Proceedings of the Nutrition Society

Research Article

Managing anorexia from a dietitian's perspective

Conference on ‘Malnutrition matters’ Symposium 8: Feeding size 0: the challenges of anorexia nervosa

on 4–5 November 2008, The Annual Meeting of the Nutrition Society and BAPEN, was held at Harrogate International Centre, Harrogate.

Annette Cockfielda1 c1 and Ursula Philpota2a3

a1 The Retreat, York, UK

a2 Yorkshire Centre for Eating Disorders, Seacroft Hospital, Leeds, UK

a3 Leeds Metropolitan University, Leeds, UK


Anorexia nervosa has the highest mortality rate of any psychiatric condition and its management is complex and multi-faceted, requiring a multidisciplinary team approach. Dietitians are an important part of the multidisciplinary team, offering objective nutritional advice with the aim of helping the patient to develop an improved relationship with food. Refeeding patients with a low body weight requires careful management; nonetheless, refeeding the low-weight patient with anorexia presents many additional complications, largely of a psychological nature. Treatment plans need to consider psychological, physical, behavioural and psycho-social factors relating to anorexia nervosa. Currently, there is no consistent approach and a paucity of evidence to support best practice for weight restoration in this group of patients. Tube feeding is utilised at varying BMI in anorexia nervosa, mainly in an inpatient setting. However, its use should be seen as a last resort and limited to a life-saving intervention. Weight restoration is best managed by an experienced dietitian within a specialist eating disorders team, using normal foods. This approach is ideal for nutrition rehabilitation, promoting skills for eating and normal behaviour and providing a longer-term solution by challenging unhelpful coping strategies from the onset. Dietitians have a unique mix of skills and knowledge in numerous areas including nutrition, physiology, psychology, sociology and behaviour change, which can be applied to support patients with thoughts and behaviours around food, weight and appetite. Further research is required into the effectiveness of dietetic interventions in eating disorders in order to establish an evidence base for best practice.

(Online publication May 06 2009)


c1 Corresponding author: Annette Cockfield, fax +44 113 8123416, email