1
Q
- How much is spent on weight loss per year?
- What % of diets fail?
A
- 30 billion $$$$
- 90-95% fail
2
Q
What are 8 red flags/clues to eating disorders in the office when evaluating a patient?
“FML - really makes such a freaking difference”
“Dogs Make Life Real Fun For Many Students”
A
- Frequent c/o constipation, abd pain, wkness in otherwise healthy patient
- They request laxatives/diuretics
- Reluctance/Refusal to be weighed
- Masking their weight loss w/ baggy clothes, weights in clothes, won’t remove clothes for exam, and fluid overloading
- Amenorrhea/Menstrual irregularity
- Depression
- Poorly healing sports injuries
- Vertebral or stress fx
3
Q
What are the 4 associated features of a person w/ Anorexia Nervosa?
“PODS”
A
- Perfectionist / High achieving
- Strong need to control one’s environment/self
- Depressive sxs (secondary to starvation)
- OCD features about food
4
Q
- How do people w/ anorexia nervosa manipulate their food intake?
- How many grams of fat are in their diet typically?
A
- Cut out all “fat & gristle” from meat
- Good food/Bad food classifications
- Covering mouth when eating/chewing
- Eating at time intervals
- Excessive condiment use
- 0 grams fat
5
Q
40% of adolescent females w/ Anorexia Nervosa have a hx of what?
A
Premorbid obesity
6
Q
- What is the mean age of onset of Anorexia Nervosa?
- At what age is it rare?
A
Bimodal: 14 yrs and 18 yrs
Rare: >40 yrs
7
Q
What are the 6 PE components for Eating Disorders?
A
- VS
- Weight
- Height
- BMI
- Complete PE
- Mental Status Exam
8
Q
Which 7 systems of the body are affected by a Anorexia Nervosa?
A
“Wide spread involvement”
- CNS
- Endocrine
- GI
- Hematologic
- Dermatologic
- Cardiovascular
- Liver dysfunction
9
Q
- What is RMR?
- What contributes to a reduced RMR?
A
- Resting Metabolic Rate
- Chronic caloric restriction
- Energy Restriction
10
Q
4 signs of Reduced RMR
A
- Bradycardia
- Hypotension
- Hypothermia
- Hypothalamic Dysfunction (sex drive, sleep, thirst) - abnormal function of hypothalamus
11
Q
Does a reduced RMR increase or decrease weight loss?
A
A reduced RMR becomes counterproductive to further weight loss efforts
(impedes weight loss)
12
Q
What 5 things contribute to Hypothalamic Dysfunction?
A
- Negative Energy Balance
- Weight loss
- Decreased body fat
- Chronic stress
- Excessive exercise
13
Q
Which 2 glands are affected by Hypothalamic Dysfunction/Amenorrhea?
A
- Pituitary (LH and FSH are decreased to pre-pubertal levels)
- Ovaries (estrogen/progesterone both decreased)
(all leading to amenorrhea - absence of menses)
14
Q
Distorted body image & excessive dieting/restrictive eating that leads to severe weight loss w/ a pathologic fear of becoming fat.
A
Definition of Anorexia Nervosa
15
Q
Weight that is less than minimally normal
A
Significantly low weight in adults
16
Q
Weight that is less than minimally expected
A
Significantly low weight in children and adolescents
17
Q
What are the 2 types of Anorexia Nervosa?
A
- Restricting type
- Binge-eating/purging type
18
Q
- During the last 3 months, has not engaged in recurrent binge eating/purging
- Has not engaged in misuse of laxatives, diuretics, enemas
- Weight loss is accomplished w/ dieting, fasting, or excessive exercise
A
Restricting type of Anorexia Nervosa
19
Q
- During the last 3 months, has engaged in episodes of binge eating/purging (vomiting, laxatives, diuretics, enemas)
A
Binge-eating / Purging type of Anorexia Nervosa
20
Q
What 2 things do you need to specify when diagnosing someone w/ Anorexia Nervosa?
A
- Type
- Current severity
21
Q
- The minimum level of severity for adults w/ Anorexia Nervosa is based on ___.
- For children is based on ____.
A
- BMI
- BMI percentile
22
Q
- Which organization’s categories are used for BMI?
A
- World Health Organization (WHO)
- Categories for “thinness” in adults
- For children/adolescents: use corresponding BMI percentiles
23
Q
The level of severity of Anorexia Nervosa may be increased to reflect which 3 things?
A
- Clinical sxs
- Degree of functional disability
- Need for supervision
24
Q
SCOFF is an acronym for a short questionere for which condition?
A
Anorexia Nervosa
2 or more + answers suggests eating disorder
25
What are 6 medical causes of weight loss/difficulty eating/loss of appetite
* IBD
* Cancer
* Depression
* Celiac Disease
* Hyperthyroidism
* Infection (TB, Valley Fever)
26
Part of your diff dx for Anorexia Nervosa could include disorders of upper GI motor activity. What are the 4 diagnosis?
* Achalasia (LES fails to open during swallowing)
* Esophageal spasm
* Severe GERD
* Upper esophageal sphincter hypertonicity
27
What 2 medications can cause side effects which may cause a patient to present as Anorexic?
* Adderall
* Thyroid medication
28
* **Recurrent episodes of binge eating**
* eating a large amount in discrete period of time
* lack of control over eating during episode (cannot stop eating/control how much one is eating)
_Bulimia Nervosa_ or _Binge Eating Disorder_
29
_Recurrent inappropriate compensatory behaviors_ in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
Bulimia Nervosa
30
The binge eating and inappropriate compensatory behaviors of **Bulimia Nervosa** both occur, on average, how often?
