Eating Disorders: [Training Model for Integral Treatment of Patients With Eating Disorders Resistant to Change].
[Training model for integral treatment of patients with eating disorders resistant to change].
Filed under: Eating Disorders
Nutr Hosp. 2012 Jun; 27(3): 763-70
Calvo Sagardoy R, Gallego Morales LT, García de Lorenzo Y Mateos A
The need to find effective treatments for patients with Anorexia or Bulimia nervosa has led to the professionals who care for them to develop new forms of treatment that take into account the variables that cause resistance to change. Patients in this study (2006-2009) have the following characteristics: 340 patients who have 7 or more years of evolution and/or have tried numerous previous treatments without having succeeded in starting and / or maintaining the desired changes, that allowed them to recover steadily. As the proposed treatment, the patient-treatment team is based on the principles of the training model. It considers the patient holistically, it informs and provides him with resources to increase its commitment to change. Teaches the patient to take care physically and mentally as a way to regain their health and leave the disorder in a stable way. Includes family members as essential support in the recovery of their closest. Therapists require extensive experience in the treatment of ED, flexibility, ability to integrate with other team members even if they use different theoretical models, skills for group sessions, ability to handle negative emotions and frustration tolerance. Finally, the model presented below has been implemented, recovered patients whose stay in the disorder exceeded 15 years of development and led to permanent occupational disability.
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Patterns and Composition of Meals and Snacks in Elite Canadian Athletes.
Filed under: Eating Disorders
Int J Sport Nutr Exerc Metab. 2012 Oct 30;
Erdman KA, Tunnicliffe J, Lun VM, Reimer RA
The purpose of this study was to determine the meal and snack eating frequency and the nutritional composition of each eating occasion of Canadian high performance athletes during training. Athletes from 8 Canadian Sport Centres prospectively completed 3-day dietary records, including all food, fluid and supplements consumed. The time of consumption and if the consumption was a meal or snack were also identified. The dietary records were analyzed for energy (kcal) and macronutrient intake (CHO, protein, fat) and compared based on gender, age, meal versus snack and training versus rest days. Three hundred and twenty-four athletic subjects (64% females and 36% males) completed the study. On average the athletes ate 4.8 ± 0.8 times daily. Nearly all athletes consumed three daily meals of breakfast (98.9%), lunch (97.9%) and dinner (98.7%) with less having snacks: 57%, 71.6% and 58.1% of athletes consumed an AM, PM and evening snack, respectively. Training day meal frequency did not differ from that during rest days, however, fewer snacks were consumed on rest days. AM and PM snacks were consumed significantly more often on training days than rest days. Overall snacks contributed 24.3% of total daily energy intake. Few dietary variations were discovered between genders, while the youngest athletes (< 18 yrs) ate less often, especially their morning snack, compared to the older athletes. In conclusion: Canadian high performance athletes self-adjusted their energy intakes on training versus rest days primarily by snacking less and reducing their carbohydrate and protein intakes on rest days yet they consistently ate regular meals. HubMed – eating
Clinical practice and variation in care for childhood obesity at seven clinics in California.
Filed under: Eating Disorders
Qual Prim Care. 2012; 20(5): 335-44
Shaikh U, Nettiksimmons J, Joseph JG, Tancredi DJ, Romano PS
The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics.Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention.Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child’s well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians’ assessment of weight status.Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documented in 71% of medical records. Fewer than 10% of medical records had documentation of weight category. Sixty-nine percent of parents received counselling on physical activity and 62% reported receiving counselling on fruit and vegetable intake. Parents were counselled less frequently on breakfast intake, sweetened beverages, television and family meals. Parents of overweight/obese children did not receive more counselling than parents of children with a healthy BMI. Clinician-level effects accounted for moderately large amount of variation in counselling, but accounted for smaller variation in documentation of BMI and weight category. There was high between-clinic variation in documentation practices, with 54% of the total variance for documentation attributable to clinic-level effects.Rural clinicians, like those elsewhere, do not uniformly assess BMI percentile or counsel families on behavioural risk factors for paediatric obesity. There exists considerable clinician-level variation in counselling practices and clinic-site level correlation in documentation practices related to BMI percentile and weight category.
