Member - Academy Of Nutrition & Dietetics. USA.
Eating Disorders Nutrition
Eating disorders are mental or psychiatric disorders that involve extreme concern over your body shape and weight resulting in serious emotional and physical problems. Anorexia, bulimia and binge eating disorder are quite common among people.
Diagnostic Criteria
Anorexia Nervosa
Anorexia nervosa (AN) is a life-threatening disorder where people assume themselves to be overweight when they are clearly underweight. During the entire life up to 4% of women have anorexia and it occurs nearly ten times more often in females than males. This extreme weight loss plan often stops menstrual periods in girls and women, a condition known as amenorrhea. Onset of this disorder occurs usually during adolescence or young adulthood. Young males with AN may have estrogen and testosterone deficiency and stunted growth and sexual development. AN has two subtypes namely restricting and binge eating/purging. Initially fitting into restricting subtype, AN may slowly proceed to purging as illness progresses. Negative self-image, perfection, anxiety disorder and over concern about body shape are few psychological factors connected with AN. Death rate is anywhere from 5% to 20% and more than 50% of deaths are due to medical complications.
Bulimia Nervosa
People with bulimia nervosa (BN) indulge in binge (eating unusually large quantities of food within a time gap of ≤2 hours) eating followed by abnormal behaviour to compensate for this by indulging in vomiting, fasting, excessive use of laxatives, exercise or a combination of these. About 2% to 3% of women have bulimia at some point in their lives. Unlike AN patients, people with BN have absolutely normal weight or may be slightly underweight or overweight. BN patients are extremely discreet and immensely unhappy with their body shape and weight. BN is subdivided into purging and nonpurging types. Patients under purging types involve themselves in vomiting and use of laxatives. Those under the nonpurging category engage themselves in strict fast or stringent exercise. Frustration, depression, anxiety disorders and self-injurious behaviour are often common in this disease. Etiology for BN includes family, cognitive-behavioral, addictive and psychodynamic models.
Eating Disorders Not Otherwise Specified
Almost 50% of people with eating disorders fall under eating disorder not otherwise specified (EDNOS) category. These people meet most of the AN or BN yardstick but not all of it. But treatment for EDNOS should be exactly same as AN or BN patients.
Binge Eating Disorder
Binge eating disorder (BED) is similar to that seen in BN without any abnormal behaviour after the binge. BED patients experience distress, powerlessness, guilt and depression after a binge. Here also women are 1.5 times more likely to develop this disorder than men. BED disorder is usually coupled with night eating syndromes (NES) where more than half of the required energy is consumed during night dinner and before breakfast.
Eating Disorders in Children
Eating disorders usually start during adolescence or young adulthood. A child can be diagnosed with eating disorder if he/she is riveted with body shape, weight, eating less and exercise. AN is prevalent in children as young as 7 years while BN in kids are rare. Reliable reports suggest that children with eating conflicts struggle with meals and unpleasant food were likely to develop eating disorder as young adults.
Eating Disorders in Athletes
Eating Disorder is also a problem in competitive athletes. Female athletes involved in ballet dancing, gymnasium, figure skating and male athletes into bodybuilding and wrestling are most vulnerable. Pressure within the athlete, from family and trainers to achieve ridiculously low body weight leads to female athlete triad-a syndrome having eating disorders, amenorrhea and osteoporosis.
Eating Disorders in Individuals with Diabetes Mellitus
When type 1 or 2 diabetes mellitus (DM) patients develop eating disorders, a combination of medical, nutritional and psychological intervention is required to cure the disease. Type 1 DM patients usually have AN, BN or EDNOS and type 2 DM patients suffer BED.
Treatment Approach
Treatment is usually a combination of medical, nutritional and psychological intervention. Also several types of care like hospitalization, residential treatment, intensive outpatient treatment and outpatient treatment are provided depending on the austerity of the disease.
Clinical Characteristics and Medical Complications
Though eating disorders are primarily psychiatric, these medical complications result in morbidity and mortality. Various physiological changes have long-term consequences which can sometimes be life threatening.
Anorexia Nervosa
You can easily guess a person with AN as they have a typical and distinctive appearance. Protein-energy malnutrition, gastrointestinal complications and osteopenia (reduced bone mineral density, BMD) are medical complications of AN. Treatment includes weight gain and calcium-vitamin supplementation.
Bulimia Nervosa
As people with BN are discreet and normal weighted, it is difficult to gauge signs and symptoms of the disease. Evidence during vomiting such as scarring of the dorsum of the hand used to stimulate the gag reflux, parotid gland enlargement and erosion of dental enamel with increased dental caries maybe helpful in identifying the disease. Chronic vomiting can result in dehydration. Clinical manifestations include sore throat, abdominal pain and gastrointestinal problems.
