Eating disorders are a profound disturbance of the identity of a person, because the consciousness, the security for what is special, the feeling for the own self and the self-respect is lost. The physical experience, the weight disappears z. B. underweight and becomes meaningless. Eating disorders & eating problems need to be treated as soon as possible. Above all, the handling of food and the relationship to one's own body are disturbed. The longer an eating disorder goes untreated, the more likely it is that it will become chronic. The earlier it is treated, the greater the healing success. Not only does the weight "disappear" (eg anorexia), eating problems can also act as a protective shield between the inner world and the environment (obesity).  They can also be a desperate struggle for a "raison d'être". Social relationships & the joie de vivre suffer & the external environment is often powerless. Every eating disorder is also a process of increasing dissociation (the splitting off of what has been experienced) & a helpless attempt to find an answer to something that the sufferer cannot cope with. This attempt concerns the entire experience - therefore experience-oriented models and methods are helpful. Body image work can change the way you look at your own body. An unlived life can be concealed in every eating disorder (restrained vitality is shown in suffering).

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A distinction is made between different forms of eating disorders / eating problems:

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1. Food addiction - obesity (obesity ≥ BMI 30 kg / m², children (> 97th percentile)

2. Selective eating behavior / SED (Selective Eating Disorders) Selective eating disorders: Strong aversions to certain foods

3. Eating behavior disorders such as stress eating, emotional eating, binge eating in general

4. Anorexia nervosa (starvation, underweight, body diagram disorder)

5. Atypical anorexia - does not contain all diagnostic features of anorexia (e.g. normal weight, body pattern disorder)

6. Anorexia athletica (atypical anorexia, excessive exercise to reduce energy, often underweight, body scheme disorder)

7. Eating and vomiting addiction - Bulimia nervosa (food cravings with vomiting, underweight or normal weight, possibly overweight, body scheme disorder)

8. Mixed forms: e.g. anorexia and bulimia occur together at the same time (underweight, body schema disorder)

9. Binge eating disorder (food cravings without vomiting, normal weight or obesity)

10. Subtypes of disturbed eating behavior: Night-Eating-Syndrome (increased food intake in the evening and night hours, approx. 1/4 of the daily amount of energy, cause psychological stress), Chewing and spitting (chewing and spitting syndrome, the food is not swallowed, being underweight can the consequence), psychogenic loss of appetite in connection with an emotional problem or stress factors (underweight but not a body scheme disorder)

11. Orthorexia (compulsive healthy eating with strict prohibitions, often underweight)

12. Biggerexia (mostly young men, muscle building is compulsively pursued, similar to anorexia)

13. Feeding disorders in early childhood with different symptoms (refusal to eat, spitting, vomiting, picky eating behavior, possibly rumination (repeated choking up of food without nausea or digestive tract disease)

14. Pica syndrome (mostly psychiatric problem, people affected eat unusual things such as soil, scraps of paper, chalk, feces)

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Why is nutritional therapy useful?

Nutritional therapy supports you in resolving your eating disorder from a different perspective. You will learn which foods are healthy for you, which essential nutrients you need & of course how to improve your individual nutrition issues. An energy-adjusted wholesome diet under the supervision of a certified nutritionist can lead to your long-term success. The diet is adapted to your current weight and a jointly defined goal for weight gain / or loss. Your individual situation and needs will be catered for so that you can get rid of your eating disorder permanently. The aim is to supply all of the fatty acids, micronutrients (vitamins and minerals) that are important to you, energy and protein in the measure that your body is optimally supplied with. For this purpose, foods that promote inflammation are specifically avoided and plenty of anti-inflammatory foods are consumed.

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Nutritional advice is suitable as a supplement to outpatient therapy, to prepare for therapy or to accompany and support after a stay in hospital.

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Explanation of the nutritional therapy: initial and follow-up discussions

Clarify triggers for the disease, personal goals for weight gain / loss, recommended energy and protein requirements, possibly recommendations for nutrient intake in a vegan / vegetarian diet, instructions for keeping a nutrition protocol, reviewing the medical diagnosis / laboratory values,

Inquire and determine the patient's bio-psycho-social anamnesis, goals / wishes and expectations.

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Goals & content of the consultations (individual and situational)

• regaining your own importance & nourishing your own individuality

• Get confidence in your own body signals

• Empathetic treatment in counseling: Dignified encountering the distress of inner feelings

• Taking away fears before eating: individually adapted implementation of normal and fear-free eating behavior

• Experience security through meal structure

• General information on nutrition issues and physiological processes

• concrete decision-making aids on questions relating to eating behavior, eating structure and food

• Accompaniment and control of the weight (1 x weekly weighing at the same time & the same conditions, e.g. always in the morning or always in the evening)

• Support with all questions about healthy nutrition

• Dissolve thought carousel in relation to eating and not eating

• build up the counseling depending on the individual problem (e.g. avoiding binge eating etc.)

• Achieve normal weight and maintain it for the long term

• Learning of individually adapted full portion sizes

• Which nutrients are important and essential for me?

