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Eating Disorders Part 1 Flashcards

1
Q

Why is early intervention in eating disorders recommended?

A

Has better prognosis

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2
Q

Why is intervention is general for eating disorders recommended?

A
  • Eating disorders have a high mortality rate

- 80% of ED patients will reach remission

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3
Q

What increases in severity as time goes on?

A

ED’s, there is often lots of pre-contemplation prior to seeking treatment; they go through denial, have lack of insight

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4
Q

Which type of ED has the highest mortality rate?

A

Anorexia Nervosa

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5
Q

What kind of treatments to ED patients seek prior to ED help?

A

-Weight loss
-Bariatric surgery
Counterintuitive to the root of the problem

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6
Q

Describe the three key features of AN

A

1) Restriction of energy intake leading to a significant weight-loss
2) Intense fear of gaining weight or becoming fat
3) Disturbances in self-body image, lack of recognition of the seriousness of their body weight

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7
Q

(T/F) To have anorexia, patients must have a significantly low weight

A

F, they must have experienced significant weight-loss, which doesn’t necessarily mean they are at a low weight (i.e. going form BMI of 30-22)

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8
Q

When does someone recovering from and ED begin to see their lack of recognition in the own seriousness of their ED?

A

Once they stat re-gaining weight, sometimes their cognitive rigidity begins to soften

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9
Q

What are the two sub-types of AN?

A
  • Restricting type

- Binge-eating/purging type

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10
Q

BMI 17 + AN=

A

Mild

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11
Q

BMI 16-16.99 AN =

A

Moderate

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12
Q

BMI 15-15.99 AN =

A

Severe

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13
Q

BMI <15 AN +

A

Extreme

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14
Q

In the prognosis of AN, ___ of patients will normalize weight

A

2/3

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15
Q

In prognosis of AN, patients with illness before 17 y/o achieve a ___ outcome than adult onset

A

better

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16
Q

(T/F) There is a higher rate of full recovery and lower mortality in adults compared to adolescents

A

F, in adolescents

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17
Q

(T/F) AN is a more difficult course in those with the disease prior to puberty

A

True

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18
Q

List key characteristics of AN (8)

A
  • Excessive concerns about weight, shape, health
  • Excessive perfectionism
  • Social rigidity
  • Self-denial
  • Social withdrawal
  • Extreme focus on job, schoolwork
  • Anxiety
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19
Q

What is cognitive rigidity?

A

Those with AN have an “amazing” ability to restrict food intake due to their strong beliefs. We need to break down this belief system.

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20
Q

What is a major positive prognosis factor for those with AN? Why?

A

Those with a supportive social network. Once a patient leave the program, they need social support to succeed

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21
Q

(T/F) Orthorexia is officially recognized as an ED

A

F, but some patients after recovering from an ED may showcase some orthorexia like behaviours

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22
Q

What are 5 commonly observed dietary patterns in AN? (GG-RR-L)

A
  • Gradual decrease in food intake
  • Gradual decrease in portion size
  • Removal of high-energy food
  • Rigid schedule of eating
  • Limited to bulky, nutrient-poor foods
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23
Q

What are the other 5 commonly observed dietary patterns in AN? (L-FFF-V)

A
  • Limited food choices/amount of calories
  • Fat avoidance
  • Food avoidance, related to digestive symptoms
  • Fluid avoidance, or excessive fluid intake
  • Vegetarianism or veganism
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24
Q

What are the 4 key diagnoses for Bulimia nervosa?

A

1) Recurrent episodes of binge eating following by BOTH eating a large amount of food in a discrete amount of time, with a sense of lack of control
2) Compensatory behaviour to avoid weight-gain, which is recurrent
3) Distorted body image, shape and weight
4) Occurs at least once a week for the last 3 months