Psychological Management
Turning back into a patient’s history, family dynamics and psychopathology for clues regarding the development of any eating disorder is essential to treat a person accurately. Compared to AN patients, people with BN are open towards psychological intervention to cure their ailment. Psychotherapy is combined with cognitive behavioral therapy (CBT) through the treatment process where the individual is made to understand and change his/her attitude, motive and feeling towards the disorder.
Nutrition Assessment
Nutrition assessment includes the details elaborated below.
Diet History
Patients with AN generally consume less than 1000kcal/day. These people overestimate their food and energy intake thus reducing the quantity potentially. The challenge is to calculate the energy intake of BN patients. The caloric content during a binge and the amount of calories absorbed after purging make calorie estimation challenging. Though patients assume that purging leads to all the calories being flushed out of the body, the truth is that only 50% of the calorie is lost and the rest remains within the body.
AN patients usually are vegetarians thus having reduced protein content. Many AN patients lack vitamin D, folate, zinc, calcium, magnesium and vitamin B12. The nutrition intake of a BN patient depends on binge eating and restriction. Always have an eye on the fluid intake of these eating disorder individuals as they tend to drink enormous amount of water to fend off starvation.
Eating Behavior
Eating disorder patients categorize food as ‘good’ and ‘bad’. Many patients save their food until the latter part of the day while the rest are scared of eating past a certain time limit. BN patients tend to identify foods that may cause a binge episode and avoid them. It is better to reintroduce these avoided foods in small quantities at regular intervals into their meals.
AN patients tend to eat as slow as a snail to avoid excessive intake of food but this mannerism is an effect of starvation.
Laboratory Assessment
AN patients usually have high serum cholesterol levels in spite of minimal eating and low-fat diets. Patients with BN sometimes have abnormal lipid levels. BN patients eat low-fat, low-energy foods during restriction phase and high-fat, high-sugar foods during binge episodes.
Vitamin and Mineral Deficiencies
AN patients are deficient in riboflavin, vitamin B6, thiamin, niacin, folate and vitamin E while iron deficiency is uncommon in them. Zinc and energy deficiency result as a result of vegetarian choices. BN patients may be deficient in vitamin K levels.
Subheadings ‘Fluid and Electrolyte Balance’, ‘Energy Expenditure’ and ‘Anthropometric Assessment’ have been omitted.
Medical Nutrition Therapy and Counseling
Treatment varies depending on the intensity of the disease. Some AN patients begin treatment with inpatient hospitalization and the intensity of the treatment is gradually decrease with malnutrition rehabilitation and weight restoration programs. Other AN patients undergo treatment as outpatients.
Most BN patients undergo treatment as outpatients only. Hospitalization is very rare, maybe for specific purposes like fluid or electrolyte stabilization.
Anorexia Nervosa
The ultimate aim of any type of treatment includes restoration of the ideal body weight and dietary changes in the eating techniques. Hospitals differ in making meal plans. Some institutions make a fixed meal plan themselves while others include the patient in charting out a diet plan.
In outpatient treatment monitoring the diet pattern of the patient is very difficult as they have less control over the energy intake and food choices. The RD can take up counseling, motivate the patients and help them come out of their tightly wound cocoon and explore the food choices available.
The ultimate aim of any treatment is weight gain. Calorie increment must be done gradually as over packing calories may sometimes lead to life threatening diseases. The number of meals and in between snacks should also be smartly inserted to avoid the ‘guilty feeling’ of the patient. Liquid supplements are of mammoth use as they supply a reasonable amount of calories per fluid drink and also make the patients feel that they have consumed a low-calorie diet.
Bulimia Nervosa
BN patients are mostly outpatients. The binging and purging action of the patients indicate their interest in weight loss. Weight reduction is a long-term process and the first step of treatment should be to restore normal eating habits and stop the binge-purge action in BN patients. Constant motivation and positivity to BN patients help them to follow a normal diet regime without going back to the binge eating pattern. Cognitive behavioral therapy (CBT) is a widely used psychotherapeutic technique to change the attitude and approach of the patient. BN patients are more willing to take up therapy than AN patients. So, with proper channeling of the treatment process positive results are surely achievable.
Binge-Eating Disorder
Nutrition modifications and weight management are the primary treatment options available for BED. Although the treatment may yield positive results, relapse may occur. Few programs concentrate on reducing the binge episodes rather than focusing on weight loss.
Subheading ‘Monitoring Nutritional Rehabilitation’ has been omitted
Nutrition education is an indispensable part of treatment. Weight management, nutrition balance and a positive attitude to any treatment would definitely yield great outcomes. Relapse is possible in both AN and BN patients. This must again be managed with utmost responsibility by the RD and cooperation from the patient.
