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Eating Disorders

Eating disorder is a collective term for anorexia nervosa, bulimia nervosa, and binge eating which are basicallyemotional disorders. The health risks of these disorders include malnutrition, osteoporosis, menstrual cycle shutdown, heartproblems with dangerously low blood pressure, circulatory collapse, and cardiac arrest in the advanced stage. Behavioralproblems include depression, impulsiveness, and inability to cope with problems, especially family relationships.

Anorexia Nervosa

I. Definition*a disease characterized by: (1) refusal to maintain a minimally normal body weight, (2) intense fear of gainingweight, (3) body image distortion, and (4) amenorrhea in postmenarcheal females

*An eating disorder in which the patient severely rejects food, causing extreme weight loss, low basal metabolicrate, and exhaustion. Two possible outcomes include Cushing s disease and osteoporosis. Death occurs inextreme cases.

*A disorder characterized by an aversion to food and a self-imposed restriction of food intake. There is apreoccupation with food as fear of getting fat, and the individual denies being excessively thin despite extreme

emaciation, denies hunger despite malnutrition, and denies fatigue frantic exercise

II. Occurrence*It is 10 times more common in girls, especially just after the onset of puberty, peaking at 12-12 and 19-20years, but can occur at any age.

III. Signs and SymptomsFat and muscle wasting; amenorrhea of at least three consecutive cycles; hirsutism; alopecia or thin hair;constipation; dehydration; bradycardia

Diagnosis: onset before 25 years of age; weight loss of at least 25% without a known medical illness;

disturbed view of food and eating with at least 2 of the following:1. Amenorrhea2. Lanugo hair3. Bradycardia (60 beats or less)

4. Overactivity5. Bulimic episodes6. Self-induced vomiting

IV. ManagementA. Psychotherapy for the individual and his/her family; attempts insights and behaviour modificationB. Diet

1. Parenteral or enteral routes for life-threatening situations2. Re-feeding schedules

a. Re-feed slowly; start with 800-1200 kcalb. Once the patient is eating, increase kcal graduallyEnergy = 30 kcal/kg initially gradually increasing to 5-10 kcal/kg/day every 3 to 5 days until

energy intake is 70-100 kcal/kg/day3. When the desired weight is reached, give 50 kcal/day until about a year since anorectics are

hypermetabolic after recovery4. When hypermetabolic state is over, give 30 kcal/kg/day5. Vitamin and mineral supplements6. Dietary fiber7. Small frequent feeds8. Liquid supplementation

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C. Patient education1. Modify patients ideas about food2. Modify ideas about normal weight and its fluctuation

D. Drug: antidepressantBulimia nervosa

I. Definition*an illness characterized by repeated episodes of binge eating followed by inappropriate compensatorymethods such as purging, including self-induced vomiting or misuse of laxatives, diuretics, or enemas, ornonpurging, including fating or engaging in excessive exercise

*An eating disorder with food addiction as the primary coping mechanism. Criteria for diagnosis of bulimiainclude recurrent episodes of bing eating; sense of lack of control; self-evaluation unduly influenced by weightor body shape; and recurrent and inappropriate compensating behaviour two times weekly for 3 months orlonger (vomiting, use of laxatives or diuretics, fasting, excessive exercise). Two types (purging and nongorging)have been identified

*An eating disorder also called the binge-purge syndrome.The person has insatiable appetite but is afraid togain weight; binge eating is followed by purging caused by induced vomiting, diuretics, or laxatives

II. Characteristics of Bulimic Patients-they tend to experience loneliness, irritability, passivity, sadness, and suicidal behaviour-they usually have overweight mothers; eating may have been taught as a coping mechanism for stress-co-dependency may be present; co-dependency is a dysfunctional pattern of relating to ones own feelings,focus on others or on things outside of self, and denial of feelings within the family unit-patients are at normal weight or slightly above normal

III. ManagementA. Psychotherapy for the individual and his/her familyB. Drugs antidepressantsC. Patient education

1. Determine food needs and eat what is needed2. Sensible view of normal weight3. Stop vomiting and purging4. Weight maintenance diet

D. Diet1. Feeding schedule the same as anorectic but during the last phase, 25 kcal/day is given to stabilize

weight and maintain it2. Regular meals and snacks which include foods once considered taboo3. Adequate fat satiety4. Record food consumed in a diary

Binge-Eating DisorderI. Definition

*It is previously called compulsive eating, characterized by recurrent episodes of eating an amount of foodthat is larger than most people would eat in a similar period of time under similar circumstances, and a sense oflack of control over eating during the episode

*Characterized by the absence of inappropriate compensatory behaviors after the binge. Binge episodes occurat least 2 days per week for a period of 6 months

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*recurrent episode of binge eating with a sense of lack of control over the eating episodes are its mainindicators. Episodes may involve any three: eating more rapidly than normal, eating until uncomfortable, eatingwhen not physically hungry, eating these foods alone, and feeling disgusted or guilty or depressed

II. Occurrence*its onset occurs in late adolescent or in the early twenties; it is 1.5 times more common among women thanmen*chronic dieting may predispose binge eating or drug abuse

III. ManagementA. Drugs antidepressantsB. Patient education

1. Discuss use of a food diary to record time, place, foods eaten, cues, binge feelings, and othercomments

2. Discuss exercise and its effect on sense of well-being3. Discuss shopping, holidays, and stressors4. Discuss not skipping breakfast and lunch and the bingeing into the night

C. Diet 1. Offer a balanced diet2. Alter diet according to medication therapies and medical recommendations or history. This may

include restriction of CHO, protein, fat, sodium or other nutrients accordingly.