Eating Disorders

Question 1

What is an Eating Disorder?

Answer 1

Umbrella term for a group of mental health disorders (MHDs) characterised by negative beliefs about eating, body shape and weight accompanying behaviours including restricted eating, binge eating, excessive exercise, vomiting and laxative/diuretic use.

Question 2

Which sex do EDs generally affect?

Answer 2

Females (3:1)

Question 3

What is a MUST score?

Answer 3

Malnutrition Universal Screening Tool (MUST) used as a rapid nutritional assessment tool screening for nutritional risk and dietetic involvement

Question 4

What are the categories in a MUST score?

Answer 4

BMI (0-2): >20 / 18.5-20/ 18.5 >

Weight loss (0-2): < 5%/ 5-10%/ > 10%

Acutely unwell (0 or 2): Yes or No

Question 5

What are the risk categories are there for the MUST assessment?

Answer 5

Low Risk (0)

Medium risk (1)

High Risk (2≤)

Question 6

What is the definition of weight loss?

Answer 6

Loss of 5% body weight over 6 months

Question 7

When communicating with Adolescents, what key features do you aim to obtain in a Social History?

Answer 7

Home
Education + Employment
Eating 
Activities + hobbies 
Drugs (Alcohol + Tobacco)
Sex 
Self-harm + self-image
Safety

Question 8

What is Avoidant-Restrictive Food Intake Disorder?

Answer 8

Eating disorder characterised by lack of interest in food, fears of negative consequences of eating and selective eating with 1 Sx ≤ weight loss, nutritional deficiency, supplement dependency and interference with psychosocial functioning.

Question 9

Give 3 Sx and S of ARFID?

Answer 9

• Selective eating (fussy eating)
• Fear of negative consequences of eating
• Dependence on nutritional supplements

• Weight loss

Question 10

Give the Tx for ARFID?

Answer 10

• Family-based therapy
±
• Nutrition

Question 11

What is Anorexia Nervosa?

Answer 11

Eating disorder characterised by caloric intake restriction leading to low body weight, intense fear of gaining weight, body dysmorphia

Question 12

What is the Sx Triad for Anorexia Nervosa?

Answer 12

Weight + Fear + Body dysmorphia

Question 13

Give 5 Sx and S of being Anorexic

Answer 13

• Low body weight: ≤ 18.5 kg/m2
• Fear of gaining weight
• Disturbed body image (body dysmorphia)
• Calorie restriction
• Purging (behaviours to counteract food): Psychogenic vomiting; Diet pills; Laxatives; Diuretics)
• Fatigue
• Poor concentration
• Amenorrhoea
• Loss of libido
• Orthostatic hypotension
• Non-specific GI: Constipation/Fullness/Bloating/Cramping gas
• Cardiac Sx: QTc prolongation/1st degree AV heart block; T-wave changes
• Decreased SC fat
• Lanugo
• Cracked nails
• Hair thinning

Question 14

The presence of hair growth due to nutritional deficiencies in Anorexia nervosa is termed?

Answer 14

Lanugo

Question 15

How do you diagnose Anorexia?

Answer 15

Clinical Diagnosis –> SCOFF Qs (Sick/Control/One Stone/Fat/Food)

Question 16

What is the Tx for Anorexia Nervosa?

Answer 16

• Nutritional Rehabilitation: Dietary assessment; Balanced meal plan (1500-1800kCal); Fluid intake; Vitamin + Mineral replenishment (+ monitoring)
±
• Psychotherapy: Counselling/CBT

+ (Medically unstable/outpatient failure)
• Admission: Oral/Enteral/Parenteral nutrition
±
• Fluid intake correction
±
• Potassium Repletion: 40-100mEq PO OD or IV PRN
-> KCl
±
• Magnesium Repletion: 10-20mmol IV OD
-> Mg(SO4)2
±
• Calcium Repletion: 100-1000mg IV every 6 hours
-> Calcium gluconate
±
• Sodium Repletion: Fluid restriction + balanced nutrition/ Hypertonic Saline (if severe Sx – seizures; confusion; coma)

+ (Depression)
• SSRIs: Fluoxetine/Sertraline

+ (OCD)
• CBT
• SSRIs: Fluoxetine/Sertraline

Question 17

What is Bulimia Nervosa?

Answer 17

Eating disorder typified by recurrent episodic binge eating in conjunction with compensatory purging behaviours (– psychogenic vomiting; fasting; excessive exercise; misuse of laxatives; diuretics; enemas or other medication), lasting at least weekly for 3 months.

Question 18

Give the Sx + S of Bulimia Nervosa

Answer 18

• Recurrent episodic binge eating: Discrete period time + ≥ Normal intake – speed/amounts/fullness/cephalic/embarrassed/guilty
-> At least 1 week-1 over 3/12
• Purging behaviour: Psychogenic vomiting/Laxatives/ Enemas/ Suppositories
• Compensatory behaviour: Fasting/ Excessive exercise
• Body dysmorphia: Weight/Shape-conscious
• Depression: Persistent low mood + Anergia + Anhedonia
• Menstrual irregularity
• Misuse of insulin
• Self-harm
• GI Sx: GORD/Diarrhoea/Constipation/Abdominal pain

• Dental erosion: Abrasive food/ HCl/ Night-grinding
• Russel Sign: Calluses on dorsum of hand from psychogenic vomiting
• Parotid hypertrophy
• Arrhythmia

Question 19

Give the Tx for Bulimia Nervosa

Answer 19

• Nutritional Rehabilitation: Dietary assessment; Balanced meal plan (1500-1800kCal); Fluid intake; Vitamin + Mineral replenishment (+ monitoring)
±
• Psychotherapy: CBT -> x9 20 min support sessions over 16/52

+ (Depression)
• SSRI/SNRI: Fluoxetine/ Sertraline/ Venlafaxine
-> Fluoxetine 1st; Sertraline tolerated best; Venlafaxine for rapid onset

Question 20

What is Binge Eating Disorder?

Answer 20

Eating disorder characterised by regular, episodic binge eating which may be planned and commonly leads to weight gain.

Question 21

Give the Sx + S of Binge Eating Disorder

Answer 21

• Impulsivity: Buying large quantities/Eating rapidly/Eating when not hungry
• Obsession: Organising life around food/ Eating when not hungry/ Time talking about food
• Asocial behaviour: Eating in isolation
• Irritability
• Mood lability: Mood swings
• Low self-esteem/confidence
• Co-morbid MHDs
• Tiredness
• Fatigue
• Weight gain
• Bloating
• Constipation
• Abdominal pain