CPG for Eating Disorders

Algorithm 3. Treatment of AN1) It is recommended to follow the WHO’s (ICD-10) and the APA’s (DSM-IV or DSM-IV-TR) diagnostic criteria to establish the diagnosis of AN. (Good clinical practice).Recommendation 7.1.2) Nutritional or dietary counselling. This type of intervention aims mainly to modify whatthe patient eats, as well as maladaptive eating habits and attitudes, providing a model tofollow (description of a healthy diet, the benefits of maintaining a regular eating schedule,eating three meals a day, eating normal rations according to age, eating with the family, ina relaxed environment without distractions, without being the one to prepare the meal orand resting after meals, amongst others.). A normocaloric and healthy diet is required forweight restoration, except in cases where it is contraindicated due to the patient’s condition.– In feeding guidelines for children and adolescents with anorexia nervosa, carers should beincluded in any dietary information, education and meal planning. (Grade D).Recommendation 9.GM.1.3) Renutrition– Performance of standard treatments to resolve the situation acknowledging individualneeds, especially in the case of children and adolescents. (Grade D). Recommendation9.GM.1.– A physical exploration and in some cases oral multivitamin and/or mineral supplements arerecommended, both in outpatient and inpatient care, for patients with AN who are in thestage of body weight restoration. (Grade D). Recommendation 9.1.1.1.– Feeding against the will of the patient should be used as a last resort in the management ofAN. It is an intervention that must be performed by experts in the management of eatingdisorders and related clinical complications. Legal requirements must be taken into accountand complied with when deciding whether to feed a patient against his/her will. (Grade D).Recommendations 9.GM.2, 9.GM.3 and 9.GM.4.Total parenteral nutrition should not be used in patients with AN unless the patient refusesnasogastric feeding and/or when there is gastrointestinal dysfunction. (Grade D).Recommendation 9.1.1.2.– Nutritional support for patients with eating disorders will be selected based on the patient’sdegree of malnutrition and collaboration, and always with the psychiatrist’s approval.(Good clinical practice). Recommendation 9.GM.01.– Before initiating artificial nutrition the patient’s degree of collaboration must be assessedand an attempt must always be made to convince him/her of the benefits of natural feeding.(Good clinical practice). Recommendation 9.GM.02.– In day hospitals, nutritional support for low-weight patients, where an oral diet isinsufficient, can be supplemented with artificial nutrition (oral enteral nutrition). To ensureits intake, it must be administered during the day hospital’s hours, providing supplementaryenergy ranging from 300 to 1,000 kcal/day. (Good clinical practice). Recommendation9.GM.03.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS201