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/