1. Determine actual caloric expenditure by measuring oxygen consumption.

2. Have a physician counsel the patient about a diet that provides an appropriate nutrient composition and caloric content.

3. Design a diet to include foods from each of the basic food groups, with portions being increased as caloric increase is made. Foods should provide all vitamins and mineral needs, and supplements should not be necessary.

4. Emphasize a varied diet which reflects the patient's likes and dislikes.

5. Weigh foods to ensure that adequate portions are consumed and to give bulimics greater confidence that overeating will not occur.

6. Create individualized meal plans ensuring that a wide variety of foods are included in three meals and snacks.

7. Make sure the bulk content of meals is not excessive in the initial stages in order to minimize discomfort.

8. Gradually increase weekly intake by 200 calories during the early stages of the diet, following with greater increases when the patient becomes more comfortable eating.

Kenneth Burns

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