Types of Eating Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Not Otherwise Specified (NOS)
Anorexia Nervosa Warning Signs Dramatic weight loss Refusal to eat certain foods or food categories (e.g. no fats, no carbs) Consistent excuses to avoid situations involving food Excessive and rigid exercise routine Withdrawal from usual friends/relativesSource: National Eating Disorders Association Website
Treatment for Anorexia1. Hospitalization First consideration- return the patient’s nutritional state Inpatient psychiatric treatment Behavioral management Individual psychotherapy Family education and therapy In some cases psychotropics
Treatment for Anorexia Pharmacotherapy No identified medication that yields definitive improvement of core symptoms of anorexia Some support for the use of cyproheptadine (Periactine) Amitryptiline (Elavil)- also been reported to have some benefit Other medications used with variable results Clomipramine, primozide, chlorpromazine
Treatment for Anorexia Pharmacotherapy cont. Trials with fluoxetine Some weight gain Serotonergic agents May yield positive responses in the future TCAs In low-weight patients may result in Hypotension, cardiac arrhythmia, dehydration Upon return of normal nutritional state TCAs may be introduced.
Bulimia Nervosa DSM-IV-TR Defined as binge eating combined with inappropriate ways of stopping weight gain
Bulimia Nervosa Warning Signs Wrappers/containers indicating consumption of large amounts of food Frequent trips to bathroom after meals Signs of vomiting e.g. staining of teeth, calluses on hands Excessive and rigid exercise routine Withdrawal from usual friends/relativesSource: National Eating Disorders Association Website
Bulimia Nervosa According to the DSM-IV-TR Bulimia nervosa is present when: Episodes of binge eating occur relatively frequently Twice a week or more for at least 3 month Compensatory behaviors are practiced after binge eating to prevent weight gain: Self-induce vomiting Laxative abuse Diuretics Abuse of emetics Severe dieting and strenuous exercise
Bulimia Nervosa According to the DSM-IV-TR Bulimia nervosa is present when: Cont. Wight is not severely lowered as in anorexia The patient has morbid fear of fatness A relentless drive for thinness Disproportionate amount of self-evaluation depends on body shape and wight
Treatment for BulimiaNervosa Pharmacotherapy Antidepressants Shown to be helpful SSRIs (Fluoxetine 60 to 80 mg/day) Reduce binge eating Imipramine (Tofranil) Desipramine (Norpramin) Trazodone (Desyrel) MAOIs have also been helpful Carbamazepine (Tegretol) and lithium (Eskalith) – have not shown impressive results. Mostly used in bulimic patients with comorbid mood disorders such as bipolar I disorder.
Obesity Accounts for: 25% of body weight in men 18% of body weight in women
Obesity Treatment Obesity treatment is multifactorial Treatment include Diet Exercise Psychotherapy Pharmacotherapy In extreme cases: Surgery
Obesity Pharmacotherapy –(See table 23.3-7 pg 746) Drug treatment is effective because it suppresses appetite but tolerance may develop Orlistat ( Xenical) approved by the FDA in 1999 for weight loss treatment (Currently sold OTC as “Alli” Selective gastric and pancreatic lipase inhibitor 120 mg 3 times a day in combination with a low calorie diet and exercise
Obesity Orlistat Prescription orlistat is used in overweight people who may also have: high blood pressure diabetes, high cholesterol heart disease. also used after weight-loss for maintenance .Orlistat is a lipase inhibitors. It prevents some of the fat in foods eaten from being absorbed in the intestines. This unabsorbed fat is then removed from the body in the stool.
Obesity Sibutramine (Meridia) β-phenylethylamine that inhibits reuptake of serotonin and epinephrine (and dopamine to a limited extent). Approved by the FDA in 1997 for weight loss treatment and maintenance Sibutramine is no longer available in the U.S. The manufacturer has decided to stop producing sibutramine based on information from a recent clinical study. In this study, people taking sibutramine had an increased risk of cardiovascular events such as heart attack and stroke
Obesity Orlistat- Side effects oily spotting on underwear or on clothing gas with oily spotting urgent need to have a bowel movement loose stools oily or fatty stools increased number of bowel movements difficulty controlling bowel movements pain or discomfort in the rectum (bottom) stomach pain irregular menstrual periods headache anxiety
Obesity Orlistat- Serious side effects- See doctor imnmediately hives rash itching difficulty breathing or swallowing severe or continuous stomach pain excessive tiredness or weakness nausea vomiting loss of appetite pain in the upper right part of the stomach yellowing of the skin or eyes dark-colored urine light-colored stools
Obesity Rimonabant first in a new class of therapeutic agents called Cannabinoid-1 Receptor Blockers (CB1). Shown to reduce body weight and reduce cv risk factors Dose 20 mg causes significant weight loss Reduction in waist circumference FDAs Endocrine and Metabolic Drugs Advisory Committee recommended against the approval of rimonabant (known in the United States as Zimulti) due to concerns over similar serious side effects. Subsequently, the FDA did not approve rimonabant, and it has never been marketed in the United States.
Resources www.mypyramid.gov National Institutes of Health Publication No 02-4084. The Practical Guide: Identification, Evaluation, and Treatment of overweight and obesity in adults http://win.niddk.nih.gov/index.htm www.obesity.org www.eatright.org www.consumer.gov/weightloss www.naaso.org www.shapeup.org. www.nwcr.ws/Research/default.htm www.acsm.org www.thelifestylecompany.com/