Eating Disorders
primarily in women, westernized/industrialized societies
prevalence: 3% in teenagers!
Anorexia nervosa
persistent energy intake restriction --> weight less than minimum normal
fear of gaining weight - NOT alleviated by weight loss (may not recognize/acknowledge fear)
disturbance in self-perceived weight or shape
mild: BMI > 17, moderate: 16 < BMI < 17, severe: 15 < BMI < 16, extreme BMI < 15
frequent weighing/measuring
types
restricting - dieting, fasting, excessive exercise
recurrent episodes of binge eating or purging (more likely to be impulsive and abuse drugs/alcohol)
often brought to doctor by family member - patient usually lacks insight into problem
physical manifestation of extreme weight loss
hypothermia (cold insensitivity)
bradycardia/hypotension
constipation
dependent edema
lanugo
hormones: decreased growth hormone/cortisol/gonadotropin - delayed sexual development, thyroid hormones
prevalence: 1% of teenage/young adult women, 0.4% females overall; 10:1 F:M; usu younger than bulimia, assoc w/ stressful life events
chronic illness: 6% mortality rate over 10 years, increased risk of suicide
risk factors: anxiety/obsessive traits, interest in modeling/athletics, family hx, industrialized/high income societies
Bulimia nervosa
recurrent episodes of binge eating (lack of control over eating, amount larger than what most would eat in a sitting)
inappropriate compensatory behaviors to prevent weight gain
triggers: negative emotions, stress, negative feelings about body, boredom
delayed feelings of dysphoria - guilt, disgust
vomiting, laxatives, fasting, exercise
vomiting most common
self-eval unduly influenced by body shape/weight
usually in normal weight range or overweight
menstrual changes
induced vomiting: parotitis, enamel erosion, dorsal hand calluses, electrolyte disturbances, metabolic alkalosis
esophageal tears, gastric rupture, cardiac arrhythmias
1-4% of females lifetime incidence; 10-1 F:M
adolescence/young adulthood
multiple life stressors
4% mortality rate
risk factors: internalization of thing body ideal, overanxious temperament, low self esteem, depressive s/s, childhood obesity, early pubertal maturation, industrialized countries
Binge eating disorder
recurrent episodes of binge eating
episodes associated w/ 3+
eating more quickly than normal
eating until uncomfortably full
eating lots when not hungry
eating alone bc of embarrassment
feeling disgusted, depressed, guilty
at least 1/week for 3 months
no inappropriate compensatory behavior
0.8% of males, 1.6% females
dieting follows after binge eating begins (bulimia - dieting precedes)
individuals more likely to see tx due to being overweight vs other eating disorders
assessing eating disorders
thorough history
mental status exam
physical exam: vitals, weight, skin, CV
labs: cholesterol, lipids, Ca, Mg, P, liver enzymes, amylase/lipase, TFT, ECG, bone mineral density
hyperthyroidism, midline brain tumors, and malabsorption conditions can look like eating disorder
psych disease mimics
schizophrenia - bizarre eating from psychosis
MDD: poor appetite and weight loss (WL is unwanted)
OCD: rituals
autism: eating habits
Treatment
may need hospitalization for severe starvation, hypotension, hypothermia, electrolyte imbalance, depression w/ suicidal ideation, failure to gain weight in outpatient
behavior modification, counseling, family/group tx
goals for changes in eating/weight gain; target behaviors
daily weights, observation, recording fluid intake/output
diet w/ increased number of calories than needed for maintenance of current weight
stool softeners/laxatives, calcium and vit D supplements
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