anorexia nervosa & bulimia nervosa

1. anorexia nervosa &bulimia nervosa By : Payam Farahbakhsh Clinical Nutritionist

2. AN & BN • Both 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

3. OVERVIEW OF EATING DISORDERS Anorexia Nervosa • AN 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.

4. OVERVIEW OF EATING DISORDERS Bulimia Nervosa 1 • BN is a dieting disorder characterized by episodes of binge eating followed by compensatory behaviors aimed at preventing weight gain.

5. 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.

6. 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.

7. Atypical eating disorders Globushystericus, or fear of swallowing, resulting in : • severe weight loss • functional impairment • psychogenic vomiting syndromes.

8. EPIDEMIOLOGY Epidemiologic data on eating disorders is limitedfor 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

9. EPIDEMIOLOGY BED 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.

10. ETIOLOGY 1 • Genetics • polymorphisms in serotonin and dopamine-relatedgenes • leptin and estrogenreceptors • Personality • low self-esteem • Perfectionism

11. ETIOLOGY • Socio cultural Factors • Mass Media • Peers • Family • Developmental Factors • ovarian hormones • sexual development

13. CONSEQUENCES AND COMPLICATIONS 1 • Social and Developmental Complications • PsychologicComplications • low mood • apathy • anhedonia • decreased concentration and energy • alcohol abuse • anxiety disorders

14. CONSEQUENCES AND COMPLICATIONS • Physical 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

15. CONSEQUENCES AND COMPLICATIONS 2-Purging-Related Complications: • parotid and salivary gland hypertrophy • Dental caries • reflux • renal damage and nephrocalcinosis • electrolyte and acid–base imbalances

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

17. TREATMENT • Evidence-Based Treatment • cognitive behavioral treatment (CBT) • Interpersonal psychotherapy(IPT) • Family therapy • Medications • Olanzapine • fluoxetine

18. TREATMENT • Role of the Nutritionist • Three 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.

19. TREATMENT • Vegetarianism 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.

20. TREATMENT • Patients 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

21. Enteral and Parenteral Feeding • When 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 TPNhas been described as a means of supplementation for AN patients who are refusing oral or nasogastric feeding.

22. 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

23. Thank you