Eating Disorders

Question 1

What are some of the symptoms we look for with an eating disorder?

Answer 1

body image distortion, fear of being fat, desire to reduce weight, purging, compulsive exercise, poor self-esteem

Question 2

What is a good tool to screen for anorexia? How does it go?

Answer 2

SCOFF Self Test
Do you make yourself Sick? Worry you have lost Control over how much you eat? Recently lOst 14+ lbs within 3 months? Believe you are Fat when others say you’re thin? Would you say that Food dominates your life?

Question 3

How is anorexia diagnosed based off of DSM-5 criteria?

Answer 3

Persistent restriction of energy intake leading to significantly low body weight; behavior that interferes with or fear of weight gain (even though significantly low weight); or disturbance in the way one’s body weight or shape is experienced (thinking they’re fat when they are obviously very thin)

Question 4

When a patient presents with eating only minimal meals what diagnosis should you keep on your differential?

Answer 4

IBS, Upper GI disease, Hyperthyroidism, malignancies, AIDs, psych – anorexia, anxiety, depression

Question 5

What are the 2 types of anorexics?

Answer 5

Binge eating/purging type (unable to refrain from binge eating & purging even with use of laxatives with continued weight loss)
Restrictive type (limit their intake to as little as 300-600 cal/day; limited food selection; OCD symptoms regarding food)

Question 6

If you have diagnosed a patient with anorexia and they have a BMI of 15-15.99, what level are they?

Answer 6

Severe

Question 7

What’s mild & moderate AN?

Answer 7

Mild = >17

Moderate = 16-16.99

Question 8

If a patient eats an amount of food that is definitely larger than what most individuals eat in the same time period; and the patient absolutely no control over eating during this time period – what is it known as?

Answer 8

Binging

Question 9

If a patient has recurrent incidences of binging and purging in order to prevent weight gain – but they are not underweight - what diagnosis?

Answer 9

Bulimia Nervosa

Question 10

On what criteria would you diagnose BN?

Answer 10

Must occur on average 1/week for 3 months

Question 11

So, what are the categories of BN?

Answer 11

Lack of control while eating
Inappropriate compensatory behaviors (vomiting, laxatives, enemas, increased exercise)
Are of a normal weight

Question 12

If a patient has 4-7 episodes of BN per week, what level are they?

Answer 12

Moderate

Question 13

What is considered mild and severe BN?

Answer 13

Mild = 1-3/week

Severe = 8-13/week

Question 14

What does the female athlete triad consist of?

Answer 14

Nutritional (disordered eating); Endocrine; MSK

Question 15

What are some medical complications you can look for on PE from purging?

Answer 15

Russel’s sign (on the knuckles from going in the mouth); tooth erosion; overuse injuries/stress fractures; heart arrhythmias; constipation; and frequent UTI’s

Question 16

If you are highly suspicious of BN, what tests could you order?

Answer 16

Urine (ketones, pH, hydration, specific gravity); Ht & Wt in GOWN; Temp; Orthostatic BP’s; EKG; CBC, CMP, Amylase/Lipase, TSH

Question 17

If an overweight patient is presenting because they are gaining more weight what would you think of on DDx?

Answer 17

Pregnancy!; PCOS; Hypothyroidism; Diabetes; Cushing’s; steroid use; CHF; Pituitary

Question 18

If a patient binge eats, but has no compensatory behavior so they then gain weight, what is the diagnosis?

Answer 18

Binge Eating Disorder

Question 19

Binge eating episodes are associated with at least 3 of 5 things, what are they?

Answer 19

Eating very rapidly
Until uncomfortably full
Eating alone due to embarrassment
Large amounts of food when not hungry
Feeling disgusted with oneself/depressed/guilty afterwards

Question 20

How do we treat eating disorders?

Answer 20

Referral to psychotherapy or psychiatrist (who specializes in eating disorders); cognitive behavioral therapy (is the cornerstone of Tx!); family based Tx/Support
Referral to dietician (consider school involvement for accommodations)

Question 21

What medications might help with AN, BN, and Binge Eating?

Answer 21

SSRI’s