestsandothermedicalproceduresortherapeutic interventions according to anestablished plan of care relevant to thediagnosis(s)

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Followestablishedcommunicationprocedurestoensure all team members are aware of thetreatmentplanandtheirroles.

Assess the educational needs of thepatient/caretaker and provide the informationrequiredtomeettheneedsofboth.

Communicate with all team members themedical/nutritional status of the patient andimpactofinitialhydrationandfeedingdemands.

Workcollaborativelywiththeteamregardingthefeedingprotocolinthedecisionmakingregardingthe source of nutrition and method of deliverythat may be oral, tube, or in rare cases, totalparenteralnutrition(TPN).

Work collaboratively with therapy team andfamily regarding emotional status, stages ofchange,andsupportsystems(i.e.OT,PTetc.).

Monitormedical/nutritionalstatusandcomorbidillnesses and collaborate with therapy teamregarding progression and/or alterations of allaspectsofcareplan.

Participate in discharge planning andcommunicate directly with primary medicalprovideratthenextlevelofcare.

ResidentialCareThepatient at this level of care is inmoderate tohighlevel of malnutrition. There is usually less patientresistancewhen involvedinhis/herownself‐care,andthecertifiedmedicalproviderisworkingcloselywiththepatientasdeterminedbythecareplan.Thereisawidescope of service within the "residential" level oftreatment. If the facility provides a certified medical

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provider and regular medical monitoring, thisprofessionalwill have greater opportunity to continueaggressivemedicalandnutritionalsupportand follow‐up. If medical intervention is conducted off site, thecertified medical provider will work with the teammemberstomonitorthemedicalstabilityinregardstonutrition,weight,andanyothercomplications.Treatment interventions and objectives at this level ofcareshouldincludethefollowing:

CommunicationwithpreviousEDcareteam ClosecollaborationwithcurrentEDteam Establishmentofcareplanwithintheresidential

levelofcare Assessment/monitoringoflabs,medicalstability,

symptoms,weightandcomorbidmedicalillnesses Working with staff to ensure environmental

compliance and prevention of eating disordersbehaviors

Frequentinteractionwiththeteamandfamilytoensureprogress isbeingmonitored,anychangeoflevelofcareisidentifiedandafollow‐upplan

AthoroughdischargeplanPartialHospitalizationProgram(PHP)CareThislevelofcarecurrentlyrepresentsthewidestrangeofoptionscoveringfrom20hoursperweektofulldaysofcareofvariablehourswithpatientsresidingoutsideofthefacility.Patientsarejustbeginningtreatmentormaybe stepping down from a higher level of care. Thecertifiedmedical providermay be the same individualthatwastreatingthepatientatthehigherlevelofcareormay be a new provider. Treatment interventions and

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objectives at this level of care should include thefollowing:

CommunicationwithpreviousEDcareteamandmedicalprovider,ifindicated

ClosecollaborationwithcurrentEDteam Establishment of care plan within PHP level of

care Assessment/monitoringoflabs,medicalstability,

symptoms,andweightaccordingtoPHPprogram,length of stay or established by the certifiedmedicalprovider

Close communication and work with thetreatment team and family regarding patientprogressandwithestablishingmedicalfollowupuponchangeoflevelofcare.

ParticipationindischargeplanningIntensiveOutpatient(IOP)CareThis levelofcareservespatients thatare justbeginningtreatmentormaybesteppingdownfromahigherlevelofcare.Thislevelofcarehasvariablelevelsofinvolvementforthecertifiedmedicalprovider.Someprogramshaveacertifiedmedicalprovideronstaffwhileotherprogramsrequire the patient to establish their ownmedical careprovider. At this stage there is usually less inclusion ofmedical care and communicationmodes shift to the EDteamtomanage.Ifthisisthefirstpointofcontactforthepatientwithacertifiedmedicalprovider,theclinicianwillneed to provide more ED education to the patient andfamilyaswellasassistancewithestablishingthecareteamwithreferralstootherEDcareproviders.

