title: Best nutrition counseling practices for the treatment of anorexia nervosa: a Delphi study.
abstract: OBJECTIVE
  To use Delphi methodology to evaluate the extent to which a panel of registered dietitians (RDs) who treat anorexia nervosa (AN) concur on parameters related to nutrition counseling for AN.
  
  
  METHODS
  The twenty-one panelists who participated in this study: (i) were RDs (ii) had specialized in nutritional counseling for eating disorders for 5 years or more, and (iii) had Internet access at home or work. Over a 10-week period (between 8/2013 and 11/2013), panelists completed three iterative questionnaires. Questionnaire 1 included 12 open-ended questions regarding nutrition counseling for patients with AN. Subsequent questionnaires were developed based on a content analysis of responses to the first questionnaire, and panelists were asked to rank their level of agreement with these items.
  
  
  RESULTS
  Consensus was defined as 85% agreement and was achieved for 47 (35.3%) of the 133 items included in the third questionnaire. Items achieving consensus described nutrition counseling approaches that are applicable to all patients with AN, and their wording typically allowed for consideration of individual needs. Some items that did not achieve consensus reflected approaches for which individual tailoring may be necessary depending on age, stage of illness, and other patient factors. Consensus was also not shown for approaches for which there is little evidence.
  
  
  CONCLUSIONS
  Nutritional counseling intervention for AN has some consensus features, but the need for individualization was apparent. A stronger evidence-base for nutritional counseling interventions for AN would provide guidance and facilitate greater consistency among RDs regarding how to best care for this patient population.
authors: Department of Nutrition at the University of North Carolina at Chapel Hill, North Carolina.
authors: Anne M
authors: AM
authors: Mittnacht
authors: Cynthia M
authors: CM
authors: Bulik
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000178:diet therapy* / Q000523:psychology; D003376:Counseling / Q000379:methods* / Q000592:standards*; D003697:Delphi Technique; D004035:Diet Therapy / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: Delphi; nutritional counseling; qualitative; registered dietitians who treat eating disorders