Box 8.3 Guidelines for Food and Nutrient Interventions for Bulimia Nervosa and EDNOS Similar to Bulimia Nervosa (continued)
• Meal- and snacktime behavior: Discourage food rituals. Conversation should not focus on food. Address mindful eating and stress management before and after eating.
• Documentation of meals and snacks: Document intake, bingeing, and/or bingeing triggers. Patients may feel shame if food consumed in a binge episode is documented. If so, document only that a binge episode occurred. Document any compensatory behaviors.
• Beverage intake: If patient has difficulty tolerating volume, limit beverages at mealtimes. Limit caffeinated and nonca- loric beverages. If necessary, limit carbonated beverages, which can be used to help induce vomiting. If patient com- plains of excessive thirst, evaluate medications and discuss with physician. If patient is dependent on caffeine, discuss weaning program with treatment team.
