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Eating disorders Flashcards

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1
Q

Appearance related concerns

A

Reaching epidemic proportions in the Western society
Body dissatisfaction can occur from 8 years of age
Females report this phenomena more but…increasing in men

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2
Q

Aspects of appearance that concern

A

Appearance in general including many aspects of the face which are a source of concern to a range of people
Size of abdomen
Body weight
Poor muscle tone

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3
Q

Possible effects of appearance on young people

A

-ve
Teasing (peak age to cause upset is 7-8yr)
Bullying
+ve
If rated attractive likely to get more attention, be the subject of higher expectations of ability, may ‘get away with things more’

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4
Q

Differences and Body shape

A

Different cultures see things differently e.g. African American children picked bigger ideal body sizes than white children from random sample of children
Social class – In mid 19thC more weight= more wealth!
Perception of attractive body shape has changed over time eg reclining nude in Manet’s painting Olympia seen as “obscene” – not plump enough to be erotic.1863

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5
Q

Treacher Collins Syndrome

A

Recessive hereditary
Affects ears, eyes, jaws
‘Bird face’

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6
Q

How to measure body fat

A

BMI
Skinfold thickness
Waist: hip ratio
Dual energy X-ray absorptiometry (DXA)

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7
Q

BMI

A 
weight/height^2
10-20 underweight
20-25 healthy
25-30 overweight
30-40 obese
40+ morbidly obese
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8
Q

Mental Health problems in children

A

Prevalence of 1 in 10 from 5-16 years
Press attention +++ to poor C & A mental health services
Funding for Child and Adolescent Mental Health Services, CAMHS, has been dropping in real terms

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9
Q

Diagnostic criteria

A

DSM –IV criteria (Diagnostic and Statistical Manual of Mental Disorders 4th Edn) are the standard signs which are used to assess /define an eating disorder.
Some people may have a partial syndrome and meet some of the criteria
May be associated with borderline personality disorder

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10
Q

The eating disorders

A

Anorexia nervosa (av duration 8yr but…)
Bulimia nervosa – in the 1970s (av duration 5 yr but..)
Binge eating disorder (BED)
(DSM says AN,BN and Binge Eating Disorder are the main eating disorders )
Not mutually exclusive and may overlap
7% increase in hospital admissions since 2005

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11
Q

Scoff Test

A

Sick - make yourself because feel full
Control - worry over loss of in relation to food
One - stone lost in 3m
Fat - see yourself as fat when others don’t
Food - dominates life
Designed in Leeds-Score of 2 or more is a +ve screen for an eating disorder

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12
Q

Eating disorder statistics

A

More common in females but increasingly in males (NICE - approx 11% affected are male)
Develops between 15-25 years, usually
Can occur in children as young as 8 years
Can be accompanied by other problems e.g. drug use, compulsive shoplifting

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13
Q

Why

A 
Peer/ family pressure
Media eg very thin models in fashion magazines 
Stress
Genetic component
Role of Serotonin
Leptin & ghrelin function
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14
Q

Anorexia nervosa in UK

A 
Prevalence: 
1:150 15 year old girl
1:1000 15 year old boys
~1% 16-18 year olds affected
Afro-Caribbean, Asian, Hispanic women less likely to have weight concerns than white women
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15
Q

Anorexia nervosa

A 
Fear of gaining weight so eat little
15% below weight for height/age
BMI <17.5
Body Image dysfunction
Denial of low weight
If reproductive years - amenorrhoeic for at least 3 months
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16
Q

Medical consequences AN

A

Starvation and dehydration - circulatory problems, kidney/ heart failure
Long term - stunting of growth, osteoporosis, possibly fertility problems
5% die

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17
Q

General treatment for AN/BN

A 
Cognitive therapy in improving mental health (but W/L)
Individual/ group/ psychotherapy
Life skills; nutritional advice
Drugs
In-px care may be neessary
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18
Q

Specific treatment of AN

A 
Aim to attain viable weight
Alter feelings about body image/ food (medical view &amp; px's may not coincide)
Family therapy for those <16 years
In-px care may be necessary
18year+ care - transitional care?
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19
Q

Prognosis AN

A 
50% recover after treatment 
30% retain partial symptoms
Approximately:
20% become chronic
5% die – 
   starvation, heart failure or suicide
   AN has one of highest rates of suicide of all psychiatric illnesses
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20
Q

Bulimia nervosa

Study These Flashcards
A

May be of any weight
Eating pattern:
-binge eating (recurrent) of high calorie food, followed by secret purging
-food hidden in secret places
-use of laxatives and diuretics to control weight fluctuations

21
Q

BM may also have

Study These Flashcards
A

Awareness that eating pattern is abnormal
Frequent weight fluctuations > 5Kg
Depression after binge
Binges not due to AN or any other physical condition

22
Q

Prevalence BN

Study These Flashcards
A 
Female : Male = 20:1
Mainly young people
Up to 20% females binge @ some time
Anorexia- 0.25% population
 Bulimia – approx 1%
23
Q