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25
What are some compensatory mechanisms following a binge?
-Fasting, strict deprivation, use of laxatives/diuretics, excessive exercise, omitting insulin
26
What is the key difference between AN binge/purge and bulimia?
There is no significant weight loss in bulimia
27
What are the two main questions those with ED's ask?
1) WIll my body re-gain weight after recovering from an ED? | 2) What is a normal portion size
28
How do attitudes differ between those with AN and BN?
In someone with AN, their beliefs are so strong that they don't think chocolate cake is good. In BN, they agree that chocolate cake is good, but feel shameful after having it - thus resort to compensatory mechanisms.
29
(T/F) Eating a regular size meal then purging is classified as BN
F, is OFSED
30
What are the 8 key characteristics of BN? (BILE-CIAO)
- Body weight fluctuations - Inability to accurately express/identify feelings - Labile mood - Excessive concerns about weight/shape - Chaotic relationships and interaction - Impulsivity - Anxiety - Obsessive thoughts focused on restricting and bulimia
31
How is the severity of BN slotted?
Based on the average number of compensatory behaviours per week
32
Mild BN?
1-3
33
Moderate BN?
4-7
34
Severe BN?
8-13
35
Extreme BN?
14 or more
36
What is the diagnostic criteria for BED?
Recurrent episodes of binge eating, where the episodes are characterized on: 1) 3 or more factors 2) No compensatory behaviour 3) At least once a week, for three months
37
What are the 5 factors, where three are required in BED diagnosis?
- Eating rapidly - Eating until uncomfortably full - Not feeling physically hungry - Eating alone - Feeling disgusted with oneself, depressed or very guilty afterwards
38
(T/F) All people with BED feel out of control
F, some people feel as it is something normal, or something that they must do
39
How is the severity of BED slotted?
Based on the average amount of binge-eating episodes per week
40
Mild BED?
1-3
41
Moderate BED?
4-7
42
Severe BED?
8-13
43
Extreme BED?
14 or more
44
What are common characteristics of those with BED? (4)
- Obsessive thoughts focused on restricting, binge-eating - Excessive concerns about weight and shape - Long-term weight gain - No short-term weight loss when reaching abstinence
45
What are the 7 commonly observed dietary patterns in bulimia and BED? (FF-BARCD)
- Fasting - "Forbidden foods" which are usually binged on - Binge-eating - Avoidance of high-kcal foods - Removal of meals - CHO avoidance - Dieting history
46
What is the vicious cycle of BED?
Will not eat, because worried of binging but then the hunger will cause them to binge.
47
What is OFED?
Other Specified Feeding or Eating Disorder
48
What is atypical anorexia?
- OFED | - Weight within or above the "average" range for age and height
49
When in BN OFED?
When the binging/purging is of low frequency or limited duration
50
When is BED OFED?
When the binging is of low frequency or limited duration
51
What is purging disorder?
- OFED | - Persistant purging without binge eating
52
What is night-eating syndrome?
- OFED | - Excessive consumption of food following an evening meal or after waking from sleep in the night,
53
What can night-eating syndrome cause?
Extreme psychological distress and interferes with daily functioning.
54
What is ARFID?
Avoidant Restrictive Food Intake Disorder
55
What is the (1/4) ASPEN diagnostic criteria of ARFID?
Disturbance is manifested by persistent failure to meet appropriate nutritional/energy needs associated with one or more of 4 factors
56
What are the 4 factors that the failure of meeting nutrient/kcal needs in the diagnosis of ARFID?
- Significant weight loss - Significant nutrient deficiency - Dependance on EN or ONS - Marked interference with psychosocial functioning
57
What is the (2/4) ASPEN diagnostic criteria of ARFID?
The food disturbance cannot be explained by lack of available food or by an associated culturally sanctioned practice
58
What is the (3/4) ASPEN diagnostic criteria of ARFID?
The disturbance does not occur exclusively during the course on AN or BN, and there is no distortion in body image.weight (NOT driven by wanting to lose weight)
59
What is the (4/4) ASPEN diagnostic criteria of ARFID?
The disturbance is not attributed to a concurrent medical condition or mental disorder If it does, the severity exceeds what is routinely associated, which warrants additional clinical attention
60
When is ARFID more common?
In early childhood
61
(T/F) ARFID is characterized by concerns about body weight and size
F
62
How may ARFID develop?
- Food refusal | - Maladaptive coping strategies (distracted or forced feedings)
63
What is common in ARFID?
Anxiety
64
When is ARFID unresolved?
In 3-10% of children
65
What happens to many adults with ARFID?
Often referred to ED programs
66
AN prevalence?
0.5-1.0%
67
Prevalence of BN?
1-3%
68
BED women prevalence?
3%
69
BED men prevalence?
2%
70
BED in overweight people?
5-30%
71
BED in bariatric surgery patients?
40%
72
