CPG for Eating Disorders

9.GM.02. Before initiating artificial nutrition the patient’s degree of collaborationmust be assessed and an attempt must always be made to convincehim/her of the benefits of natural feeding. 9.GM.03. In day hospitals, nutritional support for low-weight patients, where anoral diet is insufficient, can be supplemented with artificial nutrition (oralenteral nutrition). To ensure its intake, it must be administered during theday hospital’s hours, providing supplementary energy ranging from 300to 1,000 kcal/day. 9.GM.04. Oral nutritional support in eating disorder inpatients is deemed adequate(favourable progress) when a ponderal gain greater than 0.5 kg per weekis produced, with up to 1 kg increments being the usual during thatperiod. Sometimes, when the patient with moderate malnutrition resistsresuming normal feeding, the diet can be reduced by 500-700 kcal and besupplemented by complementary oral enteral nutrition in the sameamount, which must be administered after meals and not instead ofmeals. 9.GM.05. In the case of severe malnutrition, extreme starvation, poor progress orlack of cooperation of the patient in terms of eating, artificial nutritiontreatment is indicated. If possible, an oral diet with or without oralenteral nutrition is always the first step, followed by a 3 to 6 day periodto assess the degree of collaboration and medical-nutritional evolution. 9.GM.06. Regarding estimated energetic requirements, it is recommended thatcaloric needs at the beginning always be below the usual, that realweight, as opposed to ideal weight, is used to make the estimation andthat in cases of severe malnutrition energetic requirements be 25 to 30kcal/kg real weight or total kcal not higher than 1,000/day.Anorexia nervosaD 9.GM.1. In feeding guidelines for children and adolescents with anorexiaNervosa, carers should be included in any dietary information, educationand meal planning.D 9.GM.2. Feeding against the will of the patient should be used as a last resort inthe management of AN.D 9.GM.3. Feeding against the will of the patient is an intervention that must beperformed by experts in the management of eating disorders and relatedclinical complications.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS21