Eating Disorders Flashcards by Cierra Pennal

Anorexia Nervosa epidemiology

Predominately Female → >90%
0.5 – 1.0% lifetime prevalence in the USA
Lowest of the eating disorders, but the deadliest
Bimodal peaks in adolescence
12-15 yo
17-21 yo
Median age of onset = 17 yo

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Anorexia Nervosa is a disease of

self-perception

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Anorexia Nervosa Early warning signs

Persistent dieting
Arrest in weight gain during puberty
Social isolation: Fear eating in public
Compulsive exercise
Preoccupation with Thinness & body image, Food
Frequently involved in food prep or
related professions

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Anorexia Nervosa
Clinical Presentation(s)

Typically, brought in by a loved one
concerned about malnourishment
&/or perceived severe weight loss
Pre-menarchal girls upon review of
height/weight chart progress
Persistent food restriction

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Average length of history at
presentation of anorexia nervosa is ___

5 years

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T/F Amenorrhea is required for a diagnosis of Anorexia Nervosa

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Anorexia Nervosa Screening (SCOFF)

S: Do you make yourself Sick because you feel uncomfortably full?
C: Do you worry you have lost Control over how much you eat?
O: Have you recently lost Over 10 lbs in a 3 month period?
F: Do you believe yourself to be Fat when others say you are too thin?
F: Would you say that Food dominates your life?

2 or more positive answers suggest eating disorder

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Anorexia Nervosa
Physical Exam

Gen: cachexia, ↓ vital signs,
hyperactivity despite malnutrition
HEENT: (Hx of vomiting)
Skin - Dry skin, lanugo hair, yellow skin, signs of self harm, hair pulling
CV: Bradycardia, Hypotension

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Anorexia Nervosa specific types

Binge-eating/purging type
Restricting type

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Anorexia Nervosa
Diagnosis by BMI severity

Mild: BMI ≥ 17 kg/m2
Moderate: BMI ≥ 16-16.99 kg/m2
Severe: BMI ≥ 15-15.99 kg/m2
Extreme: BMI < 15kg/m2

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Anorexia Nervosa
Diagnostic Testing

HCG in ♁ patients with
amenorrhea

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When to hospitalize in anorexia nervosa

Weight is < 75-85% of ideal body weight &/or if patient is unstable &
decompensating
Complications: electrolyte abnormalities, arrhythmias, acute food refusal, failed out pt. therapy, hematemesis, suicidal ideation, acute mental status change

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Weight at which normal menses resumes

~90% of avg BMI

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Tx recommended for Anorexia Nervosa

Cognitive behavioral & Family Therapy
Aids in maintaining healthy weight
(once restored) & healthy eating
Long term tx recommended
1 year

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Cautions in refeeding syndrome

Hypophosphatemia
Hypomagnesemia
Hypocalcemia
Fluid Retention

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Diet treatment goals in Anorexia Nervosa

Follow strict protocols
30-40 kcal/kg/day
Goal= 2-3 lbs/week (In pt.)
Goal= 0.5-1 lbs/week (Out pt.)

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Refeeding Syndrome (Explain)

Slide 24

Anorexia Nervosa
Medication usage

Medication is most likely to be benefit comorbid psychiatric illness

Complications of Anorexia Nervosa

Metabolic disturbances
Hypokalemia
Hypophosphatemia
Endocrinopathy
Hypothermia
Cognitive changes secondary to cortical
gray matter loss
Comorbid Major Depression
Infertility
Delayed physical growth & development

~___% of pts with a restriction pattern of AN convert to a binge eating/purging pattern & meet criteria for Bulimia Nervosa

What if the patient meets the diagnostic criteria for anorexia nervosa
* except for the weight criterion?
* or who do not have amenorrhea?

