Eating Disorders

Question 1

Describe the characteristics of Anorexia Nervosa

Answer 1

Morbid fear of becoming fat

weight loss

Food restriction - may or may not be facilitated by other behaviours such as excessive exercise, purging

Pursuit and maintenance of low body weight - can be accompanied by rigid/ritualistic behaviours (safe vs. forbidden foods)

Question 2

Describe some of the “rituals” of anorexia nervosa

Answer 2

Long period of time to prepare and eat foods
Consumed in an unusual fashion (ex. in a specific order)
not wanted to eat in front of others
hiding food
giving food away - often want to cook food for others

Question 3

What are the two types of Anorexia Nervosa?

Answer 3

Restricting Type

Binge-eating/purging type

Question 4

What are the two types of Bulimia Nervosa?

Answer 4

Purging and non purging type

Question 5

What are the characteristics of Bulimia Nervosa?

Answer 5

Often at or above normal weight
Food takes on a symbolic meaning - sadness, frustrating, disappointment etc.
Purging becomes addictive - releases anxiety

Question 6

What are the dermatologic complications of Anorexia nervosa and Bulimia nervosa?

Answer 6

Can develop skin rashes due to micronutrient deficiencies - anorexics can have lanugo hair

Question 7

What are the GI complications of Anorexia nervosa and Bulimia nervosa?

Answer 7

If there are no nutrients going through, cells can atrophy

Question 8

What are the Cardiovascular complications of Anorexia nervosa and Bulimia nervosa?

Answer 8

Low potassium levels can cause heart attacks

Question 9

What are the renal/electrolyte complications of Anorexia nervosa and Bulimia nervosa?

Answer 9

Electrolyte disturbances, lose a lot of electrolyte in the vomit

Question 10

What are the metabolic complications of Anorexia nervosa and Bulimia nervosa?

Answer 10

Down regulated REE

Question 11

What are the Musculo-skeletal complications of Anorexia nervosa and Bulimia nervosa?

Answer 11

Loss of lean body mass and bone health - poor dentition due to vomiting

Question 12

What is refeeding syndrome?

Answer 12

In a starvation state, insulin levels drop. Once CHO is reintroduced into the diet, insulin can surge and result in the increased uptake of CHO in the cell and along with it, potassium through ATPase pumps

If fed too quickly, can result in hypokalemia/phosphatemia which can kill patients

Question 13

What are some of the physiological changes that can result due to refeeding syndrome?

Answer 13

Increased serum glucose
Electrolyte disturbances
Vitamin depletion
Sodium and water retention

Question 14

What are the clinical manifestations of refeeding syndrome?

Answer 14

Edema
nausea
Vomiting
Lethargy
Respiratory and cardiac problems

Question 15

What are the risk criteria for refeeding syndrome?

Answer 15

If the patient has 1 or more of the following:
BMI less than or equal to 16
Unintentional weight loss of greater than 15% in the last 3-6 months
Little or no intake
Low serum K, PO4, Mg before refeeding

Question 16

What should you assess in patients at high risk of refeeding syndrome?

Answer 16

K
Na
Urea
Creatinine
Ca
Mg
PO4
Glucose

Question 17

What are the feeding strategies for at risk to high risk refeeding patients?

Answer 17

Start feeds at approximately 20 kcals/kg (or 1000kcals)
Advance to goal over 5-7 days

Question 18

Describe the pharmacological treatment model for AN/BN.

Answer 18

Targets destructive behaviours that can be reduced through medication such as anti anxiety/anti-depressants

Belief that some disorders are are a result of neurochemical imbalance

Question 19

Describe the addiction model for BED.

Answer 19

Belief that individuals with BED are addicted to physiological and/or psychological feelings associated with uncontrolled eating

Trigger foods are identified and excluded from the diet - similar to substance abuse therapy

Question 20

What is binge eating disorder?

Answer 20

Recurrent episodes of binge eating in the absence of regular use of inappropriate compensatory behaviours characteristic of bulimia nervosa (basically eating but not purging/fasting/exercise)

Characterized by both:
huge volume of intake in a short period of time
Sense of lack of control during the episode

Binge occurs on average, at least 1 day/week for 3 months

Question 21

What are the characteristics of BED?

Answer 21

Individuals with BED:
Have various levels of obesity
Have a long history of dieting
Feel desperate about their problems with controlling eating beahviour
Have low levels of energy expenditure
May engage in BED with smoking cessation

Question 22

What are some of the treatments of BED?

Answer 22

CBT
Nutritional rehab
medications including antidepressants, appetite suppressants and anticonvulsants

Question 23

What are the 4 components of treatment for Eating Disorders

Answer 23

Medical treatment
Nutritional Rehabilitation
Psychosocial Stabilization
Normalization of Eating Behaviours

Question 24

What is the most important component of treating patients with ED?

Answer 24

Complications of starvation/binging/purging must be treated FIRST before the psychological piece
Therapy comes second, RDs are the first people patients will see

Question 25

What are some guidelines when figuring out the new weight setpoint/range?

Answer 25

Pre-morbid weight or UBW
BMI ideally at a minimum of 20
Menstrual threshold weight + 7-10%

If adolescents - use growth charts:
Pre-morbid weight + expected weight gain for age
BMI for age
BMI of 19 or higher

Question 26

How do you increase the calories of ED patients?

Answer 26

Start at 25-30 kcal/kg but eventually may need 70-100 kcal/kg

Advance by 300 kcal increments every few days for goal weight gain rates of:
1-1.5 kg/week for meal program patients
0.5-1kg/week for outpatients

Question 27

What are some things to monitor/evaluate in ED patients?

Answer 27

Check serum PO4, K, Mg
Check for edema/rapid weight gain
Assess need for thiamine supplementation
Advance calories slowly
If necessary, change macronutrient content of diet to increase protein and decrease CHO
Is the patient meeting weight goals for recovery?