Advertisement

Discrepancies Between Australian Eating Disorder Clinicians and Consumers Regarding Essential Components of Dietetic Treatment

  • Author Footnotes
    ∗ APD = Accredited Practising Dietitian, certified in Australia.
    Caitlin M. McMaster
    Correspondence
    Address correspondence to: Caitlin M. McMaster, APD, Bhe University of Sydney Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Corner Hawkesbury Road & Hainsworth Street, Westmead, New South Wales, Australia 2145.
    Footnotes
    ∗ APD = Accredited Practising Dietitian, certified in Australia.
    Affiliations
    Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
    Search for articles by this author
  • Tracey Wade
    Affiliations
    Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia
    Search for articles by this author
  • Author Footnotes
    ∗ APD = Accredited Practising Dietitian, certified in Australia.
    Janet Franklin
    Footnotes
    ∗ APD = Accredited Practising Dietitian, certified in Australia.
    Affiliations
    Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    Search for articles by this author
  • Author Footnotes
    ∗ APD = Accredited Practising Dietitian, certified in Australia.
    Susan Hart
    Footnotes
    ∗ APD = Accredited Practising Dietitian, certified in Australia.
    Affiliations
    Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia

    Nutrition and Dietetics Department, St Vincent’s Hospital, Sydney, New South Wales, Australia
    Search for articles by this author
  • Author Footnotes
    ∗ APD = Accredited Practising Dietitian, certified in Australia.
Published:December 09, 2021DOI:https://doi.org/10.1016/j.jand.2021.12.006

      Abstract

      Background

      A recent Delphi study indicated that, compared with eating disorder (ED) consumers and carers, ED specialists were less likely to endorse involvement of a dietitian as a standard component of treatment. In addition, there was disagreement between these groups regarding the inclusion of a number of components of dietetic treatment.

      Objective

      This study aimed to further investigate these data to identify areas of disagreement among ED specialist dietitians, ED specialist non–dietetic clinicians, consumers, and carers with regard to outpatient dietetic treatment.

      Design and participants/setting

      The ED specialists panel from a previous Delphi study was recoded into 2 panels: ED specialist dietitians (n = 31) and ED specialist non–dietetic clinicians (n = 48) to compare responses of these panels with responses from consumers (n = 32) and carers (n = 23).

      Main outcome measures

      Statements in 7 categories relating to referral to dietitian, essential components of outpatient dietetic treatment regarding 4 ED patient populations, strategies to promote multidisciplinary collaboration, and skills dietitians should possess if treating patients with an ED were rated on a 5-point Likert scale.

      Statistical analysis performed

      One-way analysis of variance was conducted with post-hoc multiple comparisons to compare mean statement ratings.

      Results

      Thirty-seven statements (30%) showed statistically significant differences (P < .05) in responses between panels. Discrepancies were primarily observed for statements regarding how and when dietetics is included in treatment and essential components of dietetic treatment, particularly the use of behavioral tasks, such meal plans and self-monitoring. Results also highlighted deficits in participants’ understanding of core responsibilities of dietitians in ED treatment and dietitians “drifting” from delivering evidence-based components of dietetic treatment.

