Eating Disorders

Eating disorder is a collective term for anorexia nervosa, bulimia nervosa, and binge eating which are basically
emotional disorders. The health risks of these disorders include malnutrition, osteoporosis, menstrual cycle shutdown, heart
problems with dangerously low blood pressure, circulatory collapse, and cardiac arrest in the advanced stage. Behavioral
problems include depression, impulsiveness, and inability to cope with problems, especially family relationships.

Anorexia Nervosa

I. Definition
*a disease characterized by: (1) refusal to maintain a minimally normal body weight, (2) intense fear of gaining
weight, (3) body image distortion, and (4) amenorrhea in postmenarcheal females

*An eating disorder in which the patient severely rejects food, causing extreme weight loss, low basal metabolic
rate, and exhaustion. Two possible outcomes include Cushings disease and osteoporosis. Death occurs in
extreme cases.

*A disorder characterized by an aversion to food and a self-imposed restriction of food intake. There is a
preoccupation with food as fear of getting fat, and the individual denies being excessively thin despite extreme
emaciation, denies hunger despite malnutrition, and denies fatigue frantic exercise

II. Occurrence
*It is 10 times more common in girls, especially just after the onset of puberty, peaking at 12-12 and 19-20
years, but can occur at any age.

III. Signs and Symptoms
Fat and muscle wasting; amenorrhea of at least three consecutive cycles; hirsutism; alopecia or thin hair;
constipation; dehydration; bradycardia

Diagnosis: onset before 25 years of age; weight loss of at least 25% without a known medical illness;
disturbed view of food and eating with at least 2 of the following:
1. Amenorrhea
2. Lanugo hair
3. Bradycardia (60 beats or less)
4. Overactivity
5. Bulimic episodes
6. Self-induced vomiting

IV. Management
A. Psychotherapy for the individual and his/her family; attempts insights and behaviour modification

B. Diet
1. Parenteral or enteral routes for life-threatening situations
2. Re-feeding schedules
a. Re-feed slowly; start with 800-1200 kcal
b. Once the patient is eating, increase kcal gradually
Energy = 30 kcal/kg initially gradually increasing to 5-10 kcal/kg/day every 3 to 5 days until
energy intake is 70-100 kcal/kg/day
3. When the desired weight is reached, give 50 kcal/day until about a year since anorectics are
hypermetabolic after recovery
4. When hypermetabolic state is over, give 30 kcal/kg/day
5. Vitamin and mineral supplements
6. Dietary fiber
7. Small frequent feeds
8. Liquid supplementation
C. Patient education
1. Modify patients ideas about food
2. Modify ideas about normal weight and its fluctuation

D. Drug: antidepressant

Bulimia nervosa

I. Definition
*an illness characterized by repeated episodes of binge eating followed by inappropriate compensatory
methods such as purging, including self-induced vomiting or misuse of laxatives, diuretics, or enemas, or
nonpurging, including fating or engaging in excessive exercise

*An eating disorder with food addiction as the primary coping mechanism. Criteria for diagnosis of bulimia
include recurrent episodes of bing eating; sense of lack of control; self-evaluation unduly influenced by weight
or body shape; and recurrent and inappropriate compensating behaviour two times weekly for 3 months or
longer (vomiting, use of laxatives or diuretics, fasting, excessive exercise). Two types (purging and nongorging)
have been identified

*An eating disorder also called the binge-purge syndrome. The person has insatiable appetite but is afraid to
gain weight; binge eating is followed by purging caused by induced vomiting, diuretics, or laxatives

II. Characteristics of Bulimic Patients
-they tend to experience loneliness, irritability, passivity, sadness, and suicidal behaviour
-they usually have overweight mothers; eating may have been taught as a coping mechanism for stress
-co-dependency may be present; co-dependency is a dysfunctional pattern of relating to ones own feelings,
focus on others or on things outside of self, and denial of feelings within the family unit
-patients are at normal weight or slightly above normal

III. Management
A. Psychotherapy for the individual and his/her family
B. Drugs antidepressants
C. Patient education
1. Determine food needs and eat what is needed
2. Sensible view of normal weight
3. Stop vomiting and purging
4. Weight maintenance diet
D. Diet
1. Feeding schedule the same as anorectic but during the last phase, 25 kcal/day is given to stabilize
weight and maintain it
2. Regular meals and snacks which include foods once considered taboo
3. Adequate fat satiety
4. Record food consumed in a diary

Binge-Eating Disorder
I. Definition
*It is previously called compulsive eating, characterized by recurrent episodes of eating an amount of food
that is larger than most people would eat in a similar period of time under similar circumstances, and a sense of
lack of control over eating during the episode

*Characterized by the absence of inappropriate compensatory behaviors after the binge. Binge episodes occur
at least 2 days per week for a period of 6 months
*recurrent episode of binge eating with a sense of lack of control over the eating episodes are its main
indicators. Episodes may involve any three: eating more rapidly than normal, eating until uncomfortable, eating
when not physically hungry, eating these foods alone, and feeling disgusted or guilty or depressed

II. Occurrence
*its onset occurs in late adolescent or in the early twenties; it is 1.5 times more common among women than
men
*chronic dieting may predispose binge eating or drug abuse

III. Management
A. Drugs antidepressants

B. Patient education
1. Discuss use of a food diary to record time, place, foods eaten, cues, binge feelings, and other
comments
2. Discuss exercise and its effect on sense of well-being
3. Discuss shopping, holidays, and stressors
4. Discuss not skipping breakfast and lunch and the bingeing into the night

C. Diet
1. Offer a balanced diet
2. Alter diet according to medication therapies and medical recommendations or history. This may
include restriction of CHO, protein, fat, sodium or other nutrients accordingly.