At least once a week for 3 months
31
Self-evaluation is unduly influenced by body shape and weight.
Bulimia Nervosa
32
The disturbance does not occur exclusively during episodes of anorexia nervosa.
Bulimia Nervosa
33
The minimum level of severity is based on the frequency of inappropriate compensatory behaviors. The level of severity may be increased to reflect other symptoms and the degree of functional disability.
Bulimia Nervosa
34
**Which condition has a higher prevalence?**
* Anorexia Nervosa
* Bulimia Nervosa
Bulimia Nervosa has a _significantly higher prevalence_ as compared to AN.
35
When does Bulimia Nervosa usually onset?
Adolescence or early adulthood, but may not come to medical attention for many years
36
* Increased frequency of depression, personality disorders, substance abuse/dependence
* Impulse control problems
Bulimia Nervosa
37
Which condition contributes to _psychological vulnerability:_ abuse and bullying?
Bulimia Nervosa
38
* Cultural pressures
* Hunger
* Starvation
* Disinhibition
* Guilt
Bulimia Nervosa
39
Which 5 systems are affected by Bulimia Nervosa as compared to Anorexia?
"ROME"
* Oral/Facial (caries)
* Esophageal
* Respiratory
* Metabolic
40
* Eating more rapidly than normal
* Eating until feeling uncomfortably full
* Eating large amounts and not feeling physically hungry
* Eating along bc/ embarrassed by how much one is eating
* Feeling disgusted w/ oneself, depressed, very guilty afterward
(NO PURGE)
Binge Eating Disorder
41
Binge eating occurs how often to be dx?
At least once a week for 3 months
42
* Binge eating, w/o compensatory behavior
* Does not occur exclusively during course of bulimia nervosa or anorexia nervosa
Binge Eating Disorder
43
What are the 3 components of the Female Athlete Triad?
* Disordered Eating
* Secondary Amenorrhea
* Osteopenia (estrogens build bone)
44
Prevalence of males w/ eating disorders
1 in 10
45
What 6 diagnostic studies would you order for eating disorders?
* CBC
* CMP
* Lipid panel
* Thyroid function (TSH)
* Hormones
* EKG
46
Acute Medical Stabilization for eating disorders occurs in what 3 settings?
* Hospitalizations
* In-patient EDO Tx Center (eating disorder)
* Outpatient Intensive Therapy EDO Tx Center
47
Nutritional and fluid/electrolyte stabilization tx consists of what 2 things?
* Break binge/purge cycle in Bulimia Nervosa
* Correct starvation state in Anorexia Nervosa
* \*monitor closely to prevent gastric dilation and CHF as the stomach shrinks w/ starvation
48
In correcting the starvation state of Anorexia Nervosa, what is considered safe weight gain per day and per week?
* 0.16 kg/day
* 0.45 - 1.36 kg/week
49
* Is mental health tx for eating disorders long term or short term?
* What is often extremely helpful w/ mental health tx?
* Long term
* Family therapy
50
\*\*What is the optimal tx for Eating Disorders?\*\*
**Interprofessional Team Approach**
* PCP
* Psychologist
* Dietetic Specialist
51
Acute or Chronic care approach to tx of eating disorders?
Chronic, long term approach
52
What should you emphasize w/ motivational interviewing of patients w/ eating disorders?
Pesonal health/wellness goals instead of specific weight...
53
* SSRI are antidepressants which should be used to treat which 2 eating disorders?
* Which SSRI is used?
* Bulimia Nervosa and Anorexia Nervosa
* Fluoxetine
54
* SSRI (Fluoxetine) should be used in both depressed and non-depressed patients of which condition?
* SSRI should be used for depressed mood in which condition?
* Which one requires a higher dose?
* Bulimia Nervosa (both)
* Anorexia Nervosa (depressed) , Needs higher dose, must be nutritionally stable
55
What are 9 indications for hospitalization of patients w/ eating disorders?
"**GRUMP F**or **C**alling **C**assie **P**etty"
* Acute **C**omplications (sz, GI bleed, CHF, pancreatitis)
* **P**hysiologic instability (severe dehydration, hypotension)
* Severe **M**alnutrition (weight \< 75% ideal)
* Acute food **R**efusal
* **U**ncontrollable binging/purging
* Acute **P**sch emergency (SI)
* **C**omorbidities (severe depression, OCD)
* **Gr**owth failure/arrest in adolescents
* **F**ailure of outpatient tx
56
* Which eating disorder has highest mortality rate?
* Which disorder overall has HIGHEST mortality rates?
1. "other"
2. Anorexia Nervosa
3. Bulimia Nervosa
* Eating Disordres, compared to all mental illness
57
* What % make a complete recovery from Anorexia Nervosa?
* What % w/ Intermediate outcome/relapses
* What % Poor outcome/chronic/unremitting course
* 50%
* 25%
* 25%
58
* Relapse of Anorexia Nervosa usually occurs within the first ___ years of tx
* % of deaths by suicide
* 4 years
* 50%
59
What are the 6 Poor Prognostic Factors of Anorexia Nervosa?
1. Onset at later age
2. Psychotherpeutic tx at later age
3. Longer duration of illness before tx
4. Lower minimum weight
5. Premorbid personality disturbances
6. Failed previous attempts
60
* What % of people w/ Bulimia Nervosa make full/partial recovery?
* What % w/ Intermediate outcome/ED NOS
* What % w/ chronic
* 60%
* 30%
* 10%
61
Does Bulimia or Anorexia have better outcomes?\*\*
Bulimia
62
What 2 books for patients/family?
* Intuitive eating
* Feeling good about the way you look - program for overcoming body image problems
