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