Class 6 Flashcards
BED criteria
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. The binge-eating episodes are associated with
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed, or very guilty afterward.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Specify if:
In partial remission: After full criteria for binge-eating disorder were previously met, binge eatingoccurs at an average frequency of less than one episode per week for a sustained period of time.
In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.
Specify current severity:
The minimum level of severity is based on the frequency of episodes of binge eating (see below).
The level of severity may be increased to reflect other symptoms and the degree of functional disability.
Mild: 1–3 binge eating episodes per week.
Moderate: 4–7 binge-eating episodes per week.
Severe: 8–13 binge-eating episodes per week.
Extreme: 14 or more binge-eating episodes per week.
Obesity
BMI 30 or higher
Differential dx BED
Binge eating disorder and bulimia nervosa share the same core feature of recurrent binge eating. Binge eating disorder is distinct from bulimia nervosa, however, in that binge eating disorder patients do not report recurrent compensatory behavior such as vomiting, laxative abuse, or excessive dieting. Binge eating disorder is distinct from anorexia nervosa in that patients do not exhibit an excessive drive for thinness and are of normal weight or are obese. The prevalence of binge eating disorder is higher in overweight populations (3 percent) than in the general population (approximately 2 percent). However there are some distinctions. Obese patients with binge eating disorder have a greater caloric intake during binging and nonbinging episodes, greater eating disorder pathology (i.e., more emotional eating, chaotic eating habits), and higher rates of comorbid psychiatric disorders. Binge eating disorder is also more prevalent in families than obesity.
Genetic disorders, cerebral tumor, epilepsy.
Drug induced: steroids,
Labs to do obese
Glu, hba1c, TSH, HDL, CBC, NakCl, Mg, Ca, ECG, SV, waist circumference
Treatment BED
Symptoms of binge eating may benefit from medication treatment with several SSRIs,
desipramine (Norpramin), imipramine (Tofranil), topiramate (Topamax), and sibutramine (Meridia). SSRI medications that have demonstrated improvement in mood as well as binge eating include fluvoxamine (Luvox), citalopram (Celexa), and sertraline (Zoloft). Some studies showed that high-dose SSRI treatment (e.g., fluoxetine [Paxil] at 60 to 100 mg) often initially resulted in weight loss. However, the weight loss was
ordinarily short lived, even when medication was continued, and weight always returned when medication was discontinued. Amphetamine and amphetamine-like drugs may help but are of little use over the long term. Most, but not all, studies show that medication added to CBT is more effective than medication alone. For example, studies indicate that CBT did better than fluvoxamine or desipramine as a monotherapy for binge eating disorder; however, when CBT was used in combination with these agents, more improvement was seen in terms of weight loss compared with CBT alone.
Prevalence obesity
20% of men, 22% of women are obese.
Effects of obesity on health:
Heart, hta, cholesterol, osteoarthritis, cancer, db, obstructive sleep apnea, depression, mortality
eligibility bariatric surgery
• 18 years of age and older
• BMI greater than or equal to 40
• BMI greater than or equal to 35 but less than 40. With at least one of the following comorbidities (as determined by your physician):
o Coronary heart disease
o Type II Diabetes mellitus
o Hypertension
o Diagnosed sleep apnea
o Gastroesophageal Reflux Disease (GERD)
Ineligibility (not limited to):
• Current drug or alcohol dependency (within 6 months of referral)
• Recent major cancer (life threatening, within last 2 years)
• Untreated or inadequately treated psychiatric illness
Metabolic syndrome
3 of the following:
• High blood pressure (≥ 130/85 mm Hg, or receiving medication)
• High blood glucose levels (≥ 5.6 mmol/L, or receiving medication)
• High triglycerides (≥ 1.7 mmol/L, or receiving medication)
• Low HDL-Cholesterol (< 1.0 mmol/L in men or < 1.3 mmol/L in women)
• Large waist circumference (≥ 102 cm in men, 88 cm in women; ranges vary according to ethnicity
Recommendation obesity
- For adults who are obese (30 ≤ BMI < 40) and are at high risk of diabetes, we recommend that practitioners offer or refer to structured behavioural interventions aimed at weight loss: 1 year, focus on diet, physical activity and lifestyle changes, self-monitoring, goal setting, group and individual sessions, technology based components (Strong recommendation; moderate quality evidence)
- For adults who are overweight or obese, we recommend that practitioners offer or refer to structured behavioural interventions aimed at weight loss. (Weak recommendation; moderate quality evidence)
- For adults who are overweight or obese, we recommend that practitioners not routinely offer pharmacologic interventions (orlistat or metformin) aimed at weight loss. (Weak recommendation; moderate quality evidence)
