Eating Disorders By: Amanda Sensabaugh Hayley Fennessy
Anorexia Nervosa • Psychiatric disorder • Characterized by low body weight • Body image distortion • Obsessive fear of gaining weight • Depression • Weight loss viewed as a sign of achievement • Control Weight by: • Voluntary starvation • Purging • Excessive exercise • Diet pills or diuretic drugs
Bulimia Nervosa • Recurrent binge eating followed by feelings of guilt, depression, and intentional purging to prevent weight gain from occurring. • Purging may consist of: • Vomiting • Fasting • Use of laxatives, enemas, diuretics, or other medication • Excessive exercise
Bulimia Nervosa • Typically within normal weight range, underwt. or overwt. • More open to treatment that AN (tire of binge/purge cycle)
Binge Eating Disorders • Binge without the purge • Psychiatric disorder • Eats a large amount of food at one time-more than what a normal person would eat at the same time. • Eats until physically uncomfortably full • Feels depressed or guilty after a binge • Eats large amounts of food even if there not really hungry
Variations of Eating Disorders • Binging/purging AN • Restrictive AN • Purging BN • Non-purging BN • EDNOS (eating disorder Not otherwise specified)
Purging vs. Non Purging Bulimia • Purging: over consumption of calories then using laxatives/edemas/excessive exercise to rid calories • Non-Purging: over consumption of calories without ridding them from the body
Medical Consequences of Anorexia Nervosa • Dizziness, confusion • Dry, brittle hair • Lanugo-type hair • Low blood pressure, pulse, ECG voltage • Orthostasis • Cachexia • Biochemical changes • Decreased WBC • Decreased glucose • Increased cholesterol • Increased carotene
Medical Consequences of Anorexia Nervosa • Loss of menses • Muscle wasting • Diminishing DTRs • Osteoporosis • Dry skin • Edema • Growth retardation • Hypothermia
Medical Consequences of Bulimia Nervosa • Salivary gland enlargement • Enamel erosion • Esophagitis • Arrhythmias • Normal weight or underweight or overweight • Calluses on hands • Edema • Diarrhea
Medical Consequences of Bulimia Nervosa • Biochemical changes • Decreased potassium • Increased carbon dioxide • Increased amylase
Role of treatment • Multidisciplinary team • Physicians • Check wt. other physical signs/symptoms • Electrolyte imbalances • Heart arrhythmias • May prescribe antidepressants
Role of Treatment • Registered Dietitians • Discuss food intake • Exercise and weight related behaviors
Role of Treatment • Psychotherapists • Discuss issues leading to disordered eating patterns. • Psychiatrist • Physician that specializes in treating mental disorders.
Goals of Treating Disordered Eating • Normal eating • Eating based on physical signs that is free from fear, guilt, anxiety, obsessive thinking or behaviors or compensatory behavior. • Improved body image • Weight normalization • Discontinue extreme behaviors such as bingeing, purging, starvation • Often client exchange one coping tool for another equally destructive coping tool.
Prevention Strategies to Reduce Risk of Disordered Eating • Practice intuitive eating concepts by accepting your body type. • Healthy at every size.
Paris’ Description • 34 year old female attorney • She experiences a high amount of stress • Spent lots of hours at the recreation center in high school • Swam for 1 hr. before classes • Walked 3 miles on the indoor track after lunch • She did aerobics in the afternoon for 1 hr.
Paris’ Description • She learned how to purge using her toothbrush • She took OTC laxatives every other day • She hasn’t had a menstrual period in over two years • Tried to maintain her weight below 120 lbs. • Smokes 1 pack of cigarettes a day • Multiple food allergies: all meats, dairy foods, most desserts
Paris’ Description • She tried to stop restricting her intake of food and purging on her own but once she experienced stress she reverted back to her old coping mechanisms. • She was hospitalized while in law school for a weekend because of severe dehydration but released after 24 hrs.
Paris’ Description • She appears emaciated • She appears tired and older than age 34 • She loves to cook but gives most of the food away • She admitted that she knows she has a problem dealing with food and eating
Paris’ Anthropometrics • Height: 5’8 • Weight: 115 lbs. • BMI: 17.48 • Interpretation: underweight
Basal Energy Metabolism • Harris Benedict: 655 + (9.6 x 52.8) + (1.8 x 172.72) – (4.7 x 34)= 1313 x activity factor(1.3)= 1707 KCALS
Paris’ 24 Hr. Recall • AM: ¼ whole wheat bagel, 4 oz. calcium fortified orange juice, 6 oz black coffee • Lunch: Black coffee 2-3 c • Afternoon snack: 12 oz can Diet Coke • Dinner: 6 green peas, 18 oz water • Snack: 12 oz Diet Coke
Nutrition Problems • Rough dry skin with lanugo • Bruising • Brittle finger/toenails • Erosion of dental enamel • Multiple food allergies • Gastric/abdominal problems • Easy Bleeding/anemia
Paris’ Lab Value Results • Low albumin of 3.0 L • Low pre-albumin of 14.5 L • Low potassium of 3.0 L • Low magnesium of 1.7 L • High glucose of 115 H • High CPK of 146 H • High HDL of 60 H • Low WBC of 4.6 L
Characteristics of Refeeding Syndrome • Increases BMR • May lead to confusion, coma, convulsions and death. • Caused by introducing food to quickly to a malnourished person. • Prevent refeeding syndrome by slowly introducing foods in small amounts and advancing as tolerated.
