Eating disorders Flashcards
Appearance related concerns
Reaching epidemic proportions in the Western society
Body dissatisfaction can occur from 8 years of age
Females report this phenomena more but…increasing in men
Aspects of appearance that concern
Appearance in general including many aspects of the face which are a source of concern to a range of people
Size of abdomen
Body weight
Poor muscle tone
Possible effects of appearance on young people
-ve
Teasing (peak age to cause upset is 7-8yr)
Bullying
+ve
If rated attractive likely to get more attention, be the subject of higher expectations of ability, may ‘get away with things more’
Differences and Body shape
Different cultures see things differently e.g. African American children picked bigger ideal body sizes than white children from random sample of children
Social class – In mid 19thC more weight= more wealth!
Perception of attractive body shape has changed over time eg reclining nude in Manet’s painting Olympia seen as “obscene” – not plump enough to be erotic.1863
Treacher Collins Syndrome
Recessive hereditary
Affects ears, eyes, jaws
‘Bird face’
How to measure body fat
BMI
Skinfold thickness
Waist: hip ratio
Dual energy X-ray absorptiometry (DXA)
BMI
weight/height^2 10-20 underweight 20-25 healthy 25-30 overweight 30-40 obese 40+ morbidly obese
Mental Health problems in children
Prevalence of 1 in 10 from 5-16 years
Press attention +++ to poor C & A mental health services
Funding for Child and Adolescent Mental Health Services, CAMHS, has been dropping in real terms
Diagnostic criteria
DSM –IV criteria (Diagnostic and Statistical Manual of Mental Disorders 4th Edn) are the standard signs which are used to assess /define an eating disorder.
Some people may have a partial syndrome and meet some of the criteria
May be associated with borderline personality disorder
The eating disorders
Anorexia nervosa (av duration 8yr but…)
Bulimia nervosa – in the 1970s (av duration 5 yr but..)
Binge eating disorder (BED)
(DSM says AN,BN and Binge Eating Disorder are the main eating disorders )
Not mutually exclusive and may overlap
7% increase in hospital admissions since 2005
Scoff Test
Sick - make yourself because feel full
Control - worry over loss of in relation to food
One - stone lost in 3m
Fat - see yourself as fat when others don’t
Food - dominates life
Designed in Leeds-Score of 2 or more is a +ve screen for an eating disorder
Eating disorder statistics
More common in females but increasingly in males (NICE - approx 11% affected are male)
Develops between 15-25 years, usually
Can occur in children as young as 8 years
Can be accompanied by other problems e.g. drug use, compulsive shoplifting
Why
Peer/ family pressure Media eg very thin models in fashion magazines Stress Genetic component Role of Serotonin Leptin & ghrelin function
Anorexia nervosa in UK
Prevalence: 1:150 15 year old girl 1:1000 15 year old boys ~1% 16-18 year olds affected Afro-Caribbean, Asian, Hispanic women less likely to have weight concerns than white women
Anorexia nervosa
Fear of gaining weight so eat little 15% below weight for height/age BMI <17.5 Body Image dysfunction Denial of low weight If reproductive years - amenorrhoeic for at least 3 months
Medical consequences AN
Starvation and dehydration - circulatory problems, kidney/ heart failure
Long term - stunting of growth, osteoporosis, possibly fertility problems
5% die
General treatment for AN/BN
Cognitive therapy in improving mental health (but W/L) Individual/ group/ psychotherapy Life skills; nutritional advice Drugs In-px care may be neessary
Specific treatment of AN
Aim to attain viable weight Alter feelings about body image/ food (medical view & px's may not coincide) Family therapy for those <16 years In-px care may be necessary 18year+ care - transitional care?
