ABSTRACT
Chapter 6 explores the process of nutritional rehabilitation, which can be both emotionally and physically complicated. A registered dietitian with eating disorder expertise, in particular one holding the Certified Eating Disorders Registered Dietitian (CEDRD) designation, should optimally oversee this process. Patients may develop a hypermetabolic state during nutritional rehabilitation and need far more calories to restore weight than they would imagine. Patients most often need to start out with a prescriptive rather than an intuitive approach to eating because their bodies may not feel well as they start to eat, and their eating disorder may constantly question the rationale for portion sizes. The refeeding syndrome involves predominantly low levels of serum phosphorus and sometimes fluid shifts called edema, and it can be deadly if it goes unrecognized and untreated. The underfeeding syndrome, in which calories are started at too low a level, may be more common and dangerous for patients than the relatively low risk of refeeding syndrome. Details of how to begin calories, and the macronutrient composition of early meal plans with an eye toward managing gastroparesis, are discussed. The chapter reviews when to use tube feeding via nasogastric, surgical Percutaneous Endoscopic Gastrostomy (PEG) tubes, and total parenteral nutrition (TPN, intravenous feeding). The goal weight range is considered.
