extremely malnourished, uncooperative, or hostile (such as those who are hospitalized against their will) may need time to adjust before meeting productively with you. In these cases, a preliminary nutrition assessment should be drafted from medical records and reports from family members and other care providers.
Outpatient
In an outpatient setting, the information available prior to the nutrition assessment may be more limited than in an inpatient setting. Even when patients are accompanied by a significant other, family member(s), or caregiver(s), more voices do not always provide more useful informa- tion. Other parties may not be fully aware of the patient’s eating disorder behaviors, and there may be differences of opinion regarding severity, frequency, and duration of symptoms. In these cases, the nutrition assessment may take place over the course of several meetings. Patients who have been concealing their behaviors may not be used to honest disclosure and may minimize or deny their eating disorder out of fear of punishment or other nega- tive consequences. They may need a few sessions with you before determining that you are dependable and worth trusting. See Box 2.1 for tips on establishing trust (4–6).
