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5-Eating Disorder
5-Eating Disorder
Types .…
Anorexia nervosa
Bulimia nervosa
binge-eating disorder
Other specified and unspecified feeding and eating disorders
Anorexia Nervosa
5
Restricting type
restricting
food intake with no binge eating or purging behavior
over the past 3 months
Simply refusing to eat as a way of preventing weight gain
Some might go for days without eating
Binge eating/purging type
patientsregularly participate in bingeing or purging behaviors
over the prior 3 months
e.g., self-induced vomiting, misuse of laxatives or diuretics
Clinical presentation of AN
10
Sign/Symptoms
Patients have obsessions and fears about eating and gaining
weight.
feeling full even when they have eaten very little food.
Denial of symptoms, failure to recognize low body weight.
Weakness, lethargy, amenorrhea, vomiting, restricted food intake,
inappropriate exercise, delayed sexual development,
osteoporosis, dry cracking skin, …
Bulimia Nervosa
11
Non-purging type
useof excessive exercise or fasting to control their weight but do
not engage in purging.
Purging type
people use self-induced vomiting or purging medications
Clinical presentation of BN
13
Patients binge eat and stop when they have abdominal pain or
self-induced vomiting.
Severe dieting followed by binge eating episodes.
They are concerned about their body image but do not have
the drive to thinness, which is a characteristic of AN.
Self-evaluation is influenced by body shape & weight.
Clinical presentation of BN
14
Symptoms
Patientsdo not eat regular meals and do not feel satiety at the end
of a meal.
may use purging methods such as laxatives for weight control.
They have guilt, depression after binges.
Social isolation can result from frequent bingeing.
Troubled personal relationships and substance abuse are common.
Binge-eating disorder
15
Treatment goals ……
reduce distorted body image
restore and maintain healthy body weight
establish normal eating patterns
improve psychologic, psychosocial, and physical problems
enhance compliance
prevent relapse
weight loss ….specific to BED
Medications are rarely indicated as a sole treatment
Treatments of AN
21
Antidepressants ….
currently have no role in the acute treatment of anorexia
shouldbe initiated only if depression, anxiety, obsessions, or
compulsions persist after the target weight is achieved.
SSRI antidepressants ….preferred, b/c they are better tolerated
and have greater CV safety than TCAs and MAOIs.
Fluoxetine …. most widely studied SSRI in anorexia
initiate
at low doses (20 mg/day) and increase to a maximum of 60
mg/day based on response and tolerability.
Treatments of AN/ SGAs
25
Diagnosis:
BMI – obesity 30 kg/m2, overweight 25–29.9 kg/m2
Waist circumference men 102 cm, women 88 cm
Investigations: blood pressure, blood tests (blood glucose,
lipid profile, thyroid function tests).
Hypothyroidism is a potential cause for weight gain
Smoking cessation for smokers
Lifestyle and behavioral recommendations
Lifestyle and behavioral recommendations
37
Orlistat side-effects:
interference with absorption of fat soluble vitamins, oily spotting in
feces, flatus and fecal urgency.
Treatment should not usually continue beyond 1 year
Sibutramine
41
Side-effects:
headache, dizziness, depression, anxiety, insomnia, hypertension,
constipation, dry mouth, nausea.
Treatment should not be continued for more than 1 year
Monitoring: blood pressure, pulse rate