Eating disorders are mental or psychiatric disorders that involve extreme concern over your body shape and weight resulting in serious emotional and physical problems. Anorexia, bulimia and binge eating disorder are quite common among people.
Diagnostic Criteria
Anorexia Nervosa
Anorexia nervosa (AN) is a life-threatening disorder where people assume themselves to be overweight when they are clearly underweight. During the entire life up to 4% of women have anorexia and it occurs nearly ten times more often in females than males. This extreme weight loss plan often stops menstrual periods in girls and women, a condition known as amenorrhea. Onset of this disorder occurs usually during adolescence or young adulthood. Young males with AN may have estrogen and testosterone deficiency and stunted growth and sexual development. AN has two subtypes namely restricting and binge eating/purging. Initially fitting into restricting subtype, AN may slowly proceed to purging as illness progresses. Negative self-image, perfection, anxiety disorder and over concern about body shape are few psychological factors connected with AN. Death rate is anywhere from 5% to 20% and more than 50% of deaths are due to medical complications.
Bulimia Nervosa
People with bulimia nervosa (BN) indulge in binge (eating unusually large quantities of food within a time gap of ≤2 hours) eating followed by abnormal behaviour to compensate for this by indulging in vomiting, fasting, excessive use of laxatives, exercise or a combination of these. About 2% to 3% of women have bulimia at some point in their lives. Unlike AN patients, people with BN have absolutely normal weight or may be slightly underweight or overweight. BN patients are extremely discreet and immensely unhappy with their body shape and weight. BN is subdivided into purging and nonpurging types. Patients under purging types involve themselves in vomiting and use of laxatives. Those under the nonpurging category engage themselves in strict fast or stringent exercise. Frustration, depression, anxiety disorders and self-injurious behaviour are often common in this disease. Etiology for BN includes family, cognitive-behavioral, addictive and psychodynamic models.
Eating Disorders Not Otherwise Specified
Almost 50% of people with eating disorders fall under eating disorder not otherwise specified (EDNOS) category. These people meet most of the AN or BN yardstick but not all of it. But treatment for EDNOS should be exactly same as AN or BN patients.
Binge Eating Disorder
Binge eating disorder (BED) is similar to that seen in BN without any abnormal behaviour after the binge. BED patients experience distress, powerlessness, guilt and depression after a binge. Here also women are 1.5 times more likely to develop this disorder than men. BED disorder is usually coupled with night eating syndromes (NES) where more than half of the required energy is consumed during night dinner and before breakfast.
Eating Disorders in Children
Eating disorders usually start during adolescence or young adulthood. A child can be diagnosed with eating disorder if he/she is riveted with body shape, weight, eating less and exercise. AN is prevalent in children as young as 7 years while BN in kids are rare. Reliable reports suggest that children with eating conflicts struggle with meals and unpleasant food were likely to develop eating disorder as young adults.
Eating Disorders in Athletes
Eating Disorder is also a problem in competitive athletes. Female athletes involved in ballet dancing, gymnasium, figure skating and male athletes into bodybuilding and wrestling are most vulnerable. Pressure within the athlete, from family and trainers to achieve ridiculously low body weight leads to female athlete triad-a syndrome having eating disorders, amenorrhea and osteoporosis.
Eating Disorders in Individuals with Diabetes Mellitus
When type 1 or 2 diabetes mellitus (DM) patients develop eating disorders, a combination of medical, nutritional and psychological intervention is required to cure the disease. Type 1 DM patients usually have AN, BN or EDNOS and type 2 DM patients suffer BED.
Treatment Approach
Treatment is usually a combination of medical, nutritional and psychological intervention. Also several types of care like hospitalization, residential treatment, intensive outpatient treatment and outpatient treatment are provided depending on the austerity of the disease.
Clinical Characteristics and Medical Complications
Though eating disorders are primarily psychiatric, these medical complications result in morbidity and mortality. Various physiological changes have long-term consequences which can sometimes be life threatening.
Anorexia Nervosa
You can easily guess a person with AN as they have a typical and distinctive appearance. Protein-energy malnutrition, gastrointestinal complications and osteopenia (reduced bone mineral density, BMD) are medical complications of AN. Treatment includes weight gain and calcium-vitamin supplementation.
Bulimia Nervosa
As people with BN are discreet and normal weighted, it is difficult to gauge signs and symptoms of the disease. Evidence during vomiting such as scarring of the dorsum of the hand used to stimulate the gag reflux, parotid gland enlargement and erosion of dental enamel with increased dental caries maybe helpful in identifying the disease. Chronic vomiting can result in dehydration. Clinical manifestations include sore throat, abdominal pain and gastrointestinal problems.