      Conclusions

      Results of this study show discrepancies among ED dietitians, clinicians, consumers, and carers regarding what dietetic treatment for people with EDs should encompass. It also indicates the need for further research into optimizing dietetic treatment for EDs that is conducted in collaboration with individuals with lived experience.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hay P.
        • Chinn D.
        • Forbes D.
        • et al.
        Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders.
        Aust N Z J Psychiatry. 2014; 48: 977-1008
      1. Eating Disorders: Recognition and Treatment (NICE guideline 69). National Institute for Health and Care Excellence.
        (Published 2017. Accessed June 28, 2022)
        • McMaster C.M.
        • Wade T.
        • Franklin J.
        • Hart S.
        A review of treatment manuals for adults with an eating disorder: Nutrition content and consistency with current dietetic evidence.
        Eat Weight Disord. 2021; 26: 47-60
        • Fairburn C.G.
        Cognitive Behavior Therapy and Eating Disorders.
        Guilford Press, 2008
        • Le Grange D.
        • Lock J.
        Treating Bulimia in Adolescents: A Family-Based Approach.
        Guilford Press, 2009
        • Lock J.
        • Le Grange D.
        Treatment Manual for Anorexia Nervosa: A Family-Based Approach.
        Guilford Press, 2015
        • McMaster C.M.
        • Fong M.
        • Franklin J.
        • Hart S.
        Dietetic intervention for adult outpatients with an eating disorder: A systematic review and assessment of evidence quality.
        Nutr Rev. 2021; 79: 914-930
        • Jones N.
        • Furlanetto D.
        • Jackson J.
        • Kinn S.
        An investigation of obese adults’ views of the outcomes of dietary treatment.
        J Hum Nutr Diet. 2007; 20: 486-494
        • Spikmans F.
        • Brug J.
        • Doven M.
        • Kruizenga H.
        • Hofsteenge G.
        • Van Bokhorst-van der Schueren M.
        Why do diabetic patients not attend appointments with their dietitian?.
        J Hum Nutr Diet. 2003; 16: 151-158
        • Wade T.D.
        • Hart L.M.
        • Mitchison D.
        • Hay P.
        Driving better intervention outcomes in eating disorders: A systematic synthesis of research priority setting and the involvement of consumer input.
        Eur Eat Disord Rev. 2021; 29: 346-354
        • Australian Health Ministers’ Advisory Council
        A National Framework for Recovery-Oriented Mental Health Services: Policy and Theory.
        Commonwealth of Australia, 2013
        • McMaster C.M.
        • Wade T.
        • Franklin J.
        • Hart S.
        Development of consensus-based guidelines for outpatient dietetic treatment of eating disorders: A Delphi study.
        Int J Eat Disord. 2020; 53: 1480-1495
        • Hasson F.
        • Keeney S.
        • McKenna H.
        Research guidelines for the Delphi survey technique.
        J Adv Nurs. 2000; 32: 1008-1015
        • Jorm A.F.
        Using the Delphi expert consensus method in mental health research.
        Aust N Z J Psychiatry. 2015; 49: 887-897
        • Hart L.M.
        • Wade T.
        Identifying research priorities in eating disorders: A Delphi study building consensus across clinicians, researchers, consumers, and carers in Australia.
        Int J Eat Disord. 2020; 53: 31-40
        • Doley J.R.
        • Hart L.M.
        • Stukas A.A.
        • Morgan A.J.
        • Rowlands D.L.
        • Paxton S.J.
        Development of guidelines for giving community presentations about eating disorders: A Delphi study.
        J Eat Disord. 2017; 5: 54
        • Hart L.M.
        • Jorm A.F.
        • Paxton S.J.
        • Kelly C.M.
        • Kitchener B.A.
        First aid for eating disorders.
        Eat Disord. 2009; 17: 357-384
      2. SPSS [computer program]. IBM Corp, 2019
        Version: Version 26
        • Waller G.
        • Turner H.
        Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track.
        Behav Res Ther. 2016; 77: 129-137
        • Dietitians Association of Australia
        Role Statement for Accredited Practising Dietitians Practising in the Area of Eating Disorders.
        Dietitians Association of Australia, 2017
        • Mittnacht A.M.
        • Bulik C.M.
        Best nutrition counseling practices for the treatment of anorexia nervosa: A Delphi study.
        Int J Eat Disord. 2015; 48: 111-122
        • Heruc G.
        • Hart S.
        • Stiles G.
        • et al.
        ANZAED practice and training standards for dietitians providing eating disorder treatment.
        J Eat Disord. 2020; 8: 1-9
        • Hart S.
        • Russell J.
        • Abraham S.
        Nutrition and dietetic practice in eating disorder management.
        J Hum Nutr Diet. 2011; 24: 144-153
        • Herrin M.
        • Larkin M.
        Nutrition Counseling in the Treatment of Eating Disorders.
        Routledge, 2013
        • Hackert A.N.
        • Kniskern M.A.
        • Beasley T.M.
        Academy of Nutrition and Dietetics: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Eating Disorders.
        J Acad Nutr Diet. 2020; 120: 1902-1919.e1954
        • Biddiscombe R.J.
        • Scanlan J.N.
        • Ross J.
        • Horsfield S.
        • Aradas J.
        • Hart S.
        Exploring the perceived usefulness of practical food groups in day treatment for individuals with eating disorders.
        Aust Occup Ther J. 2018; 65: 98-106

      Biography

      C. M. McMaster is an accredited practicing dietitian and PhD student, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia; curent affiliation: The University of Sydney Children's Hospital at Westmead Clinical School, Sydney, New South Wales, Australia.

      Biography

      T. Wade is a professor, Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia.

      Biography

      J. Franklin is an accredited practicing dietitian and research coordinator, Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

      Biography

      S. Hart is an affiliate, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia; and an accredited practicing dietitian and eating disorder coordinator, Nutrition and Dietetics Department, St Vincent’s Hospital, Sydney, New South Wales, Australia.