1. Eating Disorders Epidemiology; 4% of adolescent and young adults students Anorexia nervosa has\been reported more frequently over the past several decades with increasing reports of the disorder in the prebubertal girls and in boys

2. Anorexia nervosa

3. Anorexia nervosa ---concept / etiology

4. Derived from the Greek word.loss of appetite and Latin word implying nervous in origin,it’s a syndrome characterized by 3 features 1-self induced starvation to a significant degree 2- relentless drive for thinness or morbid features of fatness 3-presence of medical signs and symptoms AN 1% BN 1-3% Female : male = 10 :1 Onset : AN-13-20 years old BN -16.5 –18 years old Mortality :5-10%

5. Etiology, Risk factors 1- multifactorial 2-individual : perfectionism and impulse to control 3-familial ; family effect,dysfunctional family environment 4-cultural factors ; common in industrialized societies,effect of media,others 5-genetic factors Risk factors 1-women who by career choice are expected to be thin

6. 2-family history (mood disorders, eating disorders,substance abuse ) 3-psychiatric illness 4-obesity 5-chronic medical illness like DM 6-history of sexual abuse AN-Anorexia nervosa -diagnosis 1-Refusal to maintain above 85% of expected wt for age and height 2-fear of becoming obese even though under weight 3- abnormal perception of body image –wt,size,age 4-absence of.> 3 consecutive menstrual cycle

7. Thinness is not a required features among our Arab culture that explain the rarity of the AN syndrom Types ; 1-restricting.no binge eating or purging 2- binge eating /purging during episode of AN Patients show strange behavior about food like ;hiding food, carry sweets in pockets,during eating they throw food,rearrange pieces,they deny this unusual behavior Obsessive Compulsive behavior,depression,and anxiety are other psychiatric symptoms related to AN Patient personality is rigid,somatic complains usually stomach discomfort Patient come to doctors when sever wt loss

8. Physical signs 1-Hypothermia 2-dependent edema 3- brady cardia and hypotension 4-lanugo hair (like baby hair in the body ) 5-amenorrhea 6-Hypokalemia and electrolyte disturbance due to use of laxative,diuretics, emetics,sever exercises 7-ECG changes such as T wave flattening or inversion

9. Complications 1- death 20% due to hypokalemia,dehydration Mesentric artery thrombosis,inflamation of salivay glands, Dental erosion Seizures

10. BN

11. Diagnosis 1-frequent binge eating ; loss of control over eating behavior, or eating in discrete periods of time an amount of food larger than normal 2- self induced vomiting,ipecac,laxatives,amphetamines,diuretics,emetics,bowel wash At least 2 aweek for the last 3 months Neglect to self image

12. Treatment Biological : 1- Reversal of starvation effect 2- Anti –depressants Psychological treatment : 1-reality oriented feed back 2- recognition of risk 3- education and good relation ship with the therapist Social treatment 1-modefy the effect of culture on women 2-family therapy 3- education regarding eating behavior

13. Medical treatment of AN Hospitalization : calculation of in put and urine output,daily wt of the patient, investigations Prevent vomiting Plan for feeding 1200-2000 calorie /day Psychotherapy No leave Prognosis : Few recover without recurrence Good prognosis associated with onset before 15 Wt gain within 2 years after treatment Poor prognosis associated with later onset,previous admission,family problem

14. Obesity

15. obesity Excess body fat in healthy individual,normaly body fat for,brain ms 25 % of woman body and 18% of man body BMI body mass index is the scale to measure obesity 20- 25 kg/m 2 represent healthy wt BMI 25-27 kg/m2 mild risk > 27 lg/m2 increased risk > 30 high risk 34% of general population is overweight Genetics,lack of activity,increase rich diet,brain damage to satiety centers