Obesity and Eating Disorders Flashcards
What is obesity?
- life long, progressive life-threatening, costly, genetically related, multi-factorial disease of excess fat storage with multiple co-morbidities
What is the disease risk associated with the different BMI classifications?
Underweight ( 40) extremely high
What are some of the health consequences with increased risk for overweight and obese individuals
- HTN
- osteoarthritis
- dyslipidemia
- T2DM
- coronary heart disease
- stroke
- gallbladder disease
- sleep apnea and respiratory problems
- cancer (endometrial, breast, colon)
What are the NCEP ATP III characteristics of metabolic syndrome
abdominal obesity glc intolerance/insulin resistance HTN Atherogenic dyslipidemia proinflammatory/prothrombic state
What is the clinical identification criteria of metabolic syndrome (NCEP ATP III)
Risk Factor Defining Level Abdominal Obesity (waist circumference) - Men >102 cm (> 40 in) - Women > 88 cm (> 35 in) TG > or = 150 mg/dL HDL-C - Men < 40 mg/dL - Women < 50 mg/dL BP > 130 / > 85 mm Hg FPG >110 mg/dL *** Diagnosis when 3 or more RF are present
What are the physical, economic, psychological, and social reasons to treat obesity?
- improvements in medical comorbidities
- decrease in mortality and morbidity
- improvement in QOL
Physical: public seating limitations, personal hygiene
Economic: employment and education discrimination
Psychological: low self esteem and depression
Social: Harassment and prejudice
What are the risk factors the can and cannot be modified for obesity?
Cannot be modified: genetic, metabolic, biochemical
Can be modified: behavioral, psychological, environmental
What diet therapy methods are used to promote wt loss?
1) Low calorie diet- Step 1
- 1000-1200 kcal for women, 1200- 1600 kcal for men or women over 165# or regular PA
- decrease to 1200 if not losing wt at 1600 kcal
- if hungry, try inc 100-200 kcal/d
2) very low calorie diet = 800 kcal/d
- not routinely used
What are the physical activity recommendations for obese pts?
- initially moderate levels of PA (30-45 min, 3-5 days/wk)
- start w/10 min, 3 days a week, then build to 30-45 min of more intense walking at least 3 days a week
- *General rule of thumb: 100 kcal/1 mile of running or walking
What is the etiology and dx criteria for Anorexia nervosa?
- etiology: sexual abuse survivors, fraternal twins and 1st degree relatives prone, 90% females
- Dx criteria: BW < 85% IBW
-intense fear of losing control, over wt, becoming fat, distorted
body image, amenorrhea
What are some of the physiological effects of anorexia nervosa?
- hypotension
- dizziness
- dry skin
- decreased bone mineral density
- delayed gastric emptying, constipation
- amenorrhea
- bradycardia
- cardiac arrhythmias
- electrocardiographic abnormalities
- muscle wasting
- cold hands and feet
- acrocyanosis
What is the etiology and dx criteria of bulimia nervosa?
Etiology:
- sexual abuse survivors prone
- fraternal twins and 1st degree relatives prone
Dx criteria:
- binge eating (at least 2x/wk for at least 3 months); may be as much as 5-10x/day
- purging- getting that shit out through laxatives, vomiting, excessive exercise
- obsessive w/ body wt and shape
What is binge eating?
- eating in a discrete period of time (w/in any 2 hr period) an amt of food that is definitely larger than what most people would eat during a similar period of time and under similar circumstances
- a sense of lack of control over eating during the episode
- a feeling that one cannot stop eating or control what or how much one is eating
What are the physiological effects of Bulimia nervosa?
- esophagitis
- gastroesophageal reflux disease
- esophageal tearing
- constipation
- laxative dependence
- callus on back of hand
- loss of dental enamel
- dental caries
- salivary gland enlargement
- syrup of ipecac (active ingredient: Emitine): cardiotoxic, long 1/2 life, accumulate in cardiac muscle, can cause:
- cardiomyopathy
- cardiac arrhythmias
- electrocardiographic abnormalities
What are the subtypes of BN?
- Purging type:
- person regularly engages in self-induced vomiting or misuse of laxatives, diuretics, or enemas
- Nonpurging type:
- person has inappropriate compensatory behaviors
- fasting, excessive exercise, has not purged
- person has inappropriate compensatory behaviors
What is an EDNOS (Eating Disorder not otherwise specified)?
- includes disorders not meeting all criteria for AN or BN
ex. pt met all criteria for AN but still has her period
ex. pt meets all dx criteria for BN but episodes are less than
2x/wk or for less than 3 months - binge eating: EDNOS
- most common dx among people who seek trt
- can be just as serious/harmful as AN or BN
- Characterized by:
- constant concern about food and wt
- restricting food or compensating for eating
- cycles of restrict, binge, purge
What is the treatment for eating disorders?
- Refer on
-psychiatric illness, use of cognitive behavior therapy- modify specific behaviors and ways of thinking that maintain the pt’s disordered eating
- trained RD is key member of health care team
- RD’s role:
- assess nutritional status
- address pt food/nutrition issue and associated behaviors
- monitor pt response to trt
- develop nutrition component of trt plan
- provide ongoing support to pt in accomplishing
goals set out in trt plan
Specific treatment of BN?
- greater likelihood of recovery
- weight restoration not the focus
- goal: normalize eating habits
- 3 meals per day with 1-3 snacks in structured manner
- laxative dependent pt will need education on high fiber and adequate fluids to prevent bowel obstruction
Specific treatment for AN?
- goal: restore BW to at least 90% expected wt
- NS used only in life-saving situations
- be cautious of “refeeding syndrome”
- monitor electrolytes and cardiac status (if wt <70% of expected)
- wt gain goals:
- 2-3 lb/wk (inpatient), 0.5-1 lb/wk (outpatient)
- initial wt gain: 30-40 kcal/kg BW/d
- active wt gain: 40-60 kcal/kg (as high as 70-100 kcal/kg - **EDNOS treatment depends, but most likely similar to AN
