1. anorexia nervosa & bulimia nervosa
By : Payam Farahbakhsh
Clinical Nutritionist

2. AN & BN
Both are characterized by an overvalued fear of fatness that drives a set of disturbed behaviors, including :
restricting food intake
binge eating
excessive exercise
self-induced vomiting
abuse of laxatives, diuretics, and diet pills

3. OVERVIEW OF EATING DISORDERS
Anorexia Nervosa
AN is a syndrome of self-starvation characterized by weight loss to a level below 85% of expected body weight.
Weight loss is accompanied by fear of fatness and, in girls and women, amenorrhea or the absence of 3 or more consecutive menstrual cycles.

4. OVERVIEW OF EATING DISORDERS
Bulimia Nervosa 1
BN is a dieting disorder characterized by episodes of binge eating followed by compensatory behaviors aimed at preventing weight gain.

5. Bulimia Nervosa
consumption of an amount of food definitely larger than most people would eat in a similar period, under similar circumstances, and is associated with a sense of loss of control over eating.
Typical binge foods are high-fat , high- calorie, “forbidden” foods, and amounts consumed are 1000 to 2000 calories or more per binge.

6. BED (binge-eating disorder)
regular binge eating, twice a week or more, associated with a subjective sense of loss of control over eating but lacking the compensatory behaviors typical of BN.
Patients with BED are more likely to be overweight or obese.

7. Atypical eating disorders
Globus hystericus, or fear of swallowing, resulting in :
severe weight loss
functional impairment
psychogenic vomiting syndromes.

8. EPIDEMIOLOGY
Epidemiologic data on eating disorders is limited for several reasons. AN : The prevalence of AN among young women is approximately 0.3% F/M : 10 Onset :15 to 19 years BN : The prevalence of BN among young women is approximately 1% F/M : 10 Onset :20 to 24 years

9. EPIDEMIOLOGY BED prevalence : 2% to 3% female-to-male 2:1
Onset : 30 to 50 years .
Rates of BED are much higher, on the order of approximately 25% , in clinical samples of obese individuals seeking weight-loss treatment.

10. ETIOLOGY 1
Genetics
polymorphisms in serotonin and dopamine-related genes
leptin and estrogen receptors
Personality
low self-esteem
Perfectionism

11. ETIOLOGY Socio cultural Factors Mass Media Peers Family
Developmental Factors
ovarian hormones
sexual development

13. CONSEQUENCES AND COMPLICATIONS 1
Social and Developmental Complications
Psychologic Complications
low mood
apathy
anhedonia
decreased concentration and energy
alcohol abuse
anxiety disorders

14. CONSEQUENCES AND COMPLICATIONS
Physical Complications and Signs
1-Starvation-Related Complications:
Malnutrition and starvation
muscle wasting and weakness
bradycardia
hypotension
hypothermia
amenorrhea and infertility
cold intolerance
constipation
Anemia
Osteoporosis
hypoglycemia

15. CONSEQUENCES AND COMPLICATIONS
2-Purging-Related Complications:
parotid and salivary gland hypertrophy
Dental caries
reflux
renal damage and nephrocalcinosis
electrolyte and acid–base imbalances

16. TREATMENT
Initial treatment goals include normalizing eating patterns and restoring weight in underweight patients by using behavioral psychotherapeutic interventions.

17. TREATMENT Evidence-Based Treatment
cognitive behavioral treatment (CBT)
Interpersonal psychotherapy(IPT)
Family therapy
Medications
Olanzapine
fluoxetine

18. TREATMENT Role of the Nutritionist Three regular meals a day
eating normal portion sizes
expanding food repertoire (which is often very narrow)
avoiding diet foods
Patients should be encouraged to consume all foods in moderation and in normal combinations and to avoid fat-free or sugar-free diet products.

19. TREATMENT
Vegetarianism that develops after the onset of dieting behavior is common in both AN and BN
diabetic exchange system without focus on calorie counting
with BN or BED should be instructed to eat approximately2000 kcal/day with an initial goal of weight maintenance.

20. TREATMENT
Patients with AN who need to gain weight should be instructed to consume the same normal, healthy, 2000-cal diet plus three high-calorie liquid supplements between meals, totaling an additional 1000 to 1500 kcal/day to gain weight.
patients are strongly motivated to restrict their intake to low–calorie density foods

21. Enteral and Parenteral Feeding
When access to a specialized behavioral inpatient eating disorders program is limited, however, an attempt at enteral feeding for severely underweight individuals who fail to gain weight with oral feeding may be warranted.
The use of TPN has been described as a means of supplementation for AN patients who are refusing oral or nasogastric feeding.

22. Prognosis and Outcomes
Outcome studies of AN and BN suggest that approximately:
50% recover fully
25% to 30% improve significantly
15% to 20% continue to have unrelenting eating disorders
mortality rates:
1% to 13% in AN
0% to 3% in BN

23. Thank you