Brennan Cliona, Green Georgia, Morgan Abigail, Baudinet Julian
Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), The Michael Rutter Centre, London, UK.
London Metropolitan University, London, UK.
J Hum Nutr Diet. 2025 Jun;38(3):e70070. doi: 10.1111/jhn.70070.
Family therapy for anorexia nervosa (FT-AN) is the first-line outpatient treatment for young people with anorexia nervosa (AN) in the UK. However, some require more intensive interventions, such as day programmes (DPs), which provide structured multidisciplinary care, including nutritional rehabilitation. Despite the integral role of dietitians in DPs, their specific responsibilities remain under-researched. This study explores clinician perspectives on the role of dietitians in adolescent AN treatment to inform future research and consensus guidelines.
A qualitative study using semi-structured interviews was conducted with 11 clinicians working in one DP for young people with AN. Participants were recruited from the Intensive Treatment Programme at the Maudsley Centre for Child and Adolescent Eating Disorders. Reflexive thematic analysis identified key themes regarding dietitians' contributions to treatment.
Clinicians emphasised the dietitian's role in early treatment containment, reinforcing therapeutic approaches and empowering parents in meal planning and nutritional rehabilitation. Dietitians were seen as crucial in personalising treatment based on cultural and sensory needs and adapting meal plans as young people progressed. They also played a key role in guiding transitions between treatment phases, particularly from weight restoration to maintenance. However, challenges included an over-reliance on dietitians for nutritional decisions and a 'good cop, bad cop' dynamic, where therapists avoided difficult conversations about food.
Findings highlight dietitians' essential role in DP treatment for AN but suggest that excessive reliance may limit therapist autonomy. Strengthening collaboration through shared decision-making and bidirectional learning is recommended. Further research should explore these dynamics across diverse settings.
在英国，神经性厌食症家庭治疗（FT - AN）是青少年神经性厌食症（AN）患者的一线门诊治疗方法。然而，一些患者需要更强化的干预措施，如日间治疗项目（DPs），该项目提供结构化的多学科护理，包括营养康复。尽管营养师在日间治疗项目中起着不可或缺的作用，但其具体职责仍未得到充分研究。本研究探讨临床医生对营养师在青少年神经性厌食症治疗中作用的看法，以为未来的研究和共识指南提供参考。
采用半结构式访谈对在一个针对青少年神经性厌食症患者的日间治疗项目中工作的11名临床医生进行了定性研究。参与者从莫兹利儿童和青少年饮食失调中心的强化治疗项目中招募。反思性主题分析确定了关于营养师对治疗贡献的关键主题。
临床医生强调了营养师在早期治疗控制、强化治疗方法以及在饮食计划和营养康复方面增强家长能力方面的作用。营养师在根据文化和感官需求个性化治疗以及随着青少年病情进展调整饮食计划方面被视为至关重要。他们在指导治疗阶段之间的过渡，特别是从体重恢复到维持阶段，也发挥了关键作用。然而，挑战包括在营养决策上过度依赖营养师以及一种“唱红脸唱白脸”的动态关系，即治疗师避免关于食物的艰难对话。
研究结果凸显了营养师在青少年神经性厌食症日间治疗项目中的重要作用，但表明过度依赖可能会限制治疗师的自主性。建议通过共同决策和双向学习加强合作。进一步的研究应在不同环境中探索这些动态关系。
