Eating Disorders

Question 1

What is considered as “obese”?

Answer 1

20% over ideal weight (BMI > 30)

Question 2

What is the etiology of obesity?

Answer 2

• Genetics - LeptinR mutation or Melanocortin 4 R mutation
• Iatrogenic - Drugs
• Lifestyle - Sedentary, Dependence on Cars

Question 3

What are the options for obesity management?

Answer 3

• Surgical - bariatric, gastric
• Pharm - Amphetamines, Orlistat (lipase inhibitor), Topiramate and Zonisamide (anticonvulsants)
• Realistic Diet/Exercise

Question 4

What are the criteria for Anorexia Nervosa?

Answer 4

• Refusal to maintain 85% typical weight
• Restriction of food intake
• Fear of gaining weight
• Body image disturbance
• Missed menstrual cycle x3

Question 5

Difference between classic and binge-purge anorexia nervosa

Answer 5

Class only restricts (does not eat); Binge-purge - binges and purges

Question 6

When does anorexia generally start? What is the ratio of women to men? What is the typical personality profile of a person with anorexia?

Answer 6

Mid teens - 20s; 20:1; Rigid/controlling and high achieving

Question 7

What are possible etiologies of anorexia nervosa?

Answer 7

Genetics (Twin/sibling studies), Family mood/drug disorders, NE imbalance (low), Endogenous Opiate imalance (high)

Question 8

Comorbidities of AN?

Answer 8

Depression, Suicide

Question 9

Medical consequences of AN

Answer 9

• Weight loss
• Hypothermia
• Bradycardia
• Amenorrhea
• Electrolyte imbalance
• ST, T, QT cardiac changes
• Lanugo hair
• Osteoporosis
• Delayed gastric emptying (slowed motility)
• Organ failure

Question 10

Tx for AN

Answer 10

• Acute: restore nutritional state
• forced tube feedings
• firm consistency
• behavioral plan

Question 11

What precautions would you undergo for an AN patient in the hospital

Answer 11

Inaccessible bathrooms so that they can’t hide food or purge

Question 12

PsychoTx for AN patients?

Answer 12

• CBT most commonly used
• Psychodynamic
• Family

Question 13

Medications for AN?

Answer 13

SSRIs and possibly ECT if depressed; Weight gain cocktails

Question 14

What is Bulimia Nervosa? Subtypes?

Answer 14

REcurrent binge eating; Purging vs. Non-purging

Question 15

Criteria for Bulimia Nervosa?

Answer 15

Recurrent binge eating with feelings of loss of control and compensatory behaviors such as vomiting, laxative use, enemas, diuretics, exercise

Question 16

At what frequency must a person binge for BN Dx? What is necessary for Dx?

Answer 16

2x/wk for 6 months; Compensatory Behavior (purge, exercise, etc)

Question 17

What is more common? AN or BN?

Answer 17

BN

Question 18

What is the ratio of women to men for BN?

Answer 18

10:1

Question 19

What is Russel’s Sign?

Answer 19

Bruises on the fingers/hand from forced vomiting

Question 20

What is the etiology of BN?

Answer 20

Later onset, 40% of college women, patients experience more personality disorder and substance abuse, more addiction/anxiety

Question 21

What are medical findings of BN?

Answer 21

Poor oral hygiene, Russell’s Sign, Normal/Overweight, Sexually active, Lab change trifecta (Low PO4, Mg; High amylase); salivary enlaragement and esophageal tears

Question 22

What has a better course? AN or BN?

Answer 22

BN - 50% improvement in most patients

Question 23

What Tx is used for BN?

Answer 23

• CBT mostly, Pdynamic
• SSRI

Question 24

What is Avoidant/Restrictive Food Intake Disorder?

Answer 24

Failure to meet dietary/energy needs but does not meet AN criteria

Question 25

What is Binge Eating Disorder?

Answer 25

Binging with lack of control for 2x/wk for 6 months without compensation activities

Question 26

What is PICA?

Answer 26

Eating non-nutritive substances for > 1 month

Question 27

What is rumination?

Answer 27

Repeated regurgitation and re-chewing of food, occurs before 6 yo