Anorexia/eating disoders

Question 1

Prevalence of eating disorders in female adolescents

Answer 1

5% prior to adulthood

Question 2

Most effective form of treatment for anorexia nervosa

Answer 2

Family based therapy

Question 3

Outline the model of family based therapy for anorexia nervosa

Answer 3

1. treatment as outpatient
2. interdisciplinary team that assists family in tackling eating disorder
3. parents are given responsibility of reutrhing child to physical health and weight restoration.

Question 4

Advantages of family based therapy

Answer 4

remains in own environment (where the eating disorder lives)
maintains ongoing connections with friends and family
empowers family that they can help their child
scarce inpatient resources can be directed to those who can’t be managed as outpatients
Allows community physicians sto introduce components of this while awaiting specialized treatment.

Question 5

how to set up care while waiting for interdisciplinary clinic for Anorexia?

Answer 5

still strive for ID care. refer to family therapist, dietician, psychiatry

Question 6

Tenets of initiating treatment of weight restoration as outpatient

Answer 6

1. tell parents and adolescent that eating disorder is not their fault
2. It is the parents responsibility to ensure child gets well
3. They are unlikely to find a specific cause for their child, oftent hey are both genetic and environmental factors that trigger development of anorexia
4. The child can no longer care for him/herself. Parents must interrupt all abnormal food and exercise behaviours

Question 7

anticipatory guidance for refeeding as outpatient in AN

Answer 7

it will be very difficult
child will become angry and defiant
parents need to work together
“Help your teenage beat an eating disorder by Lock and Le Grange”
parents need to make changes to their own schedules to supervise meals or refeeding will be impossible
offer to fill out leave of abscence paperwork for caregiver

Question 8

Behavioural methods for refeeding in AN

Answer 8

1. positive reinforcement (rewarding desired behaviour)
2. negative reinforcement (taking away privileges)
3. be consistent (weight restoration is not negotiable)

Question 9

Goal weight gain for weight restoration in anorexia

Answer 9

0.2-0.5 kg per week

3 meals, at least two snacks per day

Question 10

How to weight at outpatient visits

Answer 10

1. patient in gown
2. patient empty bladder
3. same scale
4. orthostatic vitals at each visit

Question 11

outpatient visits for AN should be

Answer 11

1. frequent
2. include chekcing weight and vitals
3. meeting patient alone for part of it to review ED behaviours
   feedback about wieght and vitals to both parents and patient at each visit
   include reminders and encouragement

Question 12

Limitations of using median BMI as treatment goal weight for AN

Answer 12

premorbid histories of being at extreme ends of the BMI spectrum may not be at optimal function at 50%

Question 13

use of return of menstrual function as treatment goal weight in AN results in

Answer 13

higher weights, on average (formula TGW + 2 kg)

Question 14

if slowed growth velocity and overall decline in height percentile in AN name one test to order

Answer 14

Bone age, reason is because there is evidence that rapid restoration back to pre-pubertal weight percentile can allow catch up growth in stature if bone age delayed

Question 15

reassessment of goal weight in AN should be done

Answer 15

every 3-6 months

Question 16

4 methods of setting a treatment goal weight in AN

Answer 16

Based on prior growth curves (height, weight, and BMI) (recommended)
based on weight at same percentile as height
based on median BMI for age (BMI 19.6)
Based on menstrual threshold + 2 kg