Eating Disorders

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Presentation Transcript

EATING DISORDERS: 

EATING DISORDERS Anorexia Nervosa Bulimia Nervosa Obesity

Learning Objectives: 

Learning Objectives Define anorexia, bulimia, and obesity. Describe the characteristics, patient profile, subtypes, signs and symptoms, lab findings, course and treatment of anorexia and bulimia.

Learning Objectives: 

Learning Objectives Describe the patient profile and health problems caused by obesity. Describe diagnostic procedures, lab findings, treatment options, and issues related to obesity.

Eating Disorders: 

Eating Disorders Anorexia Nervosa Bulimia Nervosa Obesity

Eating Disorders: 

Eating Disorders Recognized since 9th century

Anorexia: 

Anorexia Refusal to maintain weight Afraid of gaining weight Significantly disturbed body perception

Anorexia: 

Anorexia Profile Found frequently in pre- and post-puberty Affects females more than males Possible media influence At risk professions: athletics, acting, dancing, modeling Disease of developed countries

Anorexia: 

Anorexia Subtypes Restricting Type Binge-Eating/Purging Type

Anorexia: 

Anorexia Medical condition Signs & symptoms Many attributable to starvation Post menarche-Amenorrhea-common Prepubertal-delay of menarche

Anorexia: 

Anorexia Medical condition Other Signs & symptoms Constipation, abdominal pain, cold intolerance, lethargy, emaciation, bradycardia, peripheral edema, hypercarotemia, hypertrophy of salivary glands, dental enamel erosion, scars or calluses on the dorsum of the hand

Anorexia: 

Anorexia Semi-starvation can affect most major organ systems, produces disturbances Lab Findings Leukopenia, mild anemia, elevated BUN indicates dehydration, LFTs may be elevated, hypercholesterolemia

Anorexia: 

Anorexia Situations/Other Lab findings Induced vomiting may lead to metabolic alkalosis, hypochloremia, hypokalemia Laxative abuse may cause metabolic acidosis Abnormal thyroid function Females < estrogen; Males < testosterone

Anorexia: 

Anorexia Situations/Lab findings EKG shows sinus bradycardia EEG shows metabolic encephalopathy Brain imaging indicated increase in ventricular-brain ratio

Anorexia: 

Anorexia Rare after age 40 Course Calcium loss can lead to bone fractures Starvation affects vital organs Anorexia has highest psychiatric illness mortality (6%)

Anorexia: 

Anorexia Differential diagnosis Consider other weight loss illnesses: Crohn’s disease Mental disorder: depression Patients with mental disorder do not exhibit preoccupation with food

Anorexia: 

Anorexia Treatment Nutritional rehabilitation Weight restoration Cognitive-behavioral therapy, family therapy

Bulimia: 

Bulimia Diagnosed in 1980s Characterized by binge-eating episodes, then inappropriate weight control Types of inappropriate weight control methods Fasting, Enemas Laxatives, Diuretics Compulsive exercising

Bulimia: 

Bulimia Binge Episode in which person eats larger amount of food than normal Not a response to hunger Usually response to depression, stress, self-esteem issue

Bulimia: 

Bulimia Binge Episode Loss of control Then short-lived calmness Possible self-loathing Cycle is obsessive, repeated Consumption of comfort foods > 2/day

Bulimia: 

Bulimia Profile Affects1-3% young women More common in women than men Present in industrialized countries High achievers

Bulimia: 

Bulimia Profile Presentation Anglos Normal weight range Increased frequency of depressive symptoms, mood and anxiety disorders Prevalence of substance abuse, dependence (alcohol/stimulants) 30%

Bulimia: 

Bulimia Lab Studies: Electrolytes, metabolism show abnormalities from purging, various degrees of starvation Diagnosis Rule out other medical and mental disorders Check participation in inappropriate compensatory behavior, over-concern with body shape/weight

Bulimia: 

Bulimia Subtypes Purging Type Non-purging type

Bulimia: 

