Medical intervention becomes necessary when a person suffering from Anorexia Nervosa reaches a critical weight level. When the patient is hospitalised nutritional therapy is started to restore him or her to the optimum weight in accordance with Body Mass Index (BMI). Those who have been identified as anorexic but may require only partial hospitalisation follow a different protocol. The doctor will note the severity of the situation and prescribe the programme most suitable for the patient. Even though the aim is weight gain it is not a simple case of filling up an empty space. Anorexics are terrified of gaining weight and will do their best to resist any efforts at rehabilitation.
[Read: Treatment options for Anorexia]
The first step is to look into the patient’s diet history and habits. This includes alcohol intake and everything else s/ he tended to consume in the past. A thorough clinical check-up is followed by a chemical one. Laboratory assessments will determine things such as haemoglobin and protein levels. Blood cell count and deficiency levels like iron and folic acid will throw more light on the type of nutritional therapy needed.
The doctor’s job is now not to start re-feeding. A compromise has to be reached on what the patient’s body requires and what his or her mind can bear. Replenishing is a slow process and patience is the key to come out of anorexia. If the target is to gain a minimum of 0.5 kg in a week it’s a realistic goal in the most critical cases. Constant monitoring of all nutrients is extremely important. Re-feeding once started will bring out its own complications like electrolyte disturbances and changes in potassium levels. This is the stage at which utmost care is called for.
When the patient is out of danger and has gained enough energy for discussions s/he should be taken into counselling. Effects of diet restrictions and starvation should be made clear. This information should be given along with the truth about metabolic rates and exercise. Intuition over how much food your body needs cannot be acquired overnight. The patient should be encouraged with learning exercises so s/he will be able to be a better judge of his/ her own requirements in future.
Out patients and those who have to spend a number of hours under care need further counselling on food management. A steady intake will now be prescribed which will figure carbohydrates on top of the list so that the patient does not lose weight. Food supplements are also prescribed but the doctor needs to be careful that those are not abused by the patient. Many patients deny the fact that they get hungry. Psychotherapists work in tandem with nutrition experts to uncover the real cause behind a patient’s anorexia.
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