2 AN & BNBoth are characterized by an overvalued fear of fatness that drives a set of disturbed behaviors, including :restricting food intakebinge eatingexcessive exerciseself-induced vomitingabuse of laxatives, diuretics, and diet pills
3 OVERVIEW OF EATING DISORDERS Anorexia NervosaAN is a syndrome of self-starvation characterized by weight loss to a level below 85% of expected body weight.Weight loss is accompanied by fear of fatness and, in girls and women, amenorrhea or the absence of 3 or more consecutive menstrual cycles.
4 OVERVIEW OF EATING DISORDERS Bulimia Nervosa 1BN is a dieting disorder characterized by episodes of binge eating followed by compensatory behaviors aimed at preventing weight gain.
5 Bulimia Nervosaconsumption of an amount of food definitely larger than most people would eat in a similar period, under similar circumstances, and is associated with a sense of loss of control over eating.Typical binge foods are high-fat , high- calorie, “forbidden” foods, and amounts consumed are 1000 to 2000 calories or more per binge.
6 BED (binge-eating disorder) regular binge eating, twice a week or more, associated with a subjective sense of loss of control over eating but lacking the compensatory behaviors typical of BN.Patients with BED are more likely to be overweight or obese.
7 Atypical eating disorders Globus hystericus, or fear of swallowing, resulting in :severe weight lossfunctional impairmentpsychogenic vomiting syndromes.
8 EPIDEMIOLOGYEpidemiologic data on eating disorders is limited for several reasons. AN : The prevalence of AN among young women is approximately 0.3% F/M : 10 Onset :15 to 19 years BN : The prevalence of BN among young women is approximately 1% F/M : 10 Onset :20 to 24 years
9 EPIDEMIOLOGY BED prevalence : 2% to 3% female-to-male 2:1 Onset : 30 to 50 years .Rates of BED are much higher, on the order of approximately 25% , in clinical samples of obese individuals seeking weight-loss treatment.
10 ETIOLOGY 1Geneticspolymorphisms in serotonin and dopamine-related genesleptin and estrogen receptorsPersonalitylow self-esteemPerfectionism
11 ETIOLOGY Socio cultural Factors Mass Media Peers Family Developmental Factorsovarian hormonessexual development
13 CONSEQUENCES AND COMPLICATIONS 1 Social and Developmental ComplicationsPsychologic Complicationslow moodapathyanhedoniadecreased concentration and energyalcohol abuseanxiety disorders
14 CONSEQUENCES AND COMPLICATIONS Physical Complications and Signs1-Starvation-Related Complications:Malnutrition and starvationmuscle wasting and weaknessbradycardiahypotensionhypothermiaamenorrhea and infertilitycold intoleranceconstipationAnemiaOsteoporosishypoglycemia
15 CONSEQUENCES AND COMPLICATIONS 2-Purging-Related Complications:parotid and salivary gland hypertrophyDental cariesrefluxrenal damage and nephrocalcinosiselectrolyte and acid–base imbalances
16 TREATMENTInitial treatment goals include normalizing eating patterns and restoring weight in underweight patients by using behavioral psychotherapeutic interventions.
18 TREATMENT Role of the Nutritionist Three regular meals a day eating normal portion sizesexpanding food repertoire (which is often very narrow)avoiding diet foodsPatients should be encouraged to consume all foods in moderation and in normal combinations and to avoid fat-free or sugar-free diet products.
19 TREATMENTVegetarianism that develops after the onset of dieting behavior is common in both AN and BNdiabetic exchange system without focus on calorie countingwith BN or BED should be instructed to eat approximately2000 kcal/day with an initial goal of weight maintenance.
20 TREATMENTPatients with AN who need to gain weight should be instructed to consume the same normal, healthy, 2000-cal diet plus three high-calorie liquid supplements between meals, totaling an additional 1000 to 1500 kcal/day to gain weight.patients are strongly motivated to restrict their intake to low–calorie density foods
21 Enteral and Parenteral Feeding When access to a specialized behavioral inpatient eating disorders program is limited, however, an attempt at enteral feeding for severely underweight individuals who fail to gain weight with oral feeding may be warranted.The use of TPN has been described as a means of supplementation for AN patients who are refusing oral or nasogastric feeding.
22 Prognosis and Outcomes Outcome studies of AN and BN suggest that approximately:50% recover fully25% to 30% improve significantly15% to 20% continue to have unrelenting eating disordersmortality rates:1% to 13% in AN0% to 3% in BN