Questions regarding Paris’ purging behaviors 1. What types of food trigger your bingeing/purging episodes? 2. What food rituals do you have? 3. What foods do you consider fear foods? 4. What other behavior could you do when you feel a bingeing/purging episode about to occur? 5. What weight would you consider healthy for yourself?
Diagnosis • Inadequate energy intake(NI-1.4) related to restricting food and purging as evidenced by her underweight BMI of 17.48.
Intervention • Nutrition-Related Behavior Modification Therapy C-1 • A supportive process to set priorities, establish goals and create individualized action plans that acknowledge and foster responsibility for self-care by setting goals for Paris • From Paris’ description and 24 hr. food recall we determined that Paris has anorexia nervosa with binge/purge tendencies.
Education Intervention • Teach Paris the hunger/fullness scale • Learn not to classify foods as good versus bad • Discuss physical activity in terms of health rather than using it to control her weight • Discuss with her the idea about trusting her body to fluctuate between a goal range weight for her • Gradually increase her caloric intake to prevent refeeding syndrome • Teach her to add foods that she considers “safe” into her diet. She stated she felt “safe foods” were all vegetables and salads. • Although we intend to attempt to try these intervention techniques with Paris, we realize that this may be an extremely slow process and take a very long time depending on how she reacts to treatment.
Sample Diet • 2 eggs, 1 C granola, 1 C skim milk • 1/2 C grapes • 2 oz turkey on 2 slices whole wheat bread, light mayo, mustard, 2 slices tomato, lettuce • 1 C apple juice • 2 cups mixed green salad, 2 oz tuna, 4 slices cucumber, tomato, carrots, balsamic dressing • This diet is low in calories and not meant for the long term, but it can be a good place to start.
Action Goals 1. Have Paris choose one food item of her choice at every meal. This can be a vegetable, fruit, or anything she wants. 2. To better understand intuitive eating, have her read a chapter a week from Intuitive Eating (Tribole, Resch, 1995) and focus her behavior change on that particular chapter. 3. Have Paris keep a journal of her feelings prior and post eating.
Outcome Goals: Goal Weights • Paris should aim to gain about 1 lb. per week, however this may be unrealistic at first, and that is alright in the beginning, as long as she does not lose any more weight. • Goal: 140 lbs. based upon Hamwi • 1 Month Goal: 119 lbs. • 3 Month Goal: 131 lbs. • 1 Year Goal: 126-154 lbs. • Insure a slow and steady weight gain to prevent refeeding syndrome.
Follow-Up • Follow up with Paris in one week due to being in the beginning stages of treatment. • Then follow-ups may occur every two weeks. • Have weekly talks/meetings with the other healthcare professionals on the team (physician, psychologist, etc)
Parameters to measure • Weight • Coping mechanisms • Monitor purging behavior • Continual discussion with the other members of the treatment team for Paris
References • Scarano M.G., Kalodner-Martin R.C. A description of the continuum of eating disorders: Implications for intervention and research. Journal of Counseling & Development. Vol. 72, 1994. • Williams L.R., Schaefer A.C., Shisslak M.C., Gronwaldt H.V., Comerci D.G. Eating Attidtudes & Behaviors in Adolescent Women: Discrimination of Normals, Dieters, & Suspected Bulimics Using the Eating Attitudes Test & Eating Disorder Inventory. International Journal of Eating Disorders. Vol. 5, 1986 • Kitsantas A., Gilligan D.T., Kamata A. College Women With Eating Disorders: Self-Regulation, Life Satisfaction, & Positive/Negative Affect. The Journal of Psychology. Vol. 137, 2003. • Garner M.D., Garner V.M., Rosen W.L. Anorexia Nervosa “Restricters” Who Purge: Implications for subtyping Anorexia Nervosa. International Journal of Eating Disorders. Vol. 13, 1993. • Robinson H.P. Review article: recognition and treatment of eating disorders in primary and secondary care. Alliment Pharmacol Ther. Vol. 14, 2000. • http://encyclopedia.thefreedictionary.com/anorexia+nervosa • Tribole E., Resch E. Intuitive Eating. St. Martin’s Press, 1995.