The Food and Nutrient Administration category of nutri- tion assessment includes Diet Experience—the evaluation of the patient’s past and present experiences with both prescribed and self-selected diets (1). Chronic dieting behavior and obsession with food can result in nutrient deficiencies, psychological stress, impairment in social functioning, excessive intake of bioactive substances, and other symptoms of eating disorders. Additionally, patients with a chronic dieting history may have accumulated many dieting “rules” that support their eating disorder. Investigating previous diets will provide you with a guide for your nutrition education and counseling. Patients who are overweight may be discouraged by a
history of unsuccessful attempts to lose weight or main- tain weight loss through conventional means or “doing everything right.” This frustration can lead to the harmful weight-loss attempts that precede and then trigger their eating disorder. In some of these cases, a patient can- not succeed with weight loss through appropriate means because he or she has an undiagnosed endocrine disorder (see Chapter 6). An endocrine consult is in order when a patient describes any of the following:
• Gaining weight while dieting • Rapid weight loss or weight gain without a change in eating
• Abnormal appetite or cravings surrounding menstruation
• Lack of weight loss even though eating minimally and exercising
