Kristin is a 34-year-old female who has come to see you in your outpatient private practice. Her chief complaint is that she feels “out of control and wants to stop bingeing.” Kristin currently is employed as a marketing director at a company in New York City. She describes her life to be very stressful: working approximately 50 to 55 hours per week in the office and has several social engagements in the evenings. She reports an “unhealthy” relationship with food since she was a teenager, when she was a “yoyo dieter” and would take various diet pills to lose weight. Her weight as a teenager fluctuated between slightly underweight to normal. Kristin began to purge in college after some of her friends introduced her to the idea of vomiting. Later after moving to New York and becoming stressed with life events, she began to purge more often after what she describes as “binges.” Currently Kristin reports skipping breakfast most days but has a large cup of coffee, black with 5 packets of artificial sweetener. She has a snack around 10 am of a handful of almonds and sometimes a fruit. She usually goes to the gym during her lunch hour, where she does 45 to 55 minutes of cardio. For lunch Kristin has two hardboiled eggs, a piece of toast, and diet coke. A few times per week after client lunches Kristin feels stressed that she ate “fear foods,” so she binges on cookies or candy and afterward purges in her private bathroom. In the afternoon Kristin usually has another coffee or diet coke and a protein bar. After work Kristin goes home with plans of eating a normal dinner but, after ordering take out from the local Chinese, Italian, or sushi restaurant, binges on approximately 2000 to 3000 calories worth of food before purging. Kristin has a hard time at social events that occur several times a week and binges or purges after them as well. In total Kristin estimates she is binge/purging five times per week, sometimes twice per day. Kristin is frustrated with the binge/purge cycle she is caught in and is requesting guidance for a meal plan. Medical history: Dental caries requiring three root canals and two implants; irritable bowel syndrome with constipation Current medications: Fluoxetine 40 mg, Colace 100 mg once daily Height: 5’5”, weight: 138 lb
Nutrition Diagnostic Statemen
t Disordered eating pattern related to bingeing and purging as evidenced by a pattern of restrictive eating, bingeing and then self-induced vomiting.
Questions
1. What are the medical complications Kristin is experiencing secondary to her bingeing and purging? What are some others she could develop if she does not stop?
2. Discuss which laboratory values are abnormal.
3. What are your main goals for nutrition therapy while working with Kristin?
4. How might you approach meal planning with Kristin?
5. How might you help Kristin talk about her fear foods and set goals for including them in her diet without bingeing on them?
6. What techniques would be helpful for Kristin to challenge her urges to binge and purge during stressful work situations?