Eating Disorder

Nutrition Principle GTN 207

DR. HAMID JAN B. JAN MOHAMED

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 and management

Definition
Eating disorder : A persistent (consistent) disturbance of eating (or eating-related behaviour) which impairs physical health or psychosocial functioning, or both, and which is not secondary to any general medical disorder or any other psychiatric disorder.

Types of eating disorder

Anorexia nervosa Bulimia nervosa Eating disorder not otherwise specified (EDNOS)

Anorexia nervosa
Definition Development Diagnosis Effect Management

Anorexia nervosa
Definition: - An eating disorder characterised by a refusal to maintain a minimally normal body weight and a distortion in perception of body shape and weight. Development and causes: - Generally in adolescence, some childhood-onset or prepubertal cases observed - Girls (75-80%), Boys (2025%) - Normal dieting which gets out of control. - Personality factor of perfectionism, negative selfevaluation, child abuse, genetic factor, media (size zero models), family and friends pressure, teasing.

Anorexia nervosa- Diagnosis

A person with anorexia nervosa demonstrates the following characteristics: A) Refusal to maintain body weight at or above a minimal normal weight for age and height (Eg. BMI<17.5). B) Intense fear of gaining weight or become fat, even though underweight. C) Disturbance in the way in which ones body weight or shape is experienced, undue influence of body weight or shape on selfevaluation, or denial of the seriousness of the current low body weight. D) In female past puberty, amenorrhea, i.e., the absence of at least 3 consecutive menstrual cycle.

Two types: i) Restricting type - During the episode of AN, the person does not engage in binge eating or purging behavior (Eg. Self-induced vomiting, misuse of laxative, diuretics, or enemas) ii) Binge eating/purging type - During the episode of AN, the person regularly engages in binge eating or purging behaviour (Eg. as above -)

Anorexia nervosa- Effect

Anorexia nervosa- Management

Requires a multidisciplinary approach. Teams of doctors, dietitians and psychiatrists work together to resolve two sets of issues: 1) related to food and weight Dietary management 2) 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.

Bulimia nervosa
Definition An eating disorder characterised by repeated episodes of binge eating usually followed by purging self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise Binge eating ?: the consumption of unusually large amounts of food and an aversive sense of lack of control over eating. Development & causes Common in young adults suggesting other personal and life stressors like work demand. Eg. Models, celebrities History of disturbed eating during adolescence, 30% has resemblance with AN, low genetic factor.

Bulimia nervosa- The vicious cycle of restrictive dieting and binge eating
Negative self perception

Purging

Restrictive dieting

Binge eating

Bulimia nervosa- Diagnosis

A person with bulimia nervosa demonstrates the following : A) Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following: i) Eating in a discrete period of time (Eg. within 2Hrs), an amount of food that is defined larger than most people would eat during a similar 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 weight gain, 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, on average, 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, but does not regularly engage in self-induced vomiting or laxatives, diuretics, or enemas.

Bulimia nervosa- Effect

Bulimia nervosa- Management

Requires a multidisciplinary approach. Teams of doctors, dietitians and psychiatrists work together to resolve 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 and restrictive dieting habits and learning to eat three meals a day plus healthy snacks. - Initially, energy intake should provide enough food to satisfy hunger and maintain body weight

Eating disorder not otherwise specified (EDNOS) Definition: Have symptoms similar in form to anorexia nervosa and bulimia nervosa but fail to meet their diagnostic criteria either because a particular feature is missing (partial syndrome) or because they do not meet the specified level of severity (subthreshold case).

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 normal range. C) Meet all of the criteria for BN, except that their binges occur less frequently than stated in the criteria. D) Are of normal body weight and who compensate inappropriately for eating small amounts of food (Eg. Self-induced vomiting after eating only 2 cookies) E) Repeatedly chew food, but spit it out without swallow. F) have recurrent episodes of binge but who do not compensate as do those with BN. - Treatment shall concentrate more towards behavioral change

Thank you very much