Alongside ED's what other illnesses may be present which increase comorbidities?
- Affective disorder - Anxiety - OCD - PTSD - Personality disorder - Substance misuse, dependance - ADHD
73
What causes an eating disorder?
Environmental factors and genetic predisposition
74
Give 5 examples of aberrant rules and rituals consistent with those with EDs
- Daily weighing - Eating alone - Measuring Food - No CHO - Excessive consumption of coffee, diet soda, smoking etc.
75
What are some examples of extreme concerns with weight and body image consistent with those with EDs?
- Frequent weighing - Measuring - Body checking - Comparing themselves to others - Social network
76
Explain how restrictive eating leads to binge-eating
Restrictive behaviours will lead to hunger, stress, negative emotions which will drive binge eating. After the binge, feelings of guilt, fear to gain weight and self disgust will ensue. These feelings will drive compensatory behaviours in effort to look for a sense of control over food intake and body weight - resulting int he original restrictive behaviour.
77
What are the effects of vomiting? How do they lead to ineffective weight control?
- Dehydration - Digestive resistance - Recurrent binge eating - Long-term weight gain
78
Explain how digestive resistance from vomiting will offset weight control efforts
Will become harder to vomit due to esophageal damage, burning of mouth/throat
79
Explain how recurrent binge eating is caused by vomiting in an effort to control weight
Vomiting can elicit an urge to eat more
80
What are the effects of laxative use?
- Dehydration and electrolyte losses | - Hyperaldosteronemia and edema
81
What are 3 examples of stimulant type laxatives?
- Bisacodyl - Senna - Cascara
82
What is our aim for those using laxatives?
Total abstinence or gradual decrease
83
What is the nutrition prescription for those on laxatives?
Adequate kcals. fibre and fluid rich
84
Why is weight gain expected after someone stops using laxatives?
Due to water rentention
85
Compulsive exercise is present in ____ of patients with ED's
75%
86
Why do people compulsively exercise?
- Lose calories, weight - Prevent weight gain - Cope with anxiety, negative emotions - To allow eating
87
What is the intervention in compulsive exercise?
Promote reduction or abstinence, this is a necessary step to get rid of a compulsive element, and also an obstacle to weight gain
88
Disordered eating is present in ___ of females adolescents and ___ in female athletes
13% | 20%
89
Disordered eating is present in ____ of male adolescents and in ______ of male athletes
3% | 8%
90
What is RED-S?
Relative Energy Deficit in Sport, effects of Performance
91
Give 5 consequences of RED-S
- Decreased muscle strength - Decreased glycogen stores - Depression - Impaired judgement - Deceased coordination
92
List 5 signs of ED's amongst athletes
- Frequent and prolonged visits to gyms - Frequent weighing - Km and kcal monitoring - Social withdrawal - Frequent injuries
93
Give 5 clinical warning signs for T1DM and EDs
- High HBA1C - Frequent ketoacidosis - Poor glycemic monitoring - Weight fluctuations - Less insulin adminstration - Frequent hospitalization
94
Give 5 behaviour signs of ED in T1DM
- Negative attitude towards diabetes - Excessive preocuppation with weight and body shape - Low intake of CHO - Missing appointments at diabetes clinic - Poor interest, withdrawn
95
What is the SCOFF questionnaire?
Used in screening ED's in T1DM
96
S of SCOFF?
Do you make yourself SICK because you feel uncomfortably full?
97
C of SCOFF?
Do you worry that you have lost CONTROL over how much you eat?
98
O of SCOFF?
Have you recently lost more than ONE stone (14 lbs) in a 3-mo period?
99
First F of SCOFF?
Do you believe yourself to be FAT when others say that you are too thin?
100
Second F of SCOFF?
Would you say that FOOD dominates your life OR Do you take less insulin than you should?
101
Explain the trajectory of re-gaining weight after recovering from AN (Study)
- Moderate BMI increase from remission to year 2 | - Modest increase from year 2 to year 5, then Plateau.
102
Do patients who recover from AN have a greater likelihood being overweight/obese in the years following their recovery?
NO, not when compared to average population (~30%) prevalence of overweight/obese in recovered AN is 17%
103
What is the particularity of the area of fat reagin of AN adolescents compared to adults?
- Adolescents: lose more central body fat | - Adults: lose more peripheral fat
104
Where does fat mass deposition lie in partial weight gain in female adolescents after AN?
In the trunk region
105
After short-term, partial, or complete weight restoration, adults show more ___ adiposity with respect to health and age matched controls
central
106
What is central adiposity associated with? What does it not adversely affect?
- Insulin resistance | - ED psychopathology or distress in female adults
107
When does abnormal fat distribution normalize?
After long-term maintenance of complete weight restoration

Clinical Nutrition 3 (30 decks)

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