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Treatment interventions and objectives at this level ofcareshouldincludethefollowing:

Communication with previous ED care team ifpatientwascomingfromahigherlevelofcare

ClosecollaborationwithcurrentEDteam CareplanestablishedwithinIOPlevelofcare Assessment/monitoringoflabs,medicalstability,

symptoms,andweightstatus Close communication and work with the

treatment team and family regarding patientprogressandwithestablishingmedicalfollowupuponchangeoflevelofcareforrecovery

Continuous assessment for appropriateness ofenvironmentforpatient’smedicalstability

Educationonpotentialvulnerabilitiespresentedwithin a less controlled environment and plansforrelapsepreventionifpatienthasbeensteppeddown

ThoroughdischargeplanOutpatientCareWhenapatientismanagedbyaninterdisciplinaryteamin an outpatient setting, communication among theprofessionals is essential to monitoring the patient’sprogress, making necessary adjustments to thetreatment plan, and delineating the specific roles andtasksofeachteammember.This level of care varies for how the certifiedmedicalprovider is involved, depending on patient progress,exhibitedbehaviors,motivationandfinances.Outpatientcareservespatientsthatarejustbeginningtreatmentorthose stepping down from higher level of care. The

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outpatient certified medical provider may bethefirstpointofcontactwiththepatientandthereforebecomesresponsible for helping the patient establish thetreatment team. Knowing trained professionals withinthelocalcommunitywhocanjointhemultidisciplinaryteam and provide the most effective treatment isimportantforreferrals.Credentialedpractitionerswithiaedptmhaveexpertiseineatingdisordersandwillbeagreat resource to utilize. When a patient moves frommore intense levels of treatment, the certifiedmedicalprovider is responsible for setting up the appropriatescheduleofappointmentswiththepatientand/orfamilyas well as the schedule for laboratory and otherdiagnostics.Asthepatientimproves,thefrequencyofthesessionswillvary.IfthisoutpatientcarephaseistheinitialpointofcontactandtheEDhasbeenidentifiedthrougharoutineofficevisit(medicalhistoryorexam);proceedasfollows:

Ruleoutorganicdiseaseascauseforweightlossorothersymptoms

Identify any complications stemming from theeatingdisorder

Identify safety concerns during initiation oftreatment

Assembleanoutpatienttreatmentteam Scheduleconsulttimetooutlinecareplanandfor

additionaleducation Reviewtreatmentmodalities Establish criteria for continued engagement in

school,work,physicalactivity

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Order all necessary labs, tests, diagnostics, andreferralswithothercareproviders

Assist in recognizing potential vulnerabilitiespresentedtothepatientwithinthisenvironmentandplanforrelapseprevention

Establish a communication system for howinformation is disseminated among the teammembers via regular conference calls, directcontactviaprotectedemails,faxeddocumentsorindividualcalls

Communicatewiththefamily(asappropriate)toprevent splitting of the team and maintain aneffectivesupportsystem

FamilyBasedTreatmentforChildrenandAdolescents(FBT)CareThemajordifferenceintheroleofthecertifiedmedicalcareproviderwithinFBTisnotwhatisrequiredintheirrole, but rather what is not required. The role of themedical care provider is to be a consultant to theparents or caretaker and primary therapist, offeringmedical assessment and treatment and providingguidanceandfeedback.The following is a summary ofduties in this role:GeneralIntervention

ServeasaconsultanttoparentsandFBTclinician Providecomprehensivemedicalassessmentand

ongoingmonitoring Explain medical consequences of the eating

disorder Make clear to parents or caretaker that their

adolescent’seatingdisorderisnottheirfault Avoidbeingdirective

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Empowerparentsindecisionmaking Differentiate the eating disorder from the

adolescent Supportfullweightrestorationandfullremission

RoleSpecifics

Undertakeacomprehensivemedicalassessment Involveparentsateachvisit Assess and emphasize parental and patient

strengths Setweightgoalsthatareadequateforhealthand

consistentwithgrowthbeforetheeatingdisorderonset

Preparepatientandparentsthatweightgoalswillchangewithgrowthanddevelopment

Assess weight, linear height, and vital signs ateachvisitandsharewithparents

Assess safety at every visit and hospitalize ifnecessary

Decreasethefrequencyofmedicalvisitsassoonasitissafetodoso

Supportparentand therapist tomakecommon‐sensedecisionsaroundnutritionandactivity

Create a back‐up plan with team for how tohandlefoodrefusalifitoccurs

Allowparentstohavea learningcurvebybeingless directive in your visits and normalizingstumbleswhentheyoccur

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HighRiskPopulations&TreatmentInterventionsAt risk populations may have a greater propensity todevelop an eating disorder as either a comorbiddiagnosisthatexistsalongsideanexistingillnessormayexhibit specific characteristics or rituals unique to thespecificpopulationitself.Theroleofthecertifiedmedicalprovider is to treat the ED and any co‐occurring risksusing (or recommending) other specialists as deemedappropriate. Below is a table outlining the high‐riskpopulations, treatment interventions to considerwhenworkingwith each population, and population specificco‐occurringmedicalrisks.Pleasenotethemedicalrisksindicated are identified as more common in thecorresponding high‐risk population; however, medicalrisksarenotlimitedtoonlythoselisted.