Prognosis AN
50% recover after treatment 30% retain partial symptoms Approximately: 20% become chronic 5% die – starvation, heart failure or suicide AN has one of highest rates of suicide of all psychiatric illnesses
Bulimia nervosa
May be of any weight
Eating pattern:
-binge eating (recurrent) of high calorie food, followed by secret purging
-food hidden in secret places
-use of laxatives and diuretics to control weight fluctuations
BM may also have
Awareness that eating pattern is abnormal
Frequent weight fluctuations > 5Kg
Depression after binge
Binges not due to AN or any other physical condition
Prevalence BN
Female : Male = 20:1 Mainly young people Up to 20% females binge @ some time Anorexia- 0.25% population Bulimia – approx 1%
Medical consequences of BN
GI -cramps, constipation , diarrhoea Electrolyte imbalance Damage oesophageal sphincter, muscles Lower bowel damage Throat ulcers
Oral presentation BN
Dental erosion May have: -dry mouth -inflamed palate -dry, chapped lips -swollen parotid glands
Management of dental aspects
Psychological assess (if not already done)
Preventive advice
Restoration of affected teeth
Provision of occlusal splint if indicated
Dental aspects of BN
Tact and diplomacy
Consider possible sensitivity of teeth
Treatment plan w. SM & X Rays
Prevention
Treat teeth as needed when BN under control
Monitor
-Dentists need further education in the area of ED
Dental erosion - diagnostic criteria
Palatally on upper incisors (often extensive)
Palatal aspects upper posterior teeth “cupping”
Occlusal & buccal surfaces U & L posterior teeth (variable)
“Squeaky clean “ teeth but could have gingivitis
Prognosis BN
Half – two thirds improve a lot
But tends to be a chronic/ remitting condition
Some deaths from inhalation of vomit
Obesity definition
Overweight and Obesity are defined as abnormal or excessive fat accumulation that may impair health
Trends in prevalence of obesity in adults in England
1985 9%
2000 20%
2010 27%
2050 60%
Sugar consumption
1700: 1.8kg of food pa
1800: 8.2kg per head pa
2000: 36.4kg
- should be less than 10% of our daily calorie intake (WHO)
OW and OB rates for adults
41% men, 31% women
Of which 27% OB
OW and OB rates for children
> 20% at four to 5 years
>33% at 11 years
Trend: steep rise OB/OW in 1990s
Gradual slow down until 2010
Since then plateauing
League table of obesity
Small pacific Islands eg Tonga Middle Easter countries (some) 12th USA 19th Trinidad & Tobago 27th UK
Pbesity v TV time
Link between OB and hours of TV time. NICE advises no more than 2hr / day (2015)
Children who watch commercial TV see more food/drink adverts Schmidt M E et al.2012.
Likely to be less active if watch a lot of TV
BMI v caries experience
Caries and OB are multifactorial diseases
Some studies have found an association between caries and OB/OW, some have not.
Danish study – found BMI & caries not associated but high caries risk may be a marker for future risk of OW among more advantaged
Fat v sugar
Is fat better?
Appetite control
Appetite is dependant on an interaction between biology and environment
Environment contains some influential factors which can overcome biological processes operating to maintain body weight eg media influences
Some people have physiological characteristics favouring good regulation body weight
Diabetes prevalence
2000 2.8% prevalence or 171m
2030 4.4% prevalence or 366m. worldwide
Key issue – no. of people > 65 yrs
In developing countries most people are 45-64yrs and in developed most are 64yr+
Management of OW/OB
Long term plans and goals to be approached incrementally Control of diet Behaviour management Regular Exercise Drug treatment Surgery ON-GOING MONITORING & REINFORCEMENT
Cancer
Extra fat produces hormones and growth factors which affect our cells
This can raise risk of cancer (& other diseases)
Exact mechanism not clear
Cancer Ressearch UK has billboards at bus stops etc. saying OB is cause of cancer
Obesity in children
OW = wt:ht>2 standard deviations above WHO child growth standards median
>2/3 obese 10 yr + > obese adults
Calorie dense food available +reduced physical activity > rise obesity
Levelling off in 2014
Disease of deprivation
More OB in urban than rural areas
Drug treatment of obesity if BMI>30
Can kick start weight loss but poor compliance
Only licensed drug is Xenical + side effects!
Short term use only ( poor fat absorption)
Can lose 10% body weight in 6m
Surgical treatment of obesity in UK
2m in UK eligible
BMI > 40 or 35 if co – morbidities
Restriction &/or Malabsorption
Sleeve gastrectomy – remove ¾ of stomach R)
Gastric bypass – staple stomach/duodenum & some of small intestine; for “nibblers”(R & M)
Cost of above £8-10,000 but….
Recent press releases
Jamie Oliver ‘obese poor think in a different gear’
Fasting diets - are they better?
Will the NHS ban sugary drinks from hospitals
Effect of increasing levels OW/OB on dental care
More diabetic patients, (periodontal problems, care with appointment times)
Cardio – vascular disease (anti coagulants, high BP
Arthritis (mobility problems)
More chronic periodontal disease to treat
Increased caries ?? Decreased stimulated salivary flow rate
Bariatric equipment may be needed
Increased GA & sedation risk
Setting an example
OW health care workers
- Slimmers World
- diet advice
- dance classes
Drug treatment of obesity if BMI >30
Can kick start weight loss but poor compliance
Only licensed drug is Xenical + side effects
Short term *cat ch up on slide