• Which substances does my body absolutely need and also every day so that it is well?

• Understand the body's metabolism

• Relearn healthy eating and listen to your body intuitively

• Delusion and feel hunger, satiety and fullness

• Tricks to implement a healthy diet for everyday life

• Healthy use of fats and sugars

• Lose fear of not handling food in moderation

• Enjoyment training - self-hypnosis to support therapy

• other topics

• Additional therapy options

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A multimodal therapeutic approach is essential for eating disorders:

One is important  multimodal approach. ie for example nutritional therapy advice in combination with psychotherapeutic treatment and eg hypnosis. A self-help group may be able to offer support. In the case of severe forms (below BMI 16), it is advisable to go to a clinic for eating disorders in parallel to nutritional therapy & psychotherapeutic therapy in the case of underweight, as the waiting times can sometimes be very long (up to 3 months and longer). Antidepressants can possibly support the therapy (e.g. binge eating, anorexia, bulemia). There are also residential groups that you can use for example. B. can be used immediately after a stay in a clinic to have even more stability in everyday life, before going straight to the familiar environment, where there is a risk of relapse.

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Classification of weight according to WHO:

BMI = body mass index,

is the relationship between height and weight, corresponding percentile curves apply to children and adolescents, the BMI cannot simply be applied to this age group.

BMI and interpretation: BMI: body mass index

Formula: Body weight in kg : (body height in m) 2 (gives the unit kg / m2)

Underweight: <18.5, children: <25th percentile

Normal weight: 18.5 - 24.9

Overweight = pre-obesity: 25-29.9

Obesity grade I: 30 - 34.9

Obesity grade II: 35-39.9

Obesity grade III:> 40 = per magna

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Classification of underweight (source: Federal Association of Eating Disorders eV, 2019)

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BMI 17 - 18.5 slightly underweight

BMI 16 - 17 moderately underweight

BMI <16 severely underweight (grade 1 and 2)

BMI 15 - 16 severely underweight

BMI <15 extremely underweight

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Medical classification

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Colloquial term / ICD-10 code / diagnosis

Eating disorder / F50 / eating disorder

Anorexia / F50.0 / Anorexia nervosa / F50.1 / Atypical anorexia nervosa

Eating-vomiting addiction / F50.1 / Bulimia nervosa / F50.2 / Atypical bulimia nervosa

Binge eating / F50.3 / (No separate diagnosis at the moment, but F50.4 or F50.9 possible)

F50.4 / binge eating in other mental disorders

F50.5 / Vomiting in other mental disorders

Other eating disorders / F50.8 / Other eating disorders / F50.9 Eating disorders, unspecified (= mixed forms)

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"Unspecified eating disorder"

The diagnosis "unspecified eating disorder" is made in atypical courses of anorexia and bulemia, but also in children and adolescents when there is no typical anorexia or bulimia. The therapy should, however, be analogous to the treatment of the full picture of the corresponding disorder.

Examples of diagnosis:

All the criteria of anorexia or mulemia are not met, however, the following / o. Individual ones:

- Normal weight is available

- Menstruation present

- Binge eating <than twice a week

- A normal weight person regularly takes inappropriate weight-reducing measures (e.g. vomiting)

- Binge eating, however, without inappropriate weight-reducing measures (e.g. vomiting)

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Important blood parameters & follow-up controls within the therapy

• Blood pressure and pulse always drop with weight reduction - always check

• Always substitute the electrolytes (potassium, sodium, magnesium, calcium) when they are low (except sodium); If the sodium level is low, the amount consumed must be normalized (is often u large, please adjust to 1.5 - maximum 2 l per day, e.g. keep an eye on drinking logs). Adding salt to foods helps increase the body's sodium levels.

• If the blood sugar is <60mg / dl (whether on an empty stomach or during the day), eat or drink quickly absorbable carbohydrates such as glucose or sweetened fruit juice.

• Kidney values - creatinine: Caution, if the value is increased! Then there is already severe kidney damage  & a weight normalization is to be implemented as soon as possible. Better to check the value again, because dehydration can also falsify a value (dehydration in summer due to sweating, illness, little drinking, etc.)

• Liver values (GOT, GPT, Gamma-GT): many additional values, e.g. pancreatic enzymes (especially in bulimia nervosa)

• Thyroid values (TSH basal with FT3 and FT4), a low FT3 with normal TSH & FT4 still indicates the state of hunger and must not be substituted (do not give thyroid hormones!). An isolated reduced FT3 always normalizes itself with the weight normalization.

• Vitamin D level: 1/4 annual check-up intervals are sufficient, if vitamin D is or was reduced at all), if reduced, then give vitamin D. Please note: fat is required for absorption, so do not simply take it on an empty stomach.

• Blood count: Check if anemia is present (rarely with anorexia), a lowered Hb value (treat with tablets or drops). Iron may only be given if the ferritin level is reduced, because anorexia can also have a reduced Hb value and, at the same time, increased ferritin. Then you will not have an iron deficiency & iron must not be given.