EATING DISORDER, NOT OTHERWISE SPECIFIED (NOS)
Care plan should be similar to those with DSM-5 diagnosable anorexia nervosa

Bulimia Nervosa

Eating disorder characterized by
* Repetitive binge eating
* During which there is a sense of loss of control
* & compensatory behaviors (purging) to prevent weight gain

Bulimia Nervosa Epidemiology

Usually, normal weight
Less commonly-overweight

Bulimia Nervosa HPI/PMH

May c/o bloating, fatigue, constipation,
abdominal pain, swelling of hands or
feet, irregular menses
Most pts have comorbid mood d/o
Minority of pts have comorbid personality d/o

Binge episodes

Large amount of calories, discreet time frame * Excessive food for the situation or considered excessive by the patient * Ie. ~2000-3000 kcal/40 min

Triggers for purging

dysphoric mood, interpersonal stress, dietary restraint with ensuing hunger pangs, or dissatisfaction with body shape or size

Bulimia Nervosa Psychological Testing

Bulimia Nervosa Psychological Testing * Eating Disorders Inventory (paid) * Eating Attitudes Test * Both helpful in monitoring response to treatment, but not required to make the diagnosis

Bulimia Nervosa Physical Exam: HEENT

* Teeth may be discolored or changed in shape * Dental enamel may be eroded 2° recurrent vomiting * Salivary & parotid glands may be enlarged

Bulimia Nervosa Physical Exam: Extremities

* Calluses on back of hands (Russell's sign) - 2° inducing vomiting * Edema of extremities may be present in patients abusing laxatives or diuretics

Bulimia Nervosa Testing:

Consider electrolytes * Hypochloremia (secondary to vomiting HCl -) * Hypokalemia (secondary to vomiting HCl -) * Hypophosphatemia (secondary to laxative abuse/chronic diarrhea) * Hyponatremia (secondary to laxative abuse/chronic diarrhea) * Metabolic acidosis (secondary to laxative abuse/chronic diarrhea) * ECG

Bulimia Nervosa Complications

* Dental erosions * Fluid & electrolyte imbalance * Loss of gag reflex * GERD * Esophageal tears/perforation * Arrhythmias * Edema * Amenorrhea

Most common eating disorder in the United States

Binge-Eating Disorder

Binge-Eating Disorder Epidemiology

* Women > Men (3:1) * Early 20s age of set (median = 21 yo) * Can present in childhood

Binge-Eating Disorder Etiology and risk factors

* Eating to cope with stress * Depression * ↑ impulsivity * Emotional dyregulation Risk Factors: * Family history * Black, Hispanic, Asian Americans * Eating, weight, & shape concerns by age 14

T/F Patients are typically ashamed of their binging & attempt to conceal symptoms

Binge-Eating Disorder Fam Hx/Social Hx

* Family history of obesity or eating disorder * Substance-use d/o * Frequent comorbitiy of binge-eating disorder * CAGE Questionaire or AUDIT-C (←Links)

Binge-Eating Disorder screening tool

Binge Eating Disorder Screener-7 (BEDS-7)

First question on BEDS-7

1. During the last 3 months, did you have any episodes of excessive overeating (i.e., eating significantly more than what most people would eat in a similar period of time)? * Yes or No *NOTE: IF “NO” TO QUESTION 1, STOP. THE REMAINING QUESTIONS DO NOT APPLY

Mifflin St. Jeor Equation (Replaces Harris-Benedict Equation)

For men: BMR = 10 x weight (kg) + 6.25 x height (cm) – 5 x age (years) + 5 For women: BMR = 10 x weight (kg) + 6.25 x height (cm) – 5 x age (years) – 161 Calculate Basal Metabolic Rate

Binge-Eating Disorder Diagnosis (DSM-5 criteria) - Specify current severity

* 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

Binge-Eating Disorder Management

* Referral to a specialized in-patient eating-disorders center can be helpful * Typically, can be treated outpatient * Cognitive-Behavioral Therapy, Interpersonal Therapy & Dialectical Therapy all appear effective * Consider Psychology/Psychiatry referral, especially in refractive cases * Fluoxetine (Prozac®) or other SSRIs * Lifestyle modification * Pharmacological management (weight loss medications - Semaglutide)