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Kaiser Permanente’s Community Health Initiative in Northern California: Evaluation Findings and Lessons Learned.
Filed under: Eating Disorders
Am J Health Promot. 2012 Nov-Dec; 27(2): e59-68
Cheadle A, Rauzon S, Spring R, Schwartz PM, Gee S, Gonzalez E, Ravel J, Reilly C, Taylor A, Williamson D
Abstract Purpose . To describe the evaluation findings and lessons learned from the Kaiser Permanente Healthy Eating Active Living-Community Health Initiative. Design . Mixed methods design: qualitative case studies combined with pre/post population-level food and physical activity measures, using matched comparison schools for youth surveys. Setting . Three low-income communities in Northern California (combined population 129,260). Subjects . All residents of the three communities. Intervention . Five-year grants of $ 1.5 million awarded to each community to support the implementation of community- and organizational-level policy and environmental changes. Sectors targeted included schools, health care settings, worksites, and neighborhoods. Measures . Reach (percentage exposed) and strength (effect size) of the interventions combined with population-level measures of physical activity (e.g., minutes of physical activity) and nutrition (e.g., fruit and vegetable servings). Analysis . Pre/post analysis of population level measures, comparing changes in intervention to comparison for youth survey measures. Results . The population-level results were inconclusive overall, but showed positive and significant findings for four out of nine comparisons where “high-dose” (i.e., greater than 20% of the population reached and high strength) strategies were implemented, primarily physical activity interventions targeting school-age youth. Conclusion . The positive and significant changes for the high-dose strategies suggest that if environmental interventions are of sufficient reach and strength they may be able to favorably impact obesity-related behaviors.
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Impact of an online healthful eating and physical activity program for college students.
Filed under: Eating Disorders
Am J Health Promot. 2012 Nov-Dec; 27(2): e47-58
Greene GW, White AA, Hoerr SL, Lohse B, Schembre SM, Riebe D, Patterson J, Kattelmann KK, Shoff S, Horacek T, Blissmer B, Phillips BW
Abstract Purpose . To identify impact of an online nutrition and physical activity program for college students. Design . Randomized, controlled trial using online questionnaires and on-site physical and fitness assessments with measurement intervals of 0 (baseline), 3 (postintervention), and 15 months (follow-up). Setting . Online intervention delivered to college students; a centralized Web site was used for recruitment, data collection, data management, and intervention delivery. Subjects . College students (18-24 years old, n = 1689), from eight universities (Michigan State University, South Dakota State University, Syracuse University, The Pennsylvania State University, Tuskegee University, University of Rhode Island, University of Maine, and University of Wisconsin). Intervention . A 10-lesson curriculum focusing on healthful eating and physical activity, stressing nondieting principles such as size acceptance and eating competence (software developer: Rainstorm, Inc, Orono, Maine). Measures . Measurements included anthropometrics, cardiorespiratory fitness, fruit/vegetable (FV) intake, eating competence, physical activity, and psychosocial stress. Analysis . Repeated measures analysis of variance for outcome variables. Results . Most subjects were white, undergraduate females (63%), with 25% either overweight or obese. Treatment group completion rate for the curriculum was 84%. Over 15 months, the treatment group had significantly higher FV intake (+.5 cups/d) and physical activity participation (+270 metabolic equivalent minutes per week) than controls. For both groups, anthropometric values and stress increased, and fitness levels decreased. Gender differences were present for most variables. First-year males and females gained more weight than participants in other school years. Conclusion . A 10-week online nutrition and physical activity intervention to encourage competence in making healthful food and eating decisions had a positive, lasting effect on FV intake and maintained baseline levels of physical activity in a population that otherwise experiences significant declines in these healthful behaviors.
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Eating Disorders Meal Support: Chapter 5 – Post Meal –
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