Physiotherapy and occupational therapy can play emerging roles in treating anorexia nervosa and bulimia nervosa. Physiotherapy includes supervised exercise to increase body fat, muscle strength, and improve mood without adverse effects. Occupational therapy promotes independence in daily activities and meaningful occupations to interrupt disordered eating patterns and develop social skills. Both physiotherapists and occupational therapists can implement treatments like group exercises, meal planning, relaxation techniques, and leisure activity exploration for patients with eating disorders. Precautions include monitoring for depression, suicide risk, and cardiac issues.

1. The Emerging Role of OTA/PTA in
Anorexia Nervosa & Bulimia Nervosa
Victoria Tiessen, Nicole McGregor, Nikky Friske, Sarah Hammond 2nd year, OTA/PTA Diploma Program Mohawk College
Role of Physiotherapy
Role of Occupational
Therapy
Anorexia Nervosa (AN) is a mental disorder characterized by refusal to maintain normal body
weight, intense fear of becoming obese that does not diminish despite weight loss and a distorted
body image resulting in a feeling of being fat. Bulimia nervosa is an eating disorder characterized by
bingeing and purging; the individual will eat to the point of being uncomfortably full and then
compensate the overeating by trying to rid the body of the consumed food. Eating disorders are
more common in women accounting for 90% of cases. The onsets of both disorders tend to be
during adolescence or early adulthood however eating disorders can affect people of all ages. There
is no specific cause linked to both anorexia nervosa and bulimia nervosa however genetics and
society’s view on thinness may contribute.
Eating disorders are becoming more prevalent in Canada. Since 1987, hospitalizations for
eating disorders in general hospitals have increased by 34% among young women under the age of
15 and by 29% among 15-24 year olds. Eating disorders have the highest mortality rate of any mental
disorder with 20-30% of subjects attempt suicide. Effects of eating disorders are severe and can be
detrimental to major body structures including muscle, bone, nerves, cardiac tissues and the brain.
Research has shown that physiotherapy (PT) and occupational therapy (OT), in conjunction with the
interdisciplinary team, have significant benefits in treating patients with these disorders. Knowing
there are roles for both OT and PT in treating eating disorders indicates there are emerging roles for
an OTA/PTA in this field.
References:
Cheung, P. (2011). Occupational therapy in anorexia nervosa. Retrieved from http://hksah.skhmos.hk/2011-06-20_AN_OT.pdf
Fisher, B. A., & Schenkman, M. (2012). Functional recovery of a patient with anorexia nervosa: physical therapist management in the acute care hospital setting. 92(4), 595-604. Retrieved from http://ptjournal.apta.org/content/92/4/595.long
Public Health Agency of Canada. (2002). A Report on Mental Illnesses in Canada. Retrieved from http://www.phac-aspc.gc.ca/publicat/miic-mmac/chap_6-eng.php
Reed, K. L. (2001). Quick reference to occupational therapy. (2nd ed.). Austin, TX: Pro-ed.
Lisa Scott, Physiotherapist at McMaster Children’s Hospital, personal communication, Feb 27th, 2014
L. Scott. (2012). The Role of Physical Therapy in the Treatment of Eating Disorders. Retrieved from http://blog.melioguide.com/osteoporosis-nutrition/physical-therapy-and-eating-disorders/
Sheppard Pratt Health System. (2014). Occupational Therapy at The Center for Eating Disorders. Retrieved from: http://eatingdisorder.org/treatment-and-support/therapeutic-modalities/occupational-therapy/
Stats Canada. (2013). Section-D-Eating Disorders. Retrieved from http://www.statcan.gc.ca/pub/82-619-m/2012004/sections/sectiond-eng.htm#a1
University of Toronto. (2009). Occupational science & occupational therapy. Retrieved from http://www.ot.utoronto.ca/about/the_life_of/eating_disorders.asp
Vancampfort, D. (2013, July 04). A systematic review of physiotherapy interventions for patients with anorexia and bulimia nervosa. Retrieved fromhttp://informahealthcare.com/doi/abs/10.3109/09638288.2013.808271
Treatment:
Physiotherapy is often overlooked as an adjunctive treatment for
eating disorders, however physiotherapists have a significant array of
skills that are applied to the successful treatment of patients
with AN. The integration of physiotherapy within the interdisciplinary
treatment of eating disorders depends largely on both the setting in
which one works (inpatient versus outpatient, individual versus group
approach) and the preferred therapeutic model of the clinician.