HighRiskPopulation

TreatmentInterventionConsiderations

Co‐occurringMedicalRisks

Adolescents Themajorityofeatingdisordersemergebetweentheagesof12and25

ChangesingrowthtrajectoryInfemales,amenorrheaorprimaryamenorrhea

Athletes Anysportorpositionthatemphasizesbodytypeidealsorclasses/divisionsbasedonbodyweight(e.g.leanidealsforrunners,bulkingupforfootball,weightcontrolforwrestlingandsubjectivelyjudgedsportsorcompetitions(e.g.equestrian,figureskating,diving,etc.)mayincreaseriskofeatingdisordersPerformanceenhancementsupplementsshouldnotbeused

CardiovascularhealthHydrationstatusMusculoskeletalorbonedensitystatus

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HighRiskPopulation

TreatmentInterventionConsiderations

Co‐occurringMedicalRisks

AutismSpectrumDisorders

Feedingissuesincludingmechanical,sensory,andpreferencesimpactnutritionalintake

NutritiondeficienciesInsufficientgrowthpatternsorfailuretothrive

CeliacDisease Dietaryrestrictionsimpactrelationshipwithfood

NutritiondeficienciesGastrointestinalhealthmonitoring

ComplicatedDietingHistory

Culminationofdietinghistoryinfluencesbeliefsaboutfood

Weightfluctuationswithco‐occurringmorbiditiesNutritiondeficiencies

DiabetesMellitus(DM)‐Type1and2

InsulinusemaybemodifiedtocompensateforeatingbehaviorsMonitoringformedicalcomplicationsofdiabetesincludingvision,cardiovascular,renalandneurologiccomplications

BloodglucosemonitoringMedicationadjustment

FoodAllergies Educationonthedifferencebetweenatrueallergy,sensitivity,intoleranceordislikeSubstantiatingfoodallergieswithmedicalverificationandappropriatetestingincludingfoodintolerancevs.allergicreactionsincludinganaphylaxisMayrequireareferraltoregistereddietitianwithexpertiseineatingdisorders

Nutritiondeficiencies

Model/Actress IncreasedscreeningandeducationforhighrisksupplementsIndustryspecificpressuresinfluencingbodycompositiongoals

HydrationmonitoringCardiovascularmonitoring

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HighRiskPopulation

TreatmentInterventionConsiderations

Co‐occurringMedicalRisks

OrthodoxJewishPopulation

CulturalinfluencesonbodyshapeandsizeEatingissuesmaybestigmatizedandthereforeunderreported

Weightmonitoring

PolycysticOvarySyndrome(PCOS)

SymptomsofPCOSmayinfluencebodyimageandimpacteatingbehaviors

HydrationmonitoringCardiovascularmonitoringMedicationadjustmentMonitorformetabolicsyndrome

BariatricSurgeryPatient

AssessmenttoruleouteatingdisorderbehaviorsforpatientspriortosurgeryAddresseatingbehaviorsinthecontextofpost‐surgicalweightlossDistinguishbetweenthecomplexphysicalandpsychologicalmanifestationsresultingfromsurgeryaloneorincombinationwitheatingbehaviors

DumpingsyndromePreventionofstomachstenosisandotherGIcomplications

PregnancyandEatingDisorders

TherapeuticinterventionandeducationspecifictotheeatingdisorderandrisktomotherandfetusKnowledgeofsensitivenatureofweightgain

WeightmonitoringMonitorfetalgrowth

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HighRiskPopulation

TreatmentInterventionConsiderations

Co‐occurringMedicalRisks

LGBTQandEatingDisorders

Determinationofweightgoalsbasedonhormone/musclemasschangesfortransgenderclients,adjustingcalculationsforsexchangedependingontypeanddurationofhormonetherapyTherapeuticinterventionandeducationspecifictoIntersectionbetweengenderandbodyimageconcernsFocusonsocializationofgroupsandsocialpressures

