The Importance of a Multidisciplinary Team
As an outpatient nutrition clinic, our goal at The Kahm Clinic is to collaborate closely with outside clinicians to create a successful multidisciplinary team for our patients.
To begin, our initial nutritional assessment includes Metabolic Testing and Body Composition Analysis. If these test results indicate that the patient has an eating disorder — which usually means they are hypo-metabolic, malnourished, and catabolic — multidisciplinary, integrative care is of utmost importance.
Before we continue, it’s important to note that eating disorder patients do not need to meet the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition’s full criteria for anorexia nervosa or bulimia nervosa to be a serious risk. Diagnostic criteria routinely overlooks some very sick eating disordered patients, and delaying referral frequently leads to much higher levels of care down the road. In severe cases, early treatment and aggressive multidisciplinary interventions are especially crucial: It drastically increases the chances of success and lowers the likelihood of relapse and/or chronicity.
The multidisciplinary team should include:
A physician monitors vital signs and regularly completes lab work, including a blood panel and bone density tests.
Eating disorder patients are often very difficult to diagnose for a number of reasons. Most of them have a normal or high Body Mass Index (BMI). In fact, two-thirds of those with eating disorders are not clinically underweight. Additionally, their blood work is often within normal limits. Plus, many struggling individuals don’t believe that they have a problem that merits treatment.
Furthermore, eating disorder symptoms often mask or mimic celiac disease, ulcerative colitis, chronic parasites, malabsorption, diabetes mellitus, Addison’s disease, hypothyroidism, hypopituitarism, and even some cancers. Patients complain about insomnia, gastrointestinal distress, depression, infertility, amenorrhea or oligo-menorrhea, slow-to-heal injuries from exercise, fractures, fatigue, neuropathies, and skin concerns, among other health conditions.
A malnourished body leads to all kinds of symptoms. Treating the various ways that any particular person’s body starts to break down will never get to the physiological cause of the problem, which is malnourishment. Even when an eating disorder is suspected, it is very difficult to prove and convince the patient that they need treatment. With our tests, we have empirical data proving their level of malnutrition (and how to correct it). These results powerfully motivate them to begin recovery. Alternatively, we can also see if they are healthy and rule out a possible eating disorder, helping to hone in on the real problem.
A psychotherapist focuses on self-esteem, social connections, body image acceptance, and more.
We encourage our patients to be engaged in therapy throughout the course of their treatment. Different types of therapy will be effective for different patients. While we do not advocate for any particular kind of therapy, we do work closely with the patient’s therapist. We believe that the trust and bond established by long-standing therapeutic relationships is extremely helpful and necessary in treating eating disorders.
Our work during treatment compliments and strengthens the crucial therapeutic work. When patients eat more, they have a greater ability to focus on therapy. While the brain only comprises three percent of the body’s weight, it requires 20 percent of its energy — which means that it is disproportionally disturbed by caloric restrictions. A starved brain has difficulty focusing and often manifests obsessive compulsive behaviors, depression, phobias, anxieties, memory retention issues, rumination, etc. All of these symptoms make talk therapy more difficult and less effective.
As the brain and body is better nourished, some of these symptoms are significantly lessened. Therapy, then, can more effectively do its work in treating the psychological roots of the eating disorder. Both the physiological and the psychological facets of eating disorders are utterly crucial to treatment, but in the order of recovery, nutritional healing spurs and aids psychological healing.
A psychiatrist prescribes antidepressants and other medications if needed.
Because of the complexity of eating disorders, a psychiatrist is often needed as part of the treatment team. Food is obviously of primary importance for the body and brain. However, for some patients, it can be very difficult to increase intake to an adequate level when their eating disorder voice is strong. Food restriction often causes increased anxiety and/or depression because of altered neurochemistry in the brain.
If the patient is not able to increase intake because of obsessive thoughts, psychotropic medication may help to reduce anxiety/depression. On the other hand, in order for many psychotropic medications to be effective, the body needs to be nourished. We know that medication works poorly in severely underweight malnourished anorexic patients. If the medication doesn’t work as anticipated, our Metabolic Testing and Body Composition Analysis helps to identify those patients who are malnourished or need to be re-fed.
A nutritionist/dietitian works to heal the patient’s relationship to food.
Nutrition therapy is essential to eating disorder treatment. It includes nutrition education, meal planning, goal setting, and cognitive behavioral therapy. It may also factor in hands-on exposure and skill-building. As part of the multidisciplinary team approach, the nutritionist/dietitian focuses on food-related behaviors and habits, allowing time with their psychotherapist to focus on the underlying issues.
To talk to a professional about eating disorder treatment, please reach out to our staff or schedule an appointment at The Kahm Clinic today.