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Eating disorder
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- 3. Main disorders ofeating include ♣ Anorexia nervosa ♣ Bulimia nervosa ♣ Binge-Eating Disorder ♣ Pica ♣ Compulsive Overeating ♣ Compulsive water drinking (compulsive polydipsia)
- 4. I. OBESITY Excessive accumulationof fat in the body. By convention, body weight exceeds by 20 % in the standard weight used in the usual height- weight table.
- 5. EPIDEMIOLOGY ♣ Age –20-50 years ♣ Sex – women > men ♣ Occupational status ♣ Common in black women & white men ♣ 26% of American adults or about 34million people aged between 20-75 years are overweight
- 6. DETERMINANTS OF OBESITY 1.Heredity 2. Developmental determinants 3. Physical activity 4. Brain damage 5. Endocrine factors 6. Drugs 7. Emotional determinants
- 7. CLINICAL FEATURES • Increasein body weight & encompassing mass of fatty tissue • Pressure on thorax • Orthopedic disturbance • Amenorrhea & menstrual disturbances • Abdominal & diaphragmatic hernias • Varicose vein • Hyperlipidaemia • Hypertension
- 8. DIAGNOSTIC EVALUATION • Appearance •Measurement of height and weight • Obesity is indicated by a reading above 20mm in a man, and 28mm in a woman.
- 9. MANAGEMENT • Most patientsdo not come to the treatment • Motivate & educate • Reduce energy intake or by increasing out put • No ‘slimming foods’ or ‘slimming tablets’ • Behaviour therapy Pharmacological treatment • Appetite suppressants – Amphetamine, Fenfluramine, Glycerol. • MAO inhibitors, Tricyclic antidepressants. (Phenytoin, Fluoxetine) Contd...
- 10. • Diet • Therapeuticstarvation • Exercise • Surgery ♦ Lipectomy ♦ Abdominal balloon ♦ Intestinal