Weightmonitoring

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ReferencesAllisonDB,BaskinMK.HandbookofAssessmentMethodsforEatingBehaviorsandWeight‐RelatedProblemsMeasures,Theory,andResearch.SAGEPublications:ThousandOaks,CA,2009.AmericanAcademyofPAshttps://www.aapa.org/what‐is‐a‐pa/AccessedMarch4,2018.AmericanPsychiatricAssociation:DeskReferencetotheDiagnosticCriteriafromDSM‐5,Arlington,VA,AmericanPsychiatricAssociation,2013.Costinc,SchubertGrabbG.8KeystoRecoveryfromanEatingDisorder.W.W.NortonandCompanyInc.NewYork,NY,2011.DeaneFP,GournayK.“LeadingaMultidisciplinaryTeam”Ed.LloydC,KingR,DeaneFP,GournayK.ClinicalManagementinMentalHealthServices.Oxford:Wiley,2009.7‐22.HerrinMandLarkinM.NutritionCounselingintheTreatmentofEatingDisorders.2ndEd.Routledge:NewYorkNY2013.GrilloCM,MitchellJE.(Eds.)TheTreatmentofEatingDisorders:AClinicalHandbook.TheGuilfordPress:NewYork,NY,2010.

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“TheInternationalAssociationofEatingDisordersProfessionalsFoundation”www.iaedp.com/certification‐overview/AccessedMarch7,2018.InternationalCouncilofNurses(ICN)DefinitionsandCharacteristicsoftheRolehttp://international.aanp.org/Practice/APNRolesAccessedMarch4,2018.KeysA,BrozekJ,HenschalA.MickelsenO,TaylorHL.TheBiologyofHumanStarvation(2volumes),UniversityofMinnesotaPress,1950.KatzmanDK,PeeblesR,SawyerSM,LockJ,LeGrangeD.Theroleofthepediatricianinfamily‐basedtreatmentforadolescenteatingdisorders:opportunitiesandchallenges.JournalofAdolescentHealth.2013,53:433‐440.MehlerPS,AndersonAE.EatingDisorders:AGuidetoMedicalCareandComplications.TheJohnHopkinsUniversityPress:Baltimore,MD.2010.MittnachtAM,BulikCM.BestNutritionCounselingPracticesfortheTreatmentofAnorexiaNervosa:ADelphiStudy.IntJ.Eat.Disor.2015doi:10.1002/eat.22319.ReiffDW,LampsonReiffKK.EatingDisorders:NutritionTherapyintheRecoveryProcess.AspenPublishing,Inc.1992.

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SetnickJ.ADAPocketGuidetoEatingDisorders.AmericanDieteticAssociation;Chicago,IL2011.ISBN:978‐0880914369WilliamsPM,GoddieJ,MotsingerC.TreatingEatingDisordersinPrimaryCare.AmFamPhysician.2008,15;77(2):187‐195.YagerJ,DevlinMJ,HalmiKA,HerogDB,et.al.PracticeGuidelinefortheTreatmentofPatientswithEatingDisorders.AmericanPsychiatricAssociation,2010.YagerJ,PowersPS.ClinicalManualofEatingDisorders.AmericanPsychiatricPublishingInc.Washington,DC.2007.

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Appendix1DoctorofMedicine(M.D.)DoctorofMedicine(M.D.)isaprofessionaldoctoraldegreeforphysiciansand/orsurgeonsobtainedbyamedicalschoolrequiredtopracticemedicinewithintheUnitedStates.TheDoctorofMedicinedegreeincludesadegreeandcompletionofathree‐partexamcalledtheUnitedStatesMedicalLicensingExam(USMLE).MDscompletetheirschoolingandsteponeandtwooftheUSMLEbeforeenteringaninternshipandcompletingstepthreeoftheUSMLE.AfterallthesestepsarecompleteanMDislicensedtopractice.DoctorofOsteopathicMedicine(D.O.)DoctorofOsteopathicMedicine(D.O.)isaprofessionaldoctoraldegreeforphysiciansandsurgeonsobtainedbyamedicalschooltobecomealicensedosteopathicphysician.TheprimarydifferencebetweenanM.D.andaD.O.isthataD.O.receivesfocusedtraininginmusculoskeletalosteopathicmanipulativetreatment.ToachieveaD.O.individualsmustcompletefourpartsoftheComprehensiveOsteopathicMedicalLicensureExamination.Thefirsttwostepsarecompleteinmedicalschoolwhilethefinaltwoarecompletedinaresidencyprogram.D.O.mayalsochoosetotaketheUSMLEbutarenotrequiredasapartoftheirlicensing.PhysicianAssistant(PA)Ahealthcareprofessionalwhoworksonhealthcareteams,collaboratingwithaphysicianandotherproviders.PhysicianassistantsarenationallycertifiedandlicensedintheUnitedStates.ScopeofPracticeisdeterminedbystateregulations,collaborating

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physiciansandlevelofeducation.EducationincludesattendanceatanaccreditedPAprogram,thePhysicianAssistantNationalCertifyingExam(PANCE)administeredbytheNationalCommissiononCertificationofPhysicianAssistants(NCCPA)toobtainthePhysicianAssistant‐CertifiedorPA‐Candlicensurewithinthestateorpractice.

