Perceived Occupational Performance in Youth with Eating Disorders: Treatment-Related Changes.

BACKGROUND.: This study examined changes in performance and satisfaction with self-identified occupational performance goals during a specialized day treatment admission in children and adolescents with eating disorders. Weight-related outcomes for underweight youth were also examined. METHODS.: A total of 63 youth participated in the study, with admission and discharge data on ratings of self-identified occupational performance goals (measured with the Canadian Occupational Performance Measure) available for 42 participants. FINDINGS.: Significant improvements were found in ratings of satisfaction and performance with self-identified goals over the course of treatment. The program was also effective in supporting weight restoration for underweight youth, with a large effect size observed. IMPLICATIONS.: A symptom-focused day treatment program for paediatric eating disorders led to improvements in perceived occupational performance. Collaborating with youth to develop self-identified goals in the context of eating disorders treatment can foster autonomy and potentially improve treatment engagement.

Pinch, cinch or step: Evaluating the effectiveness and acceptability of mid upper arm circumference measurements in adolescents with eating disorders.

PURPOSE: Mid Upper Arm Circumference (MUAC) measurement is proposed as an adjunctive measure of re-nutrition progress in youth with eating disorders. We propose that MUAC is a clinically-useful measurement that can be used to inform clinicians about treatment progress. The aims of this study were twofold: 1) to test whether assessments of MUAC can track weight restoration in a similar pattern to direct measures of weight and 2) to examine adolescents' self-reported feelings in response to assessments of MUAC, weighing, and skinfolds (SF). METHODS: The study involved two phases of data collection. Participants in both phases of the study were female patients who fulfilled DSM IV-TR diagnostic criteria for an eating disorder. In Phase 1, MUAC measurements and weight assessments were collected weekly to examine changes in these values during the first 8weeks of treatment. In Phase 2, participants reported their feelings towards three different anthropometric measures - weight, SF and MUAC. RESULTS: Simple contrasts between the weekly weight and MUAC assessments prospectively collected in Phase 1 (N=40) reveal that MUAC and weight follow similar patterns over time. Phase 2 (N=30) data indicate that participants felt more relaxed, and less angry, scared or embarrassed during MUAC measurements than weighing and SF. MUAC also emerged as the measurement that was most preferred by participants. CONCLUSIONS: MUAC measurements are a useful adjunct to measurements of weight, and are perceived to be less distressing than routinely used measurement techniques of weight and SF.

Evaluation of meal support training for parents and caregivers using a video and a manual.

OBJECTIVE: The purpose of the study was to evaluate the helpfulness of the contents of a video and manual for training parents and caregivers in providing meal support for eating disordered youth. METHOD: A self-report questionnaire consisting of closed and open-ended questions was given parents or caregivers of 52 new consecutive referrals to the specialized eating disorder program at British Columbia Children's Hospital. RESULTS: The return rate was 77%. Sixty-five percent of the families were dealing with a youth diagnosed with anorexia nervosa, 33%, eating disorder not otherwise specified, and 2%, bulimia nervosa. The meal support training resources were deemed informative by the parents who reviewed the material. Parents most valued hearing about the youth's experience of the eating disorder and their feelings around food. CONCLUSION: As a minimum initial intervention, the combination of the manual and DVD/video was found to be convenient to use and was well received by families with eating disordered youth. These resources could be used by clinician treating an eating disordered youth and his or her family in order to start addressing the food issues.

Eating disorder nutrition counseling: strategies and education needs of English-speaking dietitians in Canada.

The purpose of this study was to profile nutrition counseling strategies for eating disorders that English-speaking Canadian registered dietitians (RDs) use and to explore their educational needs in this area. A cross-sectional survey consisting of open- and closed-ended questions on nutrition counseling strategies was developed and administered via mail. Types of strategies included assessment, rapport-building, educational, and behavior-change strategies. Sixty-five of the 116 eligible RDs who were members of the Dietitians of Canada Eating Disorder Network responded to the survey. Descriptive statistics, chi(2), and Spearman correlation statistics were used. P values less than 0.05 were considered significant. Canadian RDs used strategies that were familiar and strategies they considered useful. Content-oriented or "doing" strategies were used more often than strategies that involved some process-oriented or "thinking" strategies. Reading and intuition were the most frequently reported learning routes. Seventy-one percent of respondents were dissatisfied with the educational opportunities available to RDs in this area in Canada. In Canada, both generalist RDs and specialist eating disorders RDs work with clients with eating disorders. In the absence of a formal nutrition counseling education program, there seems to be a reliance on informal learning routes such as reading or intuition, which may be suboptimal. To optimize eating disorders nutrition practice in Canada, formal coordinated programming that accounts for the educational needs of specialist RDs as well as generalist RDs is needed.