A registered dietitian nutritionist (RDN) is a dietician who specializes in the treatment of people who have eating disorders. Assessment, intervention, monitoring, evaluation, and care coordination are all responsibilities of the RDN. Although the presenting symptoms of AN, BN, and BED differ, the assessment and management of these illnesses are comparable.

1. Nutrition for Health And Fitness
ABSTRACT
A registereddietitiannutritionist(RDN)isadietician
whospecializesinthe treatmentof peoplewhohave
eatingdisorders.Assessment,intervention,
monitoring,evaluation,and care coordinationare all
responsibilitiesof the RDN.Althoughthe presenting
symptomsof AN,BN,and BED differ,the assessment
and managementof these illnessesare comparable.
Dr Inzamam Gurchani
[Course title]

2. N utrition Assessment
A detailedeatinghistory,aswell asbiochemical,energymetabolism, andanthropometricindicesof
nutritional status,shouldall be includedinanutritionassessment.Because patientsmayfeel
embarrassedaboutcertaineatinganddrinkinghabits,these behaviorsmaygoundetectedduringthe
initializationphase.
Diet history
Patientswithashorterdisease durationshouldbe askedabouttheirpremorbiddietandeatinghabits,
as thiscan serve as a good barometerforrecovery.Energy:macronutrient,micronutrient,andfluid
intakes;energydensity;andfoodvarietyshouldall be assessedaspartof the diethistory.
AnorexiaNerves
Patientswithtype AN whorestricttheircalorieseatlessthan1000 kcal per dayon average.The
adequacyof high-biologic-value proteinconsumptionmaybe affectedbyavegetariandiet.Patientswho
restrictdietaryfaton a regularbasisare more likelytohave dietslackinginkeyfattyacidsandfat-
soluble vitamins
BulimiaNervosa
It's difficulttoestimatetotal calorie intakeinBN because of the erraticeatingpatterns,whichrange
fromrestrictiontonormal eatingto binge eating.PatientswithBN believe thatvomitingisaneffective
wayto get ridof the caloriestakenduringbinge episodes.Patientswhoabuse laxativesassume that
catharsiswill keepthemfromabsorbingfoodandcalories.
The cycle of binge eatingandlimitationaffectsBN patients'nutrientintake.Overall foodqualityand
micronutrientconsumptionare likelytobe poor.Nutrientlossoccursasa resultof purging,evenwhen
the dietappearsto be enough.The use of vitaminandmineral supplementsshouldalsobe assessed.
Eating Behavior
Many AN patienteatveryslowlyandfrequentlyplaywiththeirfood,choppingitintosmall pieces.Many
BN patientseatquickly,indicatingthattheyhave trouble readingsatietycues.Whenitcomesto
"trigger"foods,the patientmayhave anall-or-nothingattitude.Ironiscoupledtoferritinandstored
whenitis releasedfromredcell mass.Duringthisstage of treatment,ironsupplementsshouldbe
avoided. Zincdeficiencycanoccur as a resultof insufficientcaloricintake andthe switchtoa vegetarian
diet.Zincdeficiencydoesnotappeartoinduce or perpetuate AN.
Biochemical Assessment
Many biochemical markersof malnutritionmaybe expecteddue tothe significantcachexiaof AN,
althoughthisisrarelythe case.Compensatoryprocessesare impressive,andlaboratoryabnormalities
may notbe detecteduntil the disease hasprogressedsignificantly.A low serumprealbuminlevel has
beenlinkedtothe developmentof significantrefeedingproblems.
Afterrecovery,the majorityof available researchsuggeststhatlipidabnormalitiesimprove ornormalize.
Some BN patientsare unable toadhere tothe requiredabstinence durationforafastinglipidprofile.
Duringbinge episodes,patientswithBN eaterratically,consumingahigh-fat,high-caloriediet.

3. Vitaminand Mineral deficiencies
Despite clearlyinadequatediets,few researcheshave lookedatbiochemical markersof micronutrient
statusin eatingdisorderpatients.AN hasbeenlinkedtodeficitsinzinc,copper,vitaminC,vitaminA,
riboflavin,andvitaminB.Hypercarotenemia,whichiscausedbythe mobilizationof fatstorage,can
occur in AN;carotene levelsshouldnotbe measured.Fluidretentionandhemodilutionare commonin
malnourishedpatients.
Fluidand Electrolyte balance
Vomiting,aswell asthe use of laxativesanddiuretics,cancause seriousfluidandelectrolyte
imbalances.Glycogenandleantissuedepletionare accompaniedbyobligatorywaterloss.Edemacan
developasa resultof starvationandrefeeding.
Energy expenditure
In malnourishedAN patient,energyexpenditure (REE) istypicallylow.InAN pa,refeedingenhancesand
normalizesREE.Duringrefeeding,enhanceddiet-inducedthermogenesis(DIT) hasalsobeenseen.Due
to a resorptive surge of insulin,bingeeatingfollowedbypurgingmightboostmetabolicrate.
AnthropometricAssessment
The clinical managementof EDSpatientsrequirescareful examinationandmonitoringof bodyweight
and stature.The use of BMI in the managementof eatingdisorderedpatientsisbecomingmore
common.In AN,stuntinganddelayedgrowthcanoccur,and goo rendscouldbe utilizedtodetect
whetherlocatingispresent.
Medical Nutrition Therapy and Counselling
Outpatient,intense outpatient,partial ordaytherapy,inpatient,orresidentialcare are all optionsfor
treatingan ED. Treatmentmaybeginonan inpatienthospital,butasweightlossprogresses,itmay be
scaledback to a lessintensive level.Atall levels,the registereddietitiannutritionist(RDN) isan
importantmemberof the treatmentteam.
AnorexiaNervosa
Patientswhoare growth-retardedusuallyneedtogainweightundersupervisionina specialized hospital
unitor a residential EDtreatment programmed.Duringinpatientorresidential therapy,the American
Psychological Associationrecommendsgaining2to 3 poundseachweek.Initialcalorie prescriptions,as
well aslatercaloricadjustments,are notuniversallyaccepted.