Eating disorders

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Eating disorders

  1. 1. EATING DISORDERS A s’eclairer teaching topic
  2. 2. EATING DISORDERS • Obesity (55% of U.S. population) -Second leading preventable cause of death after smoking • Anorexia nervosa (10% mortality) -Below 85% ideal body weight • Bulimia (unknown mortality) -Binge eating, normal weight
  3. 3. IDEAL BODY WEIGHT • Men- 106 plus 6 -for a man 5’ 7” -106 plus 7 times 6 = 148 lbs Women- 105 plus 5 -for a woman 5’ 3” -105 plus 3 times 5 = 120 lbs
  4. 4. BODY MASS INDEX • Weight in kilograms divided by height in meters squared -For a man 5’ 7” and 148 lbs -67 inches = 1.7 meters -148 lbs = 67.3 kilograms • 67.3 kg divided by 1.7 M squared= 23.3
  5. 5. BMI RANGES • Underweight- Below 18.5 • Normal- 18.5 to 24.9 • Overweight- 25 to 29.9 • Obesity I 30 to 34.9 • Obesity II 35 to 39.9 • Extreme 40 or more
  6. 6. OBESITY RISKS • Hypertension • Coronary heart disease • Stroke • Type 2 diabetes • Gallbladder disease • Kidney stones • Osteoarthritis • Sleep apnea • Dementia • Select cancers • Menstrual irregularities • Amenorrhea • Polycystic ovary syndrome
  7. 7. WEIGHT LOSS STRATEGY • Take in fewer calories per day than are burned i.e. diet and exercise • Reduce energy intake by 300 to 500 kcal/day • Adhere to diet (it doesn’t matter which one) • Keep track of calories
  8. 8. MAJOR DIETS • ATKINS- low carb • Ornish- fat restricted • Weight Watchers- portion and calorie restricted • Zone- low glycemic index • One year weight loss 4.6 to 7.3 lbs irrespective of diet (adherence is what matters)
  9. 9. EXERCISE • FEDERAL GUIDELINES: -To lose weight: 60 min/ day -To maintain weight loss: 90 min/day Foregoing guidelines appear highly unrealistic for someone working full time.
  10. 10. WEIGHT LOSS DRUGS • APPROVED FOR LONG TERM USE: -Silbutramine (Meridia) in combination with a reduced- calorie diet, for 16 yrs and older -Orlistat (Xenical, Alli)
  11. 11. SILBUTRAMINE • AN APPETITE SUPPRESSANT -Blocks serotonin and norepinephrine reuptake -Has antidepressant actions -10 to 15 mg /day -10 to 15 lbs over 12 months -Early responders do best (4 lbs over 4 weeks) -Headache, dry mouth, constipation, insomnia, nervousness
  12. 12. ORLISTAT • REDUCES ABSORPTION OF FAT -Inhibits gastric and pancreatic lipases that break down triglycerides -Fat absorption is reduced 30% -Reduces LDL cholesterol -Increases HDL -Reduces blood glucose -Lowers blood pressure
  13. 13. OTHER WEIGHT LOSS MEDS • APPETITE SUPPRESSANTS -Wellbutrin -Prozac -Topamax • SUGAR SUBSTITUTES -Sweet ‘N Low (saccharin) -Splenda (sucralose) -Neotame
  14. 14. LEPTIN SIGNALLING • 1994 – Jeffrey Friedman MD, Rockefeller University, discovers leptin • LEPTIN (a hormone) is produced by adipose cells • Leptin signals the hypothalamus that no more food is needed to meet metabolic needs • Obese patients appear to have Leptin insensitivity • They continue to eat more than their metabolism requires • The excess calories increase the size of adipose cells
  15. 15. REFERENCES • Kupfer DJ et al, DSM-5, American Psychiatric Association, 2013. • Lehne RA, Pharmacology for Nursing Care, Seventh Edition, Saunders Elsevier, St Louis, Missouri, 2010.

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