CPG for Eating Disorders

GENERAL RECOMMENDATIONS ON MEDICALMEASURES FOR EATING DISORDERS(QUESTIONS 9.1-9.2)Eating DisordersRecommendations 9.GM.01. Nutritional support for patients with eating disorders will be selected basedon the patient’s degree of malnutrition and collaboration, and always withthe psychiatrist’s approval. 9.GM.02. Before initiating artificial nutrition the patient’s degree of collaborationmust be assessed and an attempt must always be made to convince him/herof the benefits of natural oral feeding. 9.GM.03. In day hospitals, nutritional support for low-weight patients, where an oraldiet 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 300 to1,000 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 week isproduced, with up to 1 kg increments being the usual during that period.Sometimes, when the patient with moderate malnutrition resists resumingnormal feeding, the diet can be reduced by 500-700 kcal and besupplemented by complementary oral enteral nutrition in the same amount,which must be administered after meals and not instead of meals. 9.GM.05. In the case of severe malnutrition, extreme starvation, poor progress orlack of cooperation of the patient in terms of intake, artificial nutritiontreatment is indicated. If possible, an oral diet with or without oral enteralnutrition is always the first step, followed by a 3 to 6 day period to assessthe 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, be used to make the estimationand that in cases of severe malnutrition energetic requirements be 25to 30 kcal/kg real weight or total kcal not higher than 1,000/day.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS94