Anorexia nervosa and clinical nutrition rehabilitation - case study

Uvod: Motnje hranjenja, so bolezni, ki so bile do pred kratkim znane le ozkemu krogu strokovnjakov, danes pa predstavljajo pomemben javno-zdravstveni problem. Vzroke za nastanek motenj hranjenja lahko razdelimo v tri velike skupine: biološko-genetske, socio-kulturne in družinske. Med motnje hranjenja uvrščamo: anoreksijo nervozo, bulimijo nervozo, kompulzivno prenajedanje in novejše oblike, kot sta ortoreksija in bigoreksija nervoza. Med uspešnejše terapevtske pristope spada psihoterapija, uporablja se predvsem vedenjsko-kognitivno in/ali razvojno- dinamsko psihoterapijo, v kombinaciji s psiho-farmakoterapijo. Pomembno vlogo v procesu zdravljenja motenj hranjenja ima tudi ustrezna in pravilna prehranska obravnava. Namen: Namen diplomskega dela je opisati in predstaviti anoreksijo nervozo in klinično prehransko obravnavo pri tej bolezni. S študijo primera želimo prikazati klinično prehransko obravnavo pacientke, ki je prebolela motnjo hranjenja, potek obravnave in njeno okrevanje. Metode: Za teoretični del diplomskega dela je bila uporabljena deskriptivna metoda s pregledom tuje in domače strokovne in znanstvene literature. Empirični del diplomskega dela predstavlja študija primera klinične prehranske obravnave osebe z anoreksijo nervozo. Razprava in sklep: Bistvo prehranske obravnave je, da oseba pokrije energijske potrebe, ki so potrebne za rast in razvoj in da vnaša še dodatne kilokalorije, s katerimi počasi pridobiva izgubljeno telesno težo. Po razpoložljivih podatkih bolniki ob vnosu 300 kcal/dan ohranjajo telesno maso. Po fazi stradanja metabolizem ostane še nekaj časa nizek, čeprav je telesu na voljo dovolj hrane. Telo energijo uskladišči v maščobne zaloge, s katerimi bi preživelo morebitno naslednje obdobje stradanja. S povečanjem energijskega vnosa se postopno poveča tudi hitrost bazalnega metabolizma. Ob začetku zdravljenja se določi ciljno težo, 19-20 kg/m&#178. Načrt prehranjevanja je ključno orodje pri zdravljenju anoreksije nervoze, priporoča se redno prehranjevanje s tremi glavnimi obroki in z dvema ali tremi malicami. Zdravljenje poteka multidisciplinarno, v proces zdravljenja je pomembno vključiti kliničnega dietetika in/ali diplomirano medicinsko sestro s specialnimi znanji na področju klinične prehrane.Abstract: Eating disorders are a group of diseases which recently known only to a narrow circle of experts and represent a major public health problem. Causes of eating disorders can be divided into three major groups: biological-genetic, socio-cultural and family related. Mostly it is a mix of sources from all three groups. What we consider as eating disorders include: anorexia nervosa, bulimia nervosa, compulsive binge eating and newer forms such as ortorexia and bigorexia nervosa. A key factor in the successful treatment of people with eating disorders is their own personal motivation for treatment. Among the more successful therapeutic approaches we can include psychotherapy, mainly behavioural-cognitive and/or development-psychodynamic psychotherapy if necessary in combination with psycho-pharmacotherapy. The treatment may be outpatient or hospital type. The important role besides psychotherapy, when it comes to eating disorders treatment itself, is placed upon the appropriate and correct nutritional treatment. Healing does not mean merely the absence of symptoms of the individual eating disorders, but also appropriate psychosocial functioning. Purpose: The purpose of this thesis is to describe and present anorexia nervosa, which is one of the most common diseases among all forms of eating disorders, and clinical nutritional treatment for this disease. The thesis will present the role of food and nutrition, as well as the progress and the importance of clinical nutritional treatment. We wish to present the course of hospital treatment through our case study, recovery and clinical dietary treatment of a patient who got over the eating disorder. Methods: : The descriptive method with the overview of domestic and foreign expert literature has been used for the theoretical part of the thesis. The empirical part of the thesis will be based on the view of the person that got over anorexia. Discussion and conclusion: The essence of nutritional treatment is the that person covers the energy needs which are necessary for their growth and development and bring additional kilocalories, which are important to slowly gaining the lost weight. Acording to available data, patients need the intake of 300kcal/day to maintain weight. After the stage of starvation metabolism stil stays low for some time, even though the body has enough food. The body stores its energy in fat in order to survive any subsequent period of fasting. The increase of energy input graduallly increases the basal metabolism. At the baseline of treatment we have to determinate the target weight, 19-20kg/m&#178. Eating plan is a key tool in the treatment of anorexia nervosa, it is recommended to eat three main meals and two or three snacks in between. The treatment process is multidisciplinary, it is important to integrate clinical dietetian and/or nurses from the clinical nutrition field