Research has shown aerobic exercise, yoga, massage, and basic body
awareness therapy has yielded significant benefits with no adverse
effects observed within the studies
The PT intervention plan for a patient with an eating disorder depends
on the severity risk of physical activity. This is categorized as high (less
than 80% IBW), moderate (80-90% IBW), and low (90-100% IBW), and
also takes their CET (Compulsive Exercise Test) score into consideration.
Benefits:
• Increased treatment compliance
• Increased of body fat percentage and body mass index
• Improved therapeutic relationship
• Decreased food preoccupation
• Decreased bulimic symptoms
• Decreased negative exercise behaviour with supervised exercise
• Mood improvement
• Increased endurance and muscle strength; improves transfers, bed
mobility and ambulation
• Reduced falls risk
“An individual’s “occupation” is any activity that occupies his or her time.
When a person struggles with an eating disorder, their prior healthy
roles and occupations fade; their primary occupation becomes the
eating disorder and the many rituals and behaviors required to maintain
it. “ (Sheppard Pratt, 2014 )
Through the use of meaningful occupation, client centeredness,
collaboration, occupational therapists and can promote hope, meaning
and purpose in life to individuals with anorexia nervosa and bulimia
nervosa .
Bulimia Nervosa:
The essential features of bulimia nervosa are binge eating and
inappropriate compensatory methods to prevent weight gain.
Treatment-
Self-care:
• Increase independence skills in self-care and daily living based on
problem areas identified in the original assessment.
• Interrupt the binge-purge cycle and improve the person’s ability to
monitor eating behavior.
• The person may need to shop for clothes when their weight stabilizes
because their existing wardrobe does not fit.
Productivity:
• Increase skills in independent living
• Provide work adjustment programs to develop work habits and skills.
Leisure:
• Provide opportunities and develop leisure skills and activities. In later
stages of treatment, the person should be encouraged to use more
community resources to practice independence skills. (Reed, 2001)
Role of OTA/PTA
Treatment that can be
implemented by PTA’s include:
• Lead group exercises (e.g.
yoga)
• Supervise prescribed
exercise treatments
• Provide patient education
• Advocate for the role of PT
in treating eating disorders
Treatment that can be
implemented by OTA’s include:
• Meal planning
• Meal preparation
• Relaxation techniques
• Stress management groups
• Exploration of leisure
activities
• Clothes shopping
• Assertiveness training
• Craft activities
Anorexia Nervosa:
Occupational therapy provides people with an eating disorder the
opportunity to explore and develop their interests, and set practical and
healthy goals. We encourage group activities where people can interact
with others, which assists with building and developing social skills.
Self-care
• Provide opportunities to practice shopping for food, preparing it and
eating it
• Accompany the person to shop for new clothes or assist with sewing
• new clothes
• May ask person to keep an eating record. The record may include
when the person eats, amount eaten, hunger level and stress before
and after eating
Productivity
• Help the person explore possible career options
• Encourage the person to continue schoolwork and education
Leisure
• Explore with the person new interests
• Encourage the person to find interests that allow relaxation, fun,
humour and variety
Additional OT Treatment
• Teach the individual coping strategies
• Help them identify trigger points.
• Cognitive behavioral therapy
PRECAUTIONS
• Watch for signs of depression and possible suicide attempts
• Monitor cardiac performance
• Since this disorder is not well understood therapists should be aware
of the changing viewpoints when working with such individuals
(Reed, 2001)