Eating Disorders - fieldi

The Nurse’s Role in a Pilot Program 129
I have discovered that patients I have worked with found the first
half most interesting and informative, not at all the boring text they
expected.
The first topic covered is bingeing. The characteristics of a binge
are described, including feelings, speed of eating, agitation, secretiveness,
and loss of control. Examples of the kinds of food eaten and
different types of binges are given. He describes obesity, bulimia,
and anorexia. He discusses dieting and its effects. He touches on the
use of laxatives, vomiting, diet pills, diuretics, and excessive exercise.
He addresses concerns of physical appearance and weight, moods,
and relationships. Dr. Fairburn also describes personality characteristics
generally seen in binge-eaters. Patients, when reading this section,
often feel that he is describing them personally.
A chapter is devoted to the physical problems associated with
bingeing, purging, and dieting, such as damage to tooth enamel,
electrolyte imbalance, tears in the esophagus, and infertility. The
last chapters in this section are devoted to discussions of known and
suspected causes of binge eating, as well as binge eating as an addiction.
Various treatment modalities are reviewed.
The six steps in the program set forth by Dr. Fairburn are aimed
at behavioral changes. The first is that of record keeping, that is,
careful notation of food eaten, how, when, and what, with accompanying
remarks about feelings. Most people who have sought treatment
for their eating disorder are familiar with this exercise, and
some find it quite difficult. Facing, in black and white, exactly what
they have been eating and why is extremely painful and hard to
accept. The nurse’s nonjudgmental acceptance is extremely important.
I emphasize that record keeping is not a punishment but a goal
to reveal any pattern that may exist; for example, a particular person
or situation may repeatedly trigger a binge or a binge-purge episode.
The patient continues to record this information for the entire four
months of treatment, which is the recommended length of therapy.
I try to suggest ways to make it easier: The patient might make her
notations at the time she is actually eating, as she may not remember
what she ate when returning home at the end of the day; “stickum”
notes are most helpful as they can be tucked away in a pocket
and placed in the record directly. Also included in this first step is
weighing oneself once a week. This is something some patients