Psychological Management
Turning back into a patient’s history, family dynamics and psychopathology for clues regarding the development of any eating disorder is essential to treat a person accurately. Compared to AN patients, people with BN are open towards psychological intervention to cure their ailment. Psychotherapy is combined with cognitive behavioral therapy (CBT) through the treatment process where the individual is made to understand and change his/her attitude, motive and feeling towards the disorder.
Nutrition Assessment
Nutrition assessment includes the details elaborated below.
Diet History
Patients with AN generally consume less than 1000kcal/day. These people overestimate their food and energy intake thus reducing the quantity potentially. The challenge is to calculate the energy intake of BN patients. The caloric content during a binge and the amount of calories absorbed after purging make calorie estimation challenging. Though patients assume that purging leads to all the calories being flushed out of the body, the truth is that only 50% of the calorie is lost and the rest remains within the body.
AN patients usually are vegetarians thus having reduced protein content. Many AN patients lack vitamin D, folate, zinc, calcium, magnesium and vitamin B12. The nutrition intake of a BN patient depends on binge eating and restriction. Always have an eye on the fluid intake of these eating disorder individuals as they tend to drink enormous amount of water to fend off starvation.
Eating Behavior
Eating disorder patients categorize food as ‘good’ and ‘bad’. Many patients save their food until the latter part of the day while the rest are scared of eating past a certain time limit. BN patients tend to identify foods that may cause a binge episode and avoid them. It is better to reintroduce these avoided foods in small quantities at regular intervals into their meals.
AN patients tend to eat as slow as a snail to avoid excessive intake of food but this mannerism is an effect of starvation.
Laboratory Assessment
AN patients usually have high serum cholesterol levels in spite of minimal eating and low-fat diets. Patients with BN sometimes have abnormal lipid levels. BN patients eat low-fat, low-energy foods during restriction phase and high-fat, high-sugar foods during binge episodes.
Vitamin and Mineral Deficiencies
AN patients are deficient in riboflavin, vitamin B6, thiamin, niacin, folate and vitamin E while iron deficiency is uncommon in them. Zinc and energy deficiency result as a result of vegetarian choices. BN patients may be deficient in vitamin K levels.
Subheadings ‘Fluid and Electrolyte Balance’, ‘Energy Expenditure’ and ‘Anthropometric Assessment’ have been omitted.
Medical Nutrition Therapy and Counseling
Treatment varies depending on the intensity of the disease. Some AN patients begin treatment with inpatient hospitalization and the intensity of the treatment is gradually decrease with malnutrition rehabilitation and weight restoration programs. Other AN patients undergo treatment as outpatients.
Most BN patients undergo treatment as outpatients only. Hospitalization is very rare, maybe for specific purposes like fluid or electrolyte stabilization.
Anorexia Nervosa
The ultimate aim of any type of treatment includes restoration of the ideal body weight and dietary changes in the eating techniques. Hospitals differ in making meal plans. Some institutions make a fixed meal plan themselves while others include the patient in charting out a diet plan.
In outpatient treatment monitoring the diet pattern of the patient is very difficult as they have less control over the energy intake and food choices. The RD can take up counseling, motivate the patients and help them come out of their tightly wound cocoon and explore the food choices available.
The ultimate aim of any treatment is weight gain. Calorie increment must be done gradually as over packing calories may sometimes lead to life threatening diseases. The number of meals and in between snacks should also be smartly inserted to avoid the ‘guilty feeling’ of the patient. Liquid supplements are of mammoth use as they supply a reasonable amount of calories per fluid drink and also make the patients feel that they have consumed a low-calorie diet.
Bulimia Nervosa
BN patients are mostly outpatients. The binging and purging action of the patients indicate their interest in weight loss. Weight reduction is a long-term process and the first step of treatment should be to restore normal eating habits and stop the binge-purge action in BN patients. Constant motivation and positivity to BN patients help them to follow a normal diet regime without going back to the binge eating pattern. Cognitive behavioral therapy (CBT) is a widely used psychotherapeutic technique to change the attitude and approach of the patient. BN patients are more willing to take up therapy than AN patients. So, with proper channeling of the treatment process positive results are surely achievable.
Binge-Eating Disorder
Nutrition modifications and weight management are the primary treatment options available for BED. Although the treatment may yield positive results, relapse may occur. Few programs concentrate on reducing the binge episodes rather than focusing on weight loss.
Subheading ‘Monitoring Nutritional Rehabilitation’ has been omitted
Nutrition education is an indispensable part of treatment. Weight management, nutrition balance and a positive attitude to any treatment would definitely yield great outcomes. Relapse is possible in both AN and BN patients. This must again be managed with utmost responsibility by the RD and cooperation from the patient.