Eating Disorders

by

Dr. Shastri Motilal

(MBBS Honours, DM)

Lecturer in Family Medicine

Thursday 6th February, 2014

Objectives
Define the terms disordered eating,
dietary restraint, and binge eating.
Discuss these concepts as abnormal
means of weight control.
Briefly describe the principal eating
disorders: anorexia nervosa, bulimia
nervosa and binge eating disorders.

What is normal?
Normal eating: ingestion of healthy foods, the
intake of a mixed and balanced diet that
contains enough nutrients and calories to
meet the body's needs
Positive attitude about food (no labeling of
foods as good or bad, healthy or
fattening, which can lead to feelings of guilt
and anxiety).
It is important for patients to understand that
normal eating fluctuates; but not to the point
of leading to a nutrient deficiency or excess or
to weight loss or gain.

Normal Behaviours and

Attitudes
not deviating from a norm, rule, or principle;
conforming to a type, standard, or regular
pattern or occurring naturally.
It is human nature to crave foods, to eat more
when food is available, to eat differently because
of changing social and emotional factors
Eating attitudes could be defined as beliefs,
thoughts, feelings, and behaviors toward foods

Definitions
Eating Disorders (Eds) are psychiatric
illnesses marked by disordered eating
behaviours, disordered food intake,
disordered eating attitudes, and often
inadequate methods of weight control.
Disordered Eating includes the full
spectrum of eating-related problems
from simple dieting to clinical Eds

Main EDs
Anorexia nervosa
Bulimia nervosa
Eating disorders not otherwise
specified

Anorexia Nervosa
(AN) is marked by a
serious weight loss,
refusal to eat, and
a disturbance in the
way in which one's
body weight or
shape is
experienced.
1950 1983

Who is affected by AN?

10 times more common in females
than in males.
In young women, the risk of
developing anorexia is 0.5 to 1
percent, and mortality is estimated
at 4 to 10 percent!
Adolescents and young adults
Affects all ethnicities but most
common among whites in
industrialized nations.

What causes AN?

A combination of genetic, biological,
psychological, family, environmental,
and social factors probably
contribute to developing an eating
disorder.
There is no consensus regarding the
causes of eating disorders

How is AN diagnosed?
Patients with anorexia use caloric
restriction
(BMI) <17.5 kg/m2
Excessive exercise to control
emotional need or pain, and they are
terrified of becoming overweight.

Affects all organ systems

Constitution/whole body - Cachexia and low body mass index,
Arrested growth, Hypothermia
Cardiovascular - Myocardial atrophy, Bradycardia,
Arrhythmias which may cause sudden death, Hypotension
Gynecologic and reproductive Amenorrhea, Infertility
Endocrine - Osteoporosis and pathologic stress fractures
Gastrointestinal - Gastroparesis (delayed gastric emptying),
Constipation, Gastric dilatation, Increased colonic transit time,
Hepatitis
Renal and electrolytes - Decreased glomerular filtration rate,
Renal calculi, Impaired concentration of urine, Dehydration,
Hypokalemia, Hypomagnesemia, Hypophosphatemia,
Pulmonary - Respiratory failure
Hematologic - Anemia, Leukopenia, Thrombycytopenia
Neurologic - Cerebral atrophy, Cognitive impairment,
Peripheral neuropathy
Dermatologic Xerosis (dry skin) Lanugo hair (fine, downy, dark
hair)

Treatment of AN
Early detection
Interdisciplinary team approach,
involving:
Medical provider
Dietitian
Mental health professional

Bulimia nervosa (BN)

Bulimia nervosa
is marked by
presence of
binge eating
episodes,
followed by
compensatory
behaviors (e.g.,
vomiting or use
of laxatives)

Who gets BN?

Bulimia mainly affects women aged
16-40.
Most commonly starts around the
age of 19 years.
Women 10 times more likely to
develop bulimia than men.

Clinical Features

Treatment of BN
Mulitdisciplinary

Cognitive Behavioural Therapy (CBT)

Other psychotherapies
Antidepressant medication (SSRI)
Combination treatment are all likely
to be beneficial

Eating Disorders Not Otherwise

Specified (ED-NOS)
Patients with clearly aberrant eating
patterns and weight management
habits who do not meet the criteria for
AN and BN
binge eating disorder
night eating syndrome
sleep related eating disorder
purging disorder.

Binge-eating disorder
Defined as eating an amount of food in a
discrete period of time that is definitely larger
than most people would eat in a similar period
of time under similar circumstances.
These episodes occur at least twice a week for
at least six months.
Episodes of binge eating are associated with a
lack of control and with distress over the eating.
Without the inappropriate compensatory
behaviors that are seen in BN.

Binge-eating disorder
Obesity, hypercholesterolemia
Treatment
Psychotherapy > Behavioral weight loss
therapy > Pharmacotherapy

Ethnicity, body image perception and weightrelated behaviour among adolescent Females
attending secondary school in Trinidad.

Adolescent females from selected

secondary schools
2.4% of the participants reported
having a medical diagnosis for an
eating disorder

51% of participants had a negative

body image perception
Ramberan et al. 2006

Prevalence of bulimic behaviours and eating

attitudes in schoolgirls from Trinidad and
Barbados.

The prevalence of bulimic disorders

in Caribbean schoolgirls is still very
low, but they are a population at
increasing risk since they share the
western ideals of slimness and
engage in dieting behaviours.

Bhugra et al. 2003

Summary
Brief overview eating disorders
The SCOFF questionnaire is a useful screening tool.
Two or more positive answers should prompt a more
detailed history:
Do you ever make yourself Sick because you feel
uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a threemonth period?
Do you believe yourself to be Fat when others say you are
too thin?
Would you say that Food dominates your life?

Thank you

Comments/Question
s

References
Pritts et al. Diagnosis of Eating Disorders in Primary Care Am Fam
Physician. 2003 Jan 15;67(2):297-304.
Williams et al. Treating Eating Disorders in Primary Care. Am Fam
Physician. 2008 Jan 15;77(2):187-195.
Forman S. Eating disorders: Epidemiology, pathogenesis, clinical
features, and course of illness [Internet]. Uptodate; [updated Sep 25,
2012; cited Wed 30, 2012]. Available from:
http://www.uptodate.com/contents/eating-disorders-epidemiology-patho
genesis-clinical-features-and-course-of-illness?source=search_result
&search=eating+disorders&selectedTitle=1%7E150
Forman S. Eating disorders: Treatment and outcome [Internet].
Uptodate; [updated Mar 29, 2012; cited Wed 30, 2012]. Available from:
http://www.uptodate.com/contents/eating-disorders-treatment-and-ou
tcome?source=search_result&search=eating+disorders&selectedTitle=2
%7E150
Pereira et al. Disordered Eating: Identifying, Treating, Preventing, and