BachelorofScienceinNursing(BSN,BN)NursesobtainaBachelorofNursing(BN)orBachelorofScience(BS)withaMajorinNursing.Typically,afour‐yearprogramatacollegeoruniversitypreparingnursesforprofessionalrolesorgraduatestudiesinnursing.Toobtainalicenseasaregisterednurse,studentsmustsitfortheNCLEX‐RNexamination.Eachstate’spracticeactandregulationsgovernnursingpractice.RegisteredNurse(RN)Nursesgraduatefromanursingprogramandmeetrequirementssetbystate,countryorsimilarlicensingbody.Locallegislationandscopeofpracticeisusuallyregulatedbyaprofessionalcouncil.Registrationismaintainedusuallybymeetingaminimumpracticehoursrequirementandcontinuingeducation.DoctorofPhilosophyinNursing(PhD)NurseswithaPhDhavetraininginadvancedscienceorpracticeandconductingresearch.Programcreditrequirementsvarybystateandprogramandtakethreetofiveyearstocompleteanddonothaveclinicalpracticehourrequirements.PhDpreparednursesconductresearch,evaluateprograms,holdacademicandleadershippositions,writebooks,andleadhealthcareorganizations.

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DoctorofNursingPractice(DNP)Nursesobtainadoctorateinnursingalongwithpassingacertificationexamcorrespondingwiththespecialty.Programrequirementsvarybystateandprogram.Scopeofpracticeincludesassessing,diagnosing,prescribing,consulting,screening,educating,initiatingreferralsandthecoordinationofpatientcare.MasterofScienceinNursing(MSN)Nurseswithanadvanceddegreethatallowsformorespecializedroles,withcertificationexamsdependentupontherolebeingpursued.Examplesofnursescertifiedatthislevelinclude:certifiednursepractitioner(CNP),certifiednurseanesthetist(CRNA),clinicalnursespecialist(CNS)orcertifiednursemidwife(CNM).Masterslevelnursesaretrainedinadvancedassessmentandcounselingofpatients,leadership,management,educationandresearch.Scopeofpracticemayvarybystate.NursePractitioners(NP)Nursesatanexpertlevelwithadvancedtrainingandanexpertlevelofknowledge,skillsandclinicalcompetencyinhealthpromotionandmaintenanceofthediagnosisandtreatmentofacuteandchronicillnessconditions.AccordingtotheInternationalCouncilofNurses,"ANursePractitioner/AdvancedPracticeNurseisaregisterednursewhohasacquiredtheexpertknowledgebase,complexdecision‐makingskillsandclinicalcompetenciesforexpandedpractice,thecharacteristicsofwhichareshapedbythecontextand/orcountryinwhichshe/heiscredentialedtopractice."

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iaedp™

The International Association of Eating Disorders Professionals Foundation (iaedp™) established the certification process to promote standards of excellence within the field of eating disorders. Professionals who demonstrate clinical expertise through education, experience and a rigorous examination are eligible for the Traditional Certification as a Certified Eating Disorders Specialist (CEDS) for therapists and physicians, Certified Eating Disorders Registered Dietitian (CEDRD) for registered dietitians, Certified Eating Disorders Creative Arts Therapist (CEDCAT) for art, music, recreation and dance/movement therapists, or Certified Eating Disorders Registered Nurse (CEDRN) for registered nurses.

Individuals with iaedp™ Certification designations (CEDS, CEDRD, CEDCAT, or CEDRN) are health care professionals who have met rigorous educational and skill requirements, have accumulated a minimum number of hours of qualifying work experience, have made a commitment to stay abreast of current developments in the field through continuing education, and have agreed to comply with the Association's ethical principles.

iaedp™ Mission To promote a high level of professionalism among practitioners who treat those suffering from eating disorders by promoting ethical and professional standards, offering education and training in the field, certifying those who have met prescribed requirements, promoting public and professional awareness of eating disorders and assisting in prevention efforts.

www.iaedp.com