Medical consequences of BN

Study These Flashcards
A 
GI -cramps, constipation , diarrhoea
Electrolyte imbalance
Damage oesophageal sphincter, muscles
Lower bowel damage
Throat ulcers
24
Q

Oral presentation BN

Study These Flashcards
A 
Dental erosion
May have:
-dry mouth
-inflamed palate
-dry, chapped lips
-swollen parotid glands
25
Management of dental aspects
Psychological assess (if not already done) Preventive advice Restoration of affected teeth Provision of occlusal splint if indicated
26
Dental aspects of BN
Tact and diplomacy Consider possible sensitivity of teeth Treatment plan w. SM & X Rays Prevention Treat teeth as needed when BN under control Monitor -Dentists need further education in the area of ED
27
Dental erosion - diagnostic criteria
Palatally on upper incisors (often extensive) Palatal aspects upper posterior teeth “cupping” Occlusal & buccal surfaces U & L posterior teeth (variable) “Squeaky clean “ teeth but could have gingivitis
28
Prognosis BN
Half – two thirds improve a lot But tends to be a chronic/ remitting condition Some deaths from inhalation of vomit
29
Obesity definition
Overweight and Obesity are defined as abnormal or excessive fat accumulation that may impair health
30
Trends in prevalence of obesity in adults in England
1985 9% 2000 20% 2010 27% 2050 60%
31
Sugar consumption
1700: 1.8kg of food pa 1800: 8.2kg per head pa 2000: 36.4kg - should be less than 10% of our daily calorie intake (WHO)
32
OW and OB rates for adults
41% men, 31% women | Of which 27% OB
33
OW and OB rates for children
>20% at four to 5 years | >33% at 11 years
34
Trend: steep rise OB/OW in 1990s
Gradual slow down until 2010 | Since then plateauing
35
League table of obesity
``` Small pacific Islands eg Tonga Middle Easter countries (some) 12th USA 19th Trinidad & Tobago 27th UK ```
36
Pbesity v TV time
Link between OB and hours of TV time. NICE advises no more than 2hr / day (2015) Children who watch commercial TV see more food/drink adverts Schmidt M E et al.2012. Likely to be less active if watch a lot of TV
37
BMI v caries experience
Caries and OB are multifactorial diseases Some studies have found an association between caries and OB/OW, some have not. Danish study – found BMI & caries not associated but high caries risk may be a marker for future risk of OW among more advantaged
38
Fat v sugar
Is fat better?
39
Appetite control
Appetite is dependant on an interaction between biology and environment Environment contains some influential factors which can overcome biological processes operating to maintain body weight eg media influences Some people have physiological characteristics favouring good regulation body weight
40
Diabetes prevalence
2000 2.8% prevalence or 171m 2030 4.4% prevalence or 366m. worldwide Key issue – no. of people > 65 yrs In developing countries most people are 45-64yrs and in developed most are 64yr+
41
Management of OW/OB
``` Long term plans and goals to be approached incrementally Control of diet Behaviour management Regular Exercise Drug treatment Surgery ON-GOING MONITORING & REINFORCEMENT ```
42
Cancer
Extra fat produces hormones and growth factors which affect our cells This can raise risk of cancer (& other diseases) Exact mechanism not clear Cancer Ressearch UK has billboards at bus stops etc. saying OB is cause of cancer
43
Obesity in children
OW = wt:ht>2 standard deviations above WHO child growth standards median >2/3 obese 10 yr + > obese adults Calorie dense food available +reduced physical activity > rise obesity Levelling off in 2014 Disease of deprivation More OB in urban than rural areas
44
Drug treatment of obesity if BMI>30
Can kick start weight loss but poor compliance Only licensed drug is Xenical + side effects! Short term use only ( poor fat absorption) Can lose 10% body weight in 6m
45
Surgical treatment of obesity in UK
2m in UK eligible BMI > 40 or 35 if co – morbidities Restriction &/or Malabsorption Sleeve gastrectomy – remove ¾ of stomach R) Gastric bypass – staple stomach/duodenum & some of small intestine; for “nibblers”(R & M) Cost of above £8-10,000 but….
46
Recent press releases
Jamie Oliver 'obese poor think in a different gear' Fasting diets - are they better? Will the NHS ban sugary drinks from hospitals
47
Effect of increasing levels OW/OB on dental care
More diabetic patients, (periodontal problems, care with appointment times) Cardio – vascular disease (anti coagulants, high BP Arthritis (mobility problems) More chronic periodontal disease to treat Increased caries ?? Decreased stimulated salivary flow rate Bariatric equipment may be needed Increased GA & sedation risk
48
Setting an example
OW health care workers - Slimmers World - diet advice - dance classes
49
Drug treatment of obesity if BMI >30
Can kick start weight loss but poor compliance Only licensed drug is Xenical + side effects Short term *cat ch up on slide

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