• Vegans: often low Hb levels, & low Vit. B12 levels

• if an operation is due (also in the dental area): The platelets should always be determined with the coagulation factors

• The sex hormones (including testosterone in men with anorexia nervosa) do not need to be determined; (Reserved for special cases) The recurrence of the regular menstrual period should not take place through the administration of hormones, but through the normalized weight. Pill prescription for contraception only. Caution: gynecologists often see things differently! In adolescents before the end of bone growth (i.e. up to the age of 18-20), the hormone administration can stop the growth in length, in the sense of an unfavorable side effect. In addition, hormone administration can lead to weight increases due to water retention, which has already led to relapses in the eating disorder. It should also be noted, however, that a reduced weight and a missed period are not one hundred percent protection against pregnancy.

• Important: the lower the weight, the more severe the medical abnormalities. It is different with electrolyte disorders in the context of bulimic symptoms. These are independent of weight, but often by no means always - the effects for those affected are less serious if they are chronic. Please note: If the potassium level is in the normal range, it does not mean that the person has probably not vomited. This would not be evidence of the absence of bulimic symptoms. Potassium is therefore always determined when you find out that someone has bulimic symptoms.

• Body temperature

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Source: Recommendation of the Federal Association of Eating Disorders e. V. (SFOE)

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​ Weight gain when underweight is a crucial therapeutic goal for achieving normal weight

The targeted rate of weight gain differ significantly in different countries: the moderate weekly increase of 500g / week, which is practiced in Germany, is in contrast to the approach in Anglo-Saxon countries, which recommend an increase of 1-2 kg per week in the inpatient setting.

The target weight represents a healthy weight for the person concerned, which should be aimed for and maintained in the long term. The basic principle is that a healthy body weight is achieved when menstruation starts again. For adults, BMI values from 18.5 apply for a normal weight, for children and adolescents a weight range must be defined that is close to the 25th BMI percentile.

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Source Joint S3 guideline "Diagnostics and Therapy of Eating Disorders" 2019

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Nutritional therapy

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• Anti-inflammatory diet as a basis adapted to the current weight & jointly defined goals

• Holistic therapy - do you have any comorbidities that need to be taken into account during the consultation?

• Avoid micronutrient deficiencies and mineral deficiencies & possibly counteract them with nutrient preparations

• Prevent protein deficiency

• Which nutrients do I need in which ratio?

• Consume fiber according to the respective level (low fiber or high fiber)

• Sufficient fluid: total fluid per day: 30 - 35 ml per kg body weight and day. Attention, this is not just a drinking liquid. The liquid from food (approx. 500 - 800 ml) must still be subtracted from this so that a quantity of> 2 l drinking liquid is created.

• add valuable anti-carcinogenic (anti-cancer) secondary plant substances

• A selection of foods tailored to your needs with cooking and technical information (for breakfast, snacks, lunch, dinner)

• Do you like to eat your warm meal in the evening? I am happy to cater to your individual situation and we will create a plan on how you can implement your wholesome diet into your everyday life.

• Overall fat selection, how should it be designed?

• which oils are good for me? What should I watch out for in relation to the anti-inflammatory diet?

• How much fat spread (butter / margarine / vegetable fat) can I use and which products are recommended?

• Get enough Omgea-3 fatty acids and essential fatty acids

• How can I boost and support my metabolism with natural foods?

• Coordinate sensible meal frequency for your individual case - meal allocation

• What do I have to look out for when choosing animal foods?

• How many animal foods (e.g. meat products, milk and dairy products, cheese, fish products, eggs) are recommended?

• Define the desired weight stabilization / normalization & the estimated period for this

• what should be considered with beverages and alcoholic beverages?

• How does exercise affect your body and thus also your diet?

• Avoid blood sugar fluctuations

• Sweetening foods - sweeteners, glucose, fructose, sugar and sugar substitutes, what can I use and in what quantities? How high is the respective sweetness of the different products?

• what should be considered when baking and cooking?

• what are cheap snacks / main meals

• Eating out - what should you watch out for?

• Vacation, boat trip or hospital stay, what should be considered?

• Flatulence, bloating, diarrhea, constipation, vomiting, heartburn, loss of appetite, pain related to eating, what can I do about it?

• Daily plans as an example for practical implementation in everyday life

• Enjoyment training

• Optimizing your eating situation

• long-term maintenance of a jointly defined weight

• Strengthen the stomach and intestines with natural foods

• Additional therapy options

• Dietetic products in support of nutritional therapy

• Food supplements - under certain circumstances, a supplement can be useful

• and other topics

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Any questions? I look forward to your call or email. To contact form

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Assistance:

1. ANAD eV Supply Center for Eating Disorders

2. Overview of clinics / residential groups that treat eating disorders. To the directory of the address list

3. Federal Association for Eating Disorders (BFE)

4. Appointment within 4 weeks with a specialist / psychologist: Dial the telephone number: 116117 (also possible via app 116117), you need a transfer with an urgency note so that you can get a faster appointment within 30 km of your place of residence.