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Eating disorders unit 10
1.
2. Types of Eating
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Not Otherwise Specified (NOS)
3. Anorexia Nervosa
Warning Signs
Dramatic weight loss
Refusal to eat certain foods or food
categories (e.g. no fats, no carbs)
Consistent excuses to avoid situations
involving food
Excessive and rigid exercise routine
Withdrawal from usual friends/relatives
Source: National Eating Disorders Association Website
5. Treatment for Anorexia
1. Hospitalization
First consideration- return the patient’s
nutritional state
Inpatient psychiatric treatment
Behavioral management
Individual psychotherapy
Family education and therapy
In some cases psychotropics
6. Treatment for Anorexia
Pharmacotherapy
No identified medication that yields definitive
improvement of core symptoms of anorexia
Some support for the use of cyproheptadine
(Periactine)
Amitryptiline (Elavil)- also been reported to have some
benefit
Other medications used with variable results
Clomipramine, primozide, chlorpromazine
7. Treatment for Anorexia
Pharmacotherapy cont.
Trials with fluoxetine
Some weight gain
Serotonergic agents
May yield positive responses in the future
TCAs
In low-weight patients may result in
Hypotension, cardiac arrhythmia, dehydration
Upon return of normal nutritional state TCAs may be
introduced.
8. Bulimia Nervosa
DSM-IV-TR
Defined as binge eating combined with
inappropriate ways of stopping weight gain
9. Bulimia Nervosa
Warning Signs
Wrappers/containers indicating consumption of
large amounts of food
Frequent trips to bathroom after meals
Signs of vomiting e.g. staining of teeth, calluses on hands
Excessive and rigid exercise routine
Withdrawal from usual friends/relatives
Source: National Eating Disorders Association Website
10. Bulimia Nervosa
According to the DSM-IV-TR
Bulimia nervosa is present when:
Episodes of binge eating occur relatively frequently
Twice a week or more for at least 3 month
Compensatory behaviors are practiced after binge
eating to prevent weight gain:
Self-induce vomiting
Laxative abuse
Diuretics
Abuse of emetics
Severe dieting and strenuous exercise
11. Bulimia Nervosa
According to the DSM-IV-TR
Bulimia nervosa is present when: Cont.
Wight is not severely lowered as in anorexia
The patient has morbid fear of fatness
A relentless drive for thinness
Disproportionate amount of self-evaluation depends
on body shape and wight
13. Treatment for Bulimia
Nervosa
Pharmacotherapy
Antidepressants
Shown to be helpful
SSRIs (Fluoxetine 60 to 80 mg/day)
Reduce binge eating
Imipramine (Tofranil)
Desipramine (Norpramin)
Trazodone (Desyrel)
MAOIs have also been helpful
Carbamazepine (Tegretol) and lithium (Eskalith) – have not
shown impressive results. Mostly used in bulimic patients with
comorbid mood disorders such as bipolar I disorder.
16. Obesity
Treatment
Obesity treatment is multifactorial
Treatment include
Diet
Exercise
Psychotherapy
Pharmacotherapy
In extreme cases:
Surgery
17. Obesity
Pharmacotherapy –(See table 23.3-7 pg 746)
Drug treatment is effective because it suppresses appetite
but tolerance may develop
Orlistat ( Xenical) approved by the FDA in 1999 for weight
loss treatment (Currently sold OTC as “Alli”
Selective gastric and pancreatic lipase inhibitor
120 mg 3 times a day in combination with a low calorie diet and
exercise
18. Obesity
Orlistat
Prescription orlistat is used in overweight people
who may also have:
high blood pressure
diabetes, high cholesterol
heart disease.
also used after weight-loss for maintenance
.Orlistat is a lipase inhibitors. It prevents some of the
fat in foods eaten from being absorbed in the
intestines. This unabsorbed fat is then removed
from the body in the stool.
19. Obesity
Sibutramine (Meridia)
β-phenylethylamine that inhibits reuptake of
serotonin and epinephrine (and dopamine to a limited
extent).
Approved by the FDA in 1997 for weight loss
treatment and maintenance
Sibutramine is no longer available in the U.S. The
manufacturer has decided to stop producing sibutramine
based on information from a recent clinical study. In this
study, people taking sibutramine had an increased risk
of cardiovascular events such as heart attack and stroke
20. Obesity
Orlistat- Side effects
oily spotting on underwear or on clothing
gas with oily spotting
urgent need to have a bowel movement
loose stools
oily or fatty stools
increased number of bowel movements
difficulty controlling bowel movements
pain or discomfort in the rectum (bottom)
stomach pain
irregular menstrual periods
headache
anxiety
21. Obesity
Orlistat- Serious side effects- See doctor imnmediately
hives
rash
itching
difficulty breathing or swallowing
severe or continuous stomach pain
excessive tiredness or weakness
nausea
vomiting
loss of appetite
pain in the upper right part of the stomach
yellowing of the skin or eyes
dark-colored urine
light-colored stools
22. Obesity
Rimonabant
first in a new class of therapeutic agents called
Cannabinoid-1 Receptor Blockers (CB1).
Shown to reduce body weight and reduce cv risk
factors
Dose
20 mg causes significant weight loss
Reduction in waist circumference
FDA's Endocrine and Metabolic Drugs Advisory Committee
recommended against the approval of rimonabant (known in the
United States as Zimulti) due to concerns over similar serious side
effects. Subsequently, the FDA did not approve rimonabant, and
it has never been marketed in the United States.
23. Resources
www.mypyramid.gov
National Institutes of Health Publication No 02-4084. The Practical
Guide: Identification, Evaluation, and Treatment of overweight and
obesity in adults
http://win.niddk.nih.gov/index.htm
www.obesity.org
www.eatright.org
www.consumer.gov/weightloss
www.naaso.org
www.shapeup.org.
www.nwcr.ws/Research/default.htm
www.acsm.org
www.thelifestylecompany.com/