Development of the “Recovery from Eating Disorders for Life” Food Guide (REAL Food Guide) - a food pyramid for adults with an eating disorder

Abstract

BackgroundThere is limited evidence to inform nutrition and dietetic interventions for individuals with eating disorders even though it is recommended as an essential part of multidisciplinary management. There is minimal guidance, an absence of standardised nutrition educational material, and no research on how best to educate patients on healthy eating and how to achieve nutrition adequacy. Therefore the REAL Food Guide was developed.MethodsThe REAL Food Guide is a pyramid with four layers and key nutrition messages beside each layer that was conceived to address gaps in nutrition education and intervention for individuals with eating disorders. Written and verbal consumer feedback was obtained from consumers receiving treatment regarding the acceptability and usefulness of the REAL Food Guide. A unique database was developed to reflect the types of foods and realistic portion sizes that patients are likely to select. This database was used for nutrition modelling to assess the nutrition adequacy of three meal patterns (meat containing, vegetarian and semi-vegan) for both weight maintenance and weight regain. Each meal pattern was compared to the Nutrient Reference Values for Australia and New Zealand.ResultsNutritional analysis demonstrated nutritional adequacy of meal patterns for energy, macronutrients and most micronutrients when the recommended number of serves from the REAL Food Guide were assessed. All meal patterns were adequate in micronutrients except for the semi-vegan meal pattern that was inadequate in vitamin D. Feedback from individuals with eating disorders demonstrates the nutrition education tool was acceptable to them as they felt it was more helpful for their recovery than general nutrition guidelines.ConclusionThe REAL Food Guide is a comprehensive and user-friendly guide that clinicians can use to educate patients about components of a balanced and healthy diet. The guide can educate all eating disorder clinicians, including those who are new to the field, about the basics of nutrition. Clinicians using the guide can be confident that, if followed, patient’s energy and nutritional requirements will be met and important nutrition education messages are reinforced, that are tailored to the beliefs and concerns of individuals with eating disorders.Electronic supplementary materialThe online version of this article (10.1186/s40337-018-0192-4) contains supplementary material, which is available to authorized users.

Development of consensus‐based guidelines for outpatient dietetic treatment of eating disorders: A Delphi study

“…A number of statements regarding essential components of dietetic treatment did not reach consensus, despite evidence for their use with patients who have AN, BN, and BED. This included: avoidance of diet foods (Hart, Marnane, McMaster, & Thomas, 2018; Schebendach et al, 2017); use of meal plans in adult treatment (S. Hart, et al, 2011; Herrin & Larkin, 2013); support to improve meal preparation skills (Biddiscombe et al, 2018; Lock, Williams, Bamford, & Lacey, 2012); use of a meal plan which includes exposure to feared foods (Hart et al, 2018; S. Hart, et al, 2011; Herrin & Larkin, 2013; Ozier & Henry, 2011; Setnick, 2016); and monitoring of weight (Herrin & Larkin, 2013; Setnick, 2016; Wakefield & Williams, 2009). It is not possible, however, to determine whether these results suggest components such as exposure to feared foods and monitoring of weight should not be included in dietetic treatment or that they should be led by a non‐dietetic clinician.…”

ANZAED practice and training standards for dietitians providing eating disorder treatment

“…provided throughout treatment and across all treatment settings. This includes information regarding energy and nutrient needs [60], the impact of food and nutrients on physical and psychological wellbeing, effects of energy or nutritional deficiency, appetite cues and the relationship between dietary intake and exercise. Other topics that may be relevant for nutrition education include dietary iron and calcium requirements, family eating patterns, eating socially, shopping and cooking skills, metabolism and gastrointestinal function [59].…”

Ultra-processed foods and binge eating: A retrospective observational study

“…There has been little research into the dietary intake of people with eating disorders, despite the clear relevance to the condition (Ayton & Ibrahim, 2019). The mainstream psychological therapies encourage the re-introduction of regular eating (NICE, 2017), and emphasize the importance of widening food choices according to individual preferences, including cultural beliefs; but they pay no attention to personal metabolic and neurobiological responses, and usually include ultra-processed foods (Hart, Marnane, McMaster, & Thomas, 2018).…”