day 2 - eating disorders

Question 1

Anorexia nervosa (AN) characterised by:

Answer 1

A refusal to maintain a normal body weight
Self-starvation
Disturbed perception of weight and shape
An intense fear of becoming fat or overweight.

Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) .

Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight).

Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Question 2

Subtypes of Anorexia nervosa

Answer 2

Restrictive sub-type
Food restriction
Exercise

Bulimic sub-type
Bingeing
Vomiting
Laxative or diuretic abuse

Question 3

diagnostic features of bulimia nervosa

Answer 3

Recurrent episodes of binge eating characterized by BOTH of the following:

Eating in a discrete amount of time (within a 2 hour period) large amounts of food.

Sense of lack of control over eating during an episode.

Recurrent inappropriate compensatory behaviour in order to prevent weight gain (purging).

The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 4

Anorexia Nervosa, Management in Primary Care

Answer 4

Detection

• Presentation with weight loss, amenorrhoea, growth failure
• Avoid extensive medical investigations

Self-help

Monitoring
- Monitor physical and mental state, encourage weight gain and support the family
- BMI: wt/ht2: AN <13
Referral: Inadequate progress or high risk

Question 5

Specialist Management AN

Answer 5

Individual therapy

• Cognitive Behavioural Therapy (CBT)
• Specialist supportive Clinical Management

Family Therapy and carer support

Day care

• Group therapy
• Meals
• Monitoring and management

In-patient treatment

• Supervised diet
• Naso-gastric feeding… The MHA…

Question 6

physical monitoring in anorexia nervosa

Answer 6

BMI – but beware falsification
Muscle strength: use SUSS test (SitUpSquatStand)
Core temperature
Bloods: U and E, FBC, CK, LFTs
ECG: ST and T changes, prolonged QTc (>450ms), arrhythmias

Question 7

the most effective intervention for obesity

Answer 7

Cochrane review  (Campbell et al, 2001) found the 
most promising intervention to be a simple reduction in 
sedentary  behaviours.

Question 8

Bariatric surgery effectiveness in adults

Answer 8

Gastric Banding

• Excess weight lost at 5 yrs 61%
• Metabolic syndrome = 60% preop  13% at 7 yrs
• 60% good outcome, 33% needed band removed

Gastric bypass

• More extensive and irreversible op
• Excess weight loss at 2 yrs 66%
• Restricts and bypasses. Affects satiety hormones

Sleeve gastrectomy
- Restrictive

Long term effectiveness of Bariatric surgery is coming under scrutiny

Question 9

If you are due to see a patient with severe AN, Consult…

Answer 9

Consult MARSIPAN:
Google MARSIPAN and anorexia
(+junior MARSIPAN for <18)