anorexia nervosa &

bulimia nervosa

By : Payam Farahbakhsh Clinical Nutritionist

AN & BNBoth are characterized by an overvalued

fear of fatness that drives a set of disturbed behaviors, including :

restricting food intake binge eating excessive exercise self-induced vomiting abuse of laxatives, diuretics, and diet pills

OVERVIEW OF EATING DISORDERSAnorexia NervosaAN is a syndrome of self-starvation characterized

by weight loss to a level below 85% of expected body weight.

Weight loss is accompanied by fear of fatness and,

in girls and women, amenorrhea or the absence of

3 or more consecutive menstrual cycles.

OVERVIEW OF EATING DISORDERSBulimia Nervosa 1

BN is a dieting disorder characterized by episodes of binge eating followed by compensatory behaviors aimed at preventing weight gain.

Bulimia Nervosa consumption of an amount of food definitely larger

than most people would eat in a similar period, under similar circumstances, and is associated with a sense of loss of control over eating.

Typical binge foods are high-fat , high- calorie, “forbidden” foods, and amounts consumed are 1000 to 2000 calories or more per binge.

BED (binge-eating disorder) regular binge eating, twice a week or more,

associated with a subjective sense of loss of control over eating but lacking the compensatory behaviors typical of BN.

Patients with BED are more likely to be overweight or obese.

Atypical eating disorders Globus hystericus, or fear of swallowing, resulting in :

severe weight loss functional impairment psychogenic vomiting syndromes.

EPIDEMIOLOGYEpidemiologic data on eating disorders is limited for

several reasons.

AN :

The prevalence of AN among young women is approximately 0.3%

F/M : 10 Onset :15 to 19 years

BN :

The prevalence of BN among young women is approximately 1%

F/M : 10 Onset :20 to 24 years

EPIDEMIOLOGYBED prevalence : 2% to 3%

female-to-male 2:1

Onset : 30 to 50 years .

Rates of BED are much higher, on the order of

approximately 25% , in clinical samples of obese individuals seeking weight-loss treatment.

ETIOLOGY 1Genetics

polymorphisms in serotonin and dopamine-related genes

leptin and estrogen receptors

Personality

low self-esteem Perfectionism

ETIOLOGYSocio cultural Factors

Mass Media Peers Family

Developmental Factors

ovarian hormones sexual development

CONSEQUENCES AND COMPLICATIONS 1Social and Developmental Complications

Psychologic Complicationslow mood apathy anhedonia decreased concentration and energy alcohol abuse anxiety disorders

CONSEQUENCES AND COMPLICATIONSPhysical Complications and Signs

1-Starvation-Related Complications: Malnutrition and starvation muscle wasting and weakness bradycardia hypotension hypothermia amenorrhea and infertility cold intolerance constipation Anemia Osteoporosis hypoglycemia

CONSEQUENCES AND COMPLICATIONS2-Purging-Related Complications:

parotid and salivary gland hypertrophy Dental caries reflux renal damage and nephrocalcinosis electrolyte and acid–base imbalances

TREATMENT

Initial treatment goals include normalizing eating patterns and restoring weight in underweight patients by using behavioral psychotherapeutic interventions.

TREATMENTEvidence-Based Treatmentcognitive behavioral treatment (CBT) Interpersonal psychotherapy(IPT)Family therapy

MedicationsOlanzapine fluoxetine

TREATMENTRole of the NutritionistThree regular meals a day eating normal portion sizes expanding food repertoire (which is often very

narrow) avoiding diet foods

Patients should be encouraged to consume all foods in moderation and in normal combinations and to avoid fat-free or sugar-free diet products.

TREATMENTVegetarianism that develops after the onset of

dieting behavior is common in both AN and BN

diabetic exchange system without focus on calorie counting

with BN or BED should be instructed to eat approximately2000 kcal/day with an initial goal of weight maintenance.

TREATMENTPatients with AN who need to gain weight should be

instructed to consume the same normal, healthy, 2000-cal diet plus three high-calorie liquid supplements between meals, totaling an additional 1000 to 1500 kcal/day to gain weight.

patients are strongly motivated to restrict their intake to low–calorie density foods

Enteral and Parenteral FeedingWhen access to a specialized behavioral inpatient

eating disorders program is limited, however, an attempt at enteral feeding for severely underweight individuals who fail to gain weight with oral feeding may be warranted.

The use of TPN has been described as a means of supplementation for AN patients who are refusing oral or nasogastric feeding.

Prognosis and Outcomes

Outcome studies of AN and BN suggest that approximately:

50% recover fully 25% to 30% improve significantly 15% to 20% continue to have unrelenting eating

disorders mortality rates:1% to 13% in AN 0% to 3% in BN

Thank you