Week 2: Eating disorders Flashcards
What is an eating disorder?
Persistent disturbance of eating that significantly impairs health or psychosocial functioning
There are three broad categories:
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
People often shift between types over time
Characterised by severe disturbances in eating behaviour and excessive concern about body shape or weight
What is anorexia nervosa?
Restricting food intake leading to low body weight
•Intense fear of fatness/gaining weight
•Severely disturbed body weight and shape
•Low body weight achieved by restricting food intake or purging (e.g. vomiting, laxatives)
What is bulimia nervosa?
Recurrent episodes of binge eating
•Followed by behaviours to compensate to prevent weight gain (e.g. vomiting, misuse of laxatives)
•Occurring, on average, at least once a week for three months
•Self-evaluation unduly influenced by body shape and weight
Note. A binge eating episode is not the same as overeating, it is defined as eating unusually large amounts of food in a specific amount of time, such as over a 2-hour period, and more than what other people would consider a normal amount of food.
What is the diagnostic criteria for bulimia nervosa?
•Recurrent episodes of binge eating, associated with three or more of the following:
eating much more rapidly than normal
eating until feeling uncomfortably full
eating large amounts of food when not feeling physically hungry
eating alone because of feeling embarrassed by how much one is eating
feeling disgusted with oneself, depressed or very guilty afterward
•Severe emotional distress about binge eating
•Occurs, on average, at least once a week for three months
•Binge eating not followed by compensatory behaviours
What is the sub- threshold?
- People experiencing feeding and eating behaviours that cause clinically significant distress or impairment but do not meet the full criteria for any other eating disorders
- Includes Purging Disorder: recurrent purging behaviours to influence weight or shape (e.g. vomiting, laxatives, diet pills) but no binge eating
Epidemiology and associated risks
Eating disorders disproportionally affect females
•Typical onset for anorexia is early adolescence, Bulimia early adulthood, and BED early to late adulthood
•No single cause of eating disorders
•Associated with depression and anxiety
•Associated with physical health complications e.g. Anorexia and cardiac abnormalities, BED with obesity related complications
•Highest mortality rate of all psychiatric conditions
How is fertility affected by eating disorders?
Sub-fertility related closely to women above & below desirable body weight
•Average post-pubertal body has 28% fat (minimum of 22% needed to maintain ovulation)
•Generally this occurs when body weight is 47kg
•BMI<20 often causes sub-fertility
How do eating disorders affect pregnancy?
- Eating disorders typically affect women during childbearing years
- Roughly 5-7% of women during pregnancy, most will be OSFED1
- Women may be more likely to worry about change in body shape and weight
- Symptoms generally improve in pregnancy but cognitive distortions persist 2
- Potential for relapse or ED development 3,4
- Women are highly motivated to change during first pregnancy = good opportunity to identify and engage in treatment 5
1Easter, 2013; 2Micali, 2007; 3Blais, 2000; 4Tiller, 1998; 5Taborelli, 2015
What are the associated obstetric risks?
- Menstrual dysfunction and reduced fertility
- Low infant birth weight with Anorexia
- Miscarriage with Bulimia
- High infant birth weight with BED
What are the obstetric complications?
Fertility problems, unplanned pregnancy, negative attitudes to pregnancy 1
Anaemia, hyperemesis gravidarum and hypertension2,3
AN: Fetal growth restriction, poor fetal growth, caesarean, prematurity, smaller HC, LBW 2,3,4,5
Bulimia Nervosa: Miscarriage, fetal death, LBW 3,4
Binge Eating Disorder: Miscarriage, caesarean, HBW 3,6
Depression, anxiety, smoking and excessive GWG (gestational weight gain)
6,7,81 Easter, 2011; 2Koubaa, 2005; 3Linna, 2014;4Micali, 2007; 5Solmi, 2014; 6Bulik, 2009; 7Micali, 2011; 8Easter, 201
What are the associated postnatal risks?
Eating disorders may also effect women postnatally, increasing evidence of associated risks:
•Relapse of eating disorder symptoms 1
•PND 2
•Difficulties adjusting to motherhood 4
•Early introduction of formula milk with Anorexia
•More likely to breastfeed post 1 year PN with Bulimia
•Increased rate of childhood eating problems
•Poor infant growth 5 and delayed infant development 6
•Infant feeding difficulties 3
•Behavioural and emotional difficulties in infant 7
What are the practical implications for midwifery practice?
•Important to identify eating disorders and modifiable risk factors early in pregnancy and encourage women to engage with specialist care
•Midwives play a key role in identifying and supporting women at risk of mental illness
•Awareness that women may be reluctant to discuss their disorder due to fear of stigma
•Support women in a non‑judgmental and compassionate way
•Review relevant NICE guidance, recommendations include:
Monitor physical and psychological wellbeing
Assess need for additional fetal growth scans
Discuss healthy eating and infant feeding
Where necessary, refer for specialist care
What are the potential barriers to identifying EDs?
ED women unlikely to seek treatment and often reluctant to disclose ED- fear of stigma/social services1,2,3
HP do not routinely enquire about ED during antenatal care3
HP poor ED knowledge and empathy 3
Minimal NICE guidance for identifying or managing ED in antenatal care
1Hudson, 2007; 2Franko, 1993; 3Stringer, 2010
What can you do as a midwife?
Monitor carefully
Assess need for fetal growth scans
Discuss importance of healthy eating and ask about eating behaviours
Advise and support with infant feeding
Support in a non‑judgmental and compassionate way
Refer to mental health
Review NICE guidance for MH NICE 2004, 2007, 2014
