Eating disorders

Question 1

Eating disorders

Answer 1

Eating disorders- a range of serious disorders characterised by disordered eating behaviour

• What starts as a mental health concern, can quickly deteriorate into a physical health concern.
• If left, eating disorders can severely impact upon both short term and long term health and wellbeing.
• Eating disorders are most common between the ages of 16-40.

Question 2

The THREE types of clinical eating disorder:

Answer 2

• Anorexia nervosa.
• Bulimia nervosa.
• Other specified feeding or eating disorders (OSFED)
  – Orthorexia.
  – Compulsive eating.
  – Binge eating.
  – Night eating syndrome.

Question 3

Causes and risk factors

Answer 3

• Media focus on physical appearance and body image.
• Academic pressure
• Bullying and abuse.
• Criticism for body shape or eating habits.
• Difficult family relationships.
• Sports where being light is an ideal, such as ballet, gymnastics, ice skating and dancing.
• Genetic factors:
  – SNPs
  – Family history of eating disorders.
• Nutritional deficiencies
• Prone to depression, anxiety and worry, poor
  stress resilience and OCD tendencies.
• Perfectionism and need for control

Question 4

Anorexia nervosa (AN)

Answer 4

Anorexia nervosa (AN)- an eating disorder characterised by abnormally low body weight, a fear of gaining weight and a distorted perception of weight / body image.
* It accounts for 10% of all eating disorder cases.
* Onset is normally in adolescence or early adulthood.
* Of those with AN, 50% ‘recover’, 30% improve, 15% remain chronically ill, 5% die from complications and suicide.
* Males now account for 25% of reported anorexic cases and are at a higher risk of death, as they are often diagnosed later.

Question 5

AN: Signs and symptoms - behavioural

Answer 5

• Strict dieting excessive calorie counting
• Avoidance of all fats in food
• Opting for vegetarian / vegan diet to easily remove foods groups
• Purging, hiding food and lying about food eaten
• Over-exercising to compensate for kcal eaten
• Controlling appetite by excessive water intake or use of appetite suppressants
• Becoming socially isolated, esp. around mealtimes

Question 6

AN: Signs and symptoms - physical

Answer 6

• Lack of energy and muscle atrophy
• Poor concentration and focus
• Lightheadedness, dizzy spells
• Constipation, bloating, abdominal pain
• Growing soft, fine hair on body and face. Head hair falling out
• Lower body temperature Low blood pressure.
• Increase in anxiety and poor stress resilience
• Amenorrhoea

Question 7

AN: Concomitant symptoms / complications:

Answer 7

• Gut dysbiosis and low HCL levels.
• Food intolerances.
• Low absorption capability.
• Reproductive problems and menstrual irregularities.
• Poor immunity.
• Dentition problems.
• Anaemia and low mineral levels.
• Anxiety and depression.
• Poor skin, hair and nails.
• Reduced bone mineral density (osteopenia / osteoporosis).

Question 8

Two sub types of anorexia

Answer 8

Restrictive
Binge-purge

Question 9

AN: Clinical diagnosis

Answer 9

• Intense fear of gaining weight / a healthy
• BMI 17.5 or under
• Body dysmorphia.
• Denies weight is an issue.

Question 10

AN - Diagnosis
when to suspect an eating
disorder

Answer 10

• Wearing baggy clothing
• Angular cheilitis iron, B12, B2 deficiencies.
• Dark circle under the eyes iron deficiency and kidney Qi depletion.
• Pallor or yellowing to skin tone anaemia

Question 11

Zinc

Answer 11

• Confusion
• Loss of appetite and motivation
• Depression
• Slow growth and development
• Emotional instability
  *Recurrent infections; slow wound healing
• Low stomach acid

Question 12

Magnesium deficiency

Answer 12

• Irritability / agitation
• Constipation
  *Insomnia / sleep disorders
• Depression

Question 13

Tryptophan deficiency

Answer 13

• Anxiety, low mood, insomnia
  Bowel irregularity

Question 14

Protein deficiency

Answer 14

• Fatigue and weakness
• Poor hair, skin and nails

Question 15

Omega-3 deficiency

Answer 15

• Depression / mental fatigue
• Dry skin

Question 16

B vitamin deficiency

Answer 16

• Anxiety and depression
• Confusion and irritability
• Poor concentration and memory
• Poor stress resilience

Question 17

Anorexia: Therapeutics

Answer 17

Zinc - enhances recovery rate
Probiotics - increase in immune markers
L-arginine - CVD protective
– Anxiolytics, e.g., passionflower, chamomile, ashwagandha.
– Serotonin support
- Bach flowers

Question 18

Bulimia

Answer 18

Bulimia, also called bulimia nervosa, is a disorder in the eating disorder
spectrum:
* Bulimia is characterised by episodes of secretive
excessive eating (bingeing) followed by inappropriate
compensatory methods of weight control ; such as
self induced vomiting (purging), abuse of laxatives and diuretics, or excessive exercise to prevent weight gain.
* There is a sense of lack of control during a feeding episode.
* Subtypes: Purging (vomiting / laxatives / diuretics / enemas) and non purging (fasting / excess exercise).
* The diagnostic criteria states that binge eating and compensatory
behaviour occur on average at least twice a week for 3 months.

Question 19

BN: Clinical signs and symptoms

Answer 19

• Most often normal weight to slightly overweight.
• Binge eating large amounts of food.
• Often follows anorexia or previous episodes of dieting.
• Associated depression, anxiety and tension.
• Periods of fasting and / or laxative abuse.
• Erratic menstrual periods.
• Frequent weight changes.
• Disappearing to the toilet after meals.
• Periods of relapse and episodic purging.
• Sore throat, tooth erosion and swollen parotid glands.
• Reluctance to socialise where food is involved.

Question 20

BN: Causes and risk factors

Answer 20

• Personality types that are more giving and passive.
• Jobs which demand weight control or place people near food.
• Shift working.
• Increased alcohol consumption.
• People with glucose intolerance and food intolerances.
• People with low esteem coupled with poor body image.
• Obesity or perceived obesity of specific body parts.

Question 21

Harm minimisation

Answer 21

• Encouraging the use of bicarbonate soda mouth wash after vomiting to reduce dental problems and acid reflux problems.
• Wean clients off laxative use and diuretic use and dispel the myths of use.
• Being aware that often substance abuse (alcohol and drugs) can often go hand in hand with bulimia and refer if necessary to support groups or other professionals.

Question 22

Binge Eating Disorder (BED)

Answer 22

Binge eating disorder = similar to bulimia.
* They don’t use dangerous weight loss methods ― purging / laxatives / extreme dieting
* Most do not seek medical help, unless for obesity
― unlike BN sufferers, those with BED are typically overweight.
* If a BED client presents for weight loss as they are obese, they will need extra support to address the bingeing. You can work with them in tandem with a mental health professional or refer your client to a programme such as Overeaters Anon (OA).
*
It is thought that 10 to 15% of mildly obese people enrolled
in weight loss programmes have BED.

Question 23

BED: Clinical presentation

Answer 23

• Discreet episodes of rapid and excessive food consumption not necessarily driven by hunger or metabolic need.
• Individuals will eat until they feel uncomfortably
  full and may or may not use compensatory
  behaviours for them, such as self induced vomiting.
• Binge eating is often accompanied by feelings of
  loss of control and psychological distress.
• Not surprisingly, overweight and obesity, together with the associated physical and psychological health
  concerns, are commonly comorbid with binge eating.

Question 24

BN and BED: Therapeutics

Answer 24

Protein -enahnce recovery time
Tryptophan - correct depletion
Inositol - increases serotonin receptor sensitisation