We describe a nutritional counseling program emphasizing the importance of healthy eating behavior and the practical aspects of its implementation to counter the starvelbingelpurge cycle of bulimia nervosa. We describe its rationale, its implementation, and, using a case illustration, its preliminary results.
Bulimia nervosa is an eating disorder that has been estimated to affect between 2-4% of young women in Western societies (Cooper
& Fairburn, 1983; Pyle et al., 1983). It is characterized by episodic eating binges accompanied by an irresistible urge to overeat and followed by self-induced vomiting or laxative abuse. Although the patients are usually at normal weight, they invariably demonstrate a morbid fear of fatness. Despite the considerable physical and psychiatric morbidity associated with the disorder (Mitchell, Hatsukami, Eckert, & Pyle, 1985) and perhaps a sixfold increase in standardized mortality ratio (Patton, 1988), at least one-third of the patients surveyed in the community have never sought treatment (Fairburn & Cooper, 1982; Yager, Landsverk, & Edelstein, 1987).
Recently, nutritional counseling combined with cognitive behavioral therapy has been found to be effective in the treatment of the illness. However, descriptions of the combined treatment approach have focused almost exclusively on the cognitive behavioral component. Many studies mentioned meal planning and nutritional education, but gave no details (e.g.,