Bulimia Treatment Medication Antidepressants: SSRIs, generics Imipramine, Despiramine, Trazadone, and MAOIs

Bulimia: 

Bulimia Treatment Clinical intervention Psychiatric evaluation for comorbid conditions May be on outpatient basis Individual cognitive-behavioral group and family therapy Possible hospitalization

Obesity: 

Obesity 1.Tobacco 2. ?? 3. Alcohol consumption 4. Microbial agents 5. Toxic agents Leading causes of death in the U.S. in 1990 & 2000: 6. Motor vehicles 7. Firearms 8. Sexual behavior 9. Illicit drug use

Obesity: 

Obesity # 2 cause of death is poor diet and physical inactivity (16.6%) 1998 NIH report: >50% U.S. adults overweight/obese

Obesity: 

Obesity Standards BMI: measure of body fat based on height/weight Disadvantages of BMI as standard May overestimate body fat in athletes/those with muscular build May underestimate body fat in older person/those with depleted muscle mass

Obesity: 

Obesity BMI Categories Underweight = <18.5 Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30 or greater

Obesity: 

Obesity Standards Weight tables Women-5 feet = 100 lbs; add 5 lbs for each additional inch, +/-5%-10% Men-5 feet = 106 lbs; add 5 lbs for each additional inch, +/-5%-10%

Obesity: 

Obesity Weight factors: genetics, environment, behavioral, psychological Definition of weight gain: Intake of calories exceeds calories expended

Obesity: 

Obesity 60% U.S. meals consumed outside home. These meals significantly higher in fat, calories, are served in larger portions, lower in fruits, vegetables, grains

Obesity: 

Obesity Risks to children School lunch nutritional standards do not apply to vending machines 80% U.S. children consume 3 sodas/day Decline in physical activity Time watching TV: 3 hr/day Need early intervention

Obesity: 

Obesity Risks to adults Inactivity due to sedentary entertainment, job, time at computer, lack of exercise

Obesity: 

Obesity Costs $75 billion in 2003 Half costs paid by Medicare/Medicaid

Obesity-Related Health Problems: 

Obesity-Related Health Problems Diabetes Heart disease Sleep apnea Hypertension Osteoarthritis Cancer DVT ESRD

Obesity-Other Related Health Problems: 

Obesity-Other Related Health Problems Impaired respiratory function Wound infection following surgery Infertility Liver disease Low back pain, Birth defects Chronic venous insufficiency Daytime sleepiness Gall bladder disease, gout, stroke

Obesity: 

Obesity Recommendations for the HCP Counsel patients Be informed Utilize personal exercise program, watch calories, be a role model Screen patients using BMI/weight tables Provide resources

Obesity: 

Obesity Lab Studies Check cardiovascular disorders, hypertension, hypercholesterolemia, diabetes, osteoarthritis, others Check for depression/anxiety

Treatment Options: 

Treatment Options Diets Exercise Behavioral counseling Pharmacotherapy Bariatric surgery

Treatment Options: 

Treatment Options Diets: restrictive/variety/support groups Exercise Behavioral counseling

Treatment Options: 

Treatment Options Pharmacotherapy Modestly effective Amphetamines increase norepinephrine Some drugs prevent macronutrient absorption Xenical® inhibits fat absorption Prescription meds are controlled substances except Orlistat [generic] Use caution

Treatment Options: 

Treatment Options Bariatric surgery: Gastric bypass, stomach transection/stapling Determine degree of obesity Comorbidities Goal to allow patient to make healthy lifestyle changes

Treatment Options (cont’): 

Treatment Options (cont’) Follow-on considerations Patient determination, education

Obesity: 

Obesity Issues Health maintenance

Summary: 

Summary Definitions of anorexia, bulimia, and obesity Characteristics, patient profile, subtypes, signs and symptoms, lab findings, course and treatment of anorexia and bulimia

Summary: 

Summary Patient profile and health problems caused by obesity Diagnostic procedures, lab findings, treatment options, and issues related to obesity