16.eating disorder

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Eating Disorder

Nutrition PrincipleGTN 207

DR. HAMID JAN B. JAN MOHAMED


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By the end of this lecture you should be able to:

Define eating disorder

Explain the types of eating disorder

Identify the common group of individuals

experiencing eating disorder

Explain the definition, development, diagnosis,effect and management of anorexia nervosa and

bulimia nervosa. Define eating disorder not otherwise specified

(EDNOS) and discuss the diagnosis andmanagement


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Types of eating disorder

Anorexia nervosa

Bulimia nervosa

Eating disorder nototherwise specified(EDNOS)


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Anorexia nervosa

Definition

Development

Diagnosis Effect

Management


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Anorexia nervosa

Definition:

- An eating disordercharacterised by a refusal tomaintain a minimally normalbody weight and a distortionin perception of body shapeand weight.

Development and causes:- Generally in adolescence,some childhood-onset or pre-pubertal cases observed- Girls (75-80%), Boys (20-25%)

- Normal dieting which getsout of control.- Personality factor ofperfectionism, negative self-evaluation, child abuse,genetic factor, media (sizezero models), family and

friends pressure, teasing.


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A person with anorexia nervosa demonstrates the following characteristics:

A) Refusal to maintain body weight at or above a minimal normal weightfor age and height (Eg. BMI


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Anorexia nervosa- Effect


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Requires a multidisciplinary approach.

Teams of doctors, dietitians and psychiatrists work together toresolve two sets of issues:1) related to food and weight Dietary management2) related to relationship with oneself- Psychiatry management

The initial phase of treatment

1) Engagement: Between health team and patients.2) Education: Educating the patients.3) Agreeing the need for weight gain: Gradually, Ego-synthonic.4) Deciding on the treatment setting:

Inpatient: No or low motivated patient, High risk, 2000

kcal/day within 2 weeks, 1 to 1.5 kg/week weight gain,sometimes using high energy drink, Psychotherapy. Outpatient: Motivated patients, Mild medical risk. Day-patient: Motivated patients, Low medical risk, 4-7 days

weekly, supervised meals and group therapy.

Anorexia nervosa- Management


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Bulimia nervosa

Definition An eating disorder characterised by

repeated episodes of binge eatingusually followed by purging self-inducedvomiting, misuse of laxatives ordiuretics, fasting, or excessive exercise

Binge eating ?: the consumption ofunusually large amounts of food and anaversive sense of lack of control overeating.

Development & causes

Common in young adults suggesting

other personal and life stressors likework demand. Eg. Models, celebritiesHistory of disturbed eating duringadolescence, 30% has resemblancewith AN, low genetic factor.


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Bulimia nervosa- The vicious cycle ofrestrictive dieting and binge eating

Negativeself

perception

Bingeeating

PurgingRestrictive

dieting


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A person with bulimia nervosa demonstrates the following :

A) Recurrent episodes of binge eating. An episode of binge eating ischaracterised by both of the following:i) Eating in a discrete period of time (Eg. within 2Hrs), an amountof food that is defined larger than most people would eat during asimilar period of time and under similar circumstances.ii) A sense of lack of control over eating during the episode(type & amount)

B) Recurrent inappropriate compensatory behaviour in order to prevent weightgain, such as self-induced vomiting; misuses of laxative, diuretics, enemas,or other medications; fasting; or excessive exercise.

C) Binge eating and inappropriate compensatory behaviors both occur, onaverage, at least twice a week for three months.

D) The disturbance does not occur exclusively during episode of anorexia

nervosa.Two types:i) Purging type: The person regularly engages in self-induced vomiting or

the misuses of laxatives, diuretics, or enemas.ii) Non-purging type: The person uses other inappropriate compensatory

behaviors, such as fasting or excessive exercise, butdoes not regularly engage in self-induced vomiting or

laxatives, diuretics, or enemas.

Bulimia nervosa- Diagnosis


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Bulimia nervosa- Effect


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Requires a multidisciplinary approach.

Teams of doctors, dietitians and psychiatrists work together toresolve two sets of issues:

1) related to food and weight Dietary management

2) related to relationship with oneself- Psychiatry management

- Major steps towards recovery include discontinuing purging andrestrictive dieting habits and learning to eat three meals a dayplus healthy snacks.

- Initially, energy intake should provide enough food to satisfyhunger and maintain body weight

Bulimia nervosa- Management


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Eating disorder not otherwise specified

(EDNOS)

Definition:

Have symptoms similar in form to anorexianervosa and bulimia nervosa but fail tomeet their diagnostic criteria eitherbecause a particular feature is missing(partial syndrome) or because they do not

meet the specified level of severity (sub-threshold case).


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EDNOS- Diagnosis

Criteria for diagnosis of unspecified eating disorder, in general:A) Meet all the criteria for AN, except irregular menses.

B) Meet all the criteria for AN, except that their weights fall within the normalrange.

C) Meet all of the criteria for BN, except that their binges occur lessfrequently than stated in the criteria.

D) Are of normal body weight and who compensate inappropriately foreating small amounts of food (Eg. Self-induced vomiting after eating only 2cookies)

E) Repeatedly chew food, but spit it out without swallow.

F) have recurrent episodes of binge but who do not compensate as dothose with BN.

- Treatment shall concentrate more towards behavioral change


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Thank you very much

16.eating disorder

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