eating disorders unit 10
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Types of Eating
Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Not Otherwise Specified (NOS)
Anorexia Nervosa
Warning SignsDramatic weight lossRefusal to eat certain foods or food
categories (e.g. no fats, no carbs)Consistent excuses to avoid situations
involving foodExcessive and rigid exercise routineWithdrawal from usual
friends/relatives
Source: National Eating Disorders Association Website
Anorexia
Heart failure Kidney failure Low protein stores Digestive problems Electrolyte
imbalance
Treatment for Anorexia
1. Hospitalization First consideration- return the patient’s
nutritional state Inpatient psychiatric treatment
Behavioral management Individual psychotherapy Family education and therapy In some cases psychotropics
Treatment for Anorexia
Pharmacotherapy No identified medication that yields
definitive improvement of core symptoms of anorexia
Some support for the use of cyproheptadine (Periactine)
Amitryptiline (Elavil)- also been reported to have some benefit
Other medications used with variable results Clomipramine, primozide, chlorpromazine
Treatment for Anorexia
Pharmacotherapy cont. Trials with fluoxetine
Some weight gain
Serotonergic agents May yield positive responses in the future
TCAs In low-weight patients may result in
Hypotension, cardiac arrhythmia, dehydration
Upon return of normal nutritional state TCAs may be introduced.
Bulimia Nervosa
DSM-IV-TR Defined as binge eating combined with
inappropriate ways of stopping weight gain
Bulimia Nervosa
Warning SignsWrappers/containers indicating
consumption of large amounts of foodFrequent trips to bathroom after mealsSigns of vomiting e.g. staining of teeth, calluses on hands
Excessive and rigid exercise routineWithdrawal from usual friends/relatives
Source: National Eating Disorders Association Website
Bulimia Nervosa
According to the DSM-IV-TR Bulimia nervosa is present when:
Episodes of binge eating occur relatively frequently Twice a week or more for at least 3 month
Compensatory behaviors are practiced after binge eating to prevent weight gain: Self-induce vomiting Laxative abuse Diuretics Abuse of emetics Severe dieting and strenuous exercise
Bulimia Nervosa
According to the DSM-IV-TR Bulimia nervosa is present when:
Cont. Wight is not severely lowered as in
anorexia The patient has morbid fear of fatness A relentless drive for thinness Disproportionate amount of self-evaluation
depends on body shape and wight
Bulimia Nervosa
Health Risks Electrolyte
imbalance Laxative
dependence Dental problems Stomach rupture Menstruation
irregularities
Treatment for Bulimia Nervosa Pharmacotherapy
Antidepressants Shown to be helpful
SSRIs (Fluoxetine 60 to 80 mg/day) Reduce binge eating
Imipramine (Tofranil) Desipramine (Norpramin) Trazodone (Desyrel) MAOIs have also been helpful
Carbamazepine (Tegretol) and lithium (Eskalith) – have not shown impressive results. Mostly used in bulimic patients with comorbid mood disorders such as bipolar I disorder.
Obesity
Complex disease resulting from: Genetic succeptibility Increased availability of high-energy
foods Decreased physical activity
Obesity
Accounts for: 25% of body weight in men 18% of body weight in women
Obesity
Treatment Obesity treatment is multifactorial Treatment include
Diet Exercise Psychotherapy Pharmacotherapy In extreme cases:
Surgery
Obesity
Pharmacotherapy –(See table 23.3-7 pg 746) Drug treatment is effective because it
suppresses appetite but tolerance may develop Orlistat ( Xenical) approved by the FDA in 1999
for weight loss treatment (Currently sold OTC as “Alli” Selective gastric and pancreatic lipase inhibitor 120 mg 3 times a day in combination with a low
calorie diet and exercise
Obesity
Orlistat Prescription orlistat is used in overweight
people who may also have: high blood pressure diabetes, high cholesterol heart disease. also used after weight-loss for maintenance .Orlistat is a lipase inhibitors. It prevents
some of the fat in foods eaten from being absorbed in the intestines. This unabsorbed fat is then removed from the body in the stool.
Obesity
Sibutramine (Meridia) β-phenylethylamine that inhibits reuptake of
serotonin and epinephrine (and dopamine to a limited extent).
Approved by the FDA in 1997 for weight loss treatment and maintenance
Sibutramine is no longer available in the U.S. The manufacturer has decided to stop producing sibutramine based on information from a recent clinical study. In this study, people taking sibutramine had an increased risk of cardiovascular events such as heart attack and stroke
Obesity
Orlistat- Side effects oily spotting on underwear or on clothing gas with oily spotting urgent need to have a bowel movement loose stools oily or fatty stools increased number of bowel movements difficulty controlling bowel movements pain or discomfort in the rectum (bottom) stomach pain irregular menstrual periods headache anxiety
Obesity
Orlistat- Serious side effects- See doctor imnmediately hives rash itching difficulty breathing or swallowing severe or continuous stomach pain excessive tiredness or weakness nausea vomiting loss of appetite pain in the upper right part of the stomach yellowing of the skin or eyes dark-colored urine light-colored stools
Obesity Rimonabant
first in a new class of therapeutic agents called Cannabinoid-1 Receptor Blockers (CB1).
Shown to reduce body weight and reduce cv risk factors
Dose 20 mg causes significant weight loss Reduction in waist circumference
FDA's Endocrine and Metabolic Drugs Advisory Committee recommended against the approval of rimonabant (known in the United States as Zimulti) due to concerns over similar serious side effects. Subsequently, the FDA did not approve rimonabant, and it has never been marketed in the United States.
Resources
www.mypyramid.gov National Institutes of Health Publication No 02-4084.
The Practical Guide: Identification, Evaluation, and Treatment of overweight and obesity in adults
http://win.niddk.nih.gov/index.htm www.obesity.org www.eatright.org www.consumer.gov/weightloss www.naaso.org www.shapeup.org. www.nwcr.ws/Research/default.htm www.acsm.org www.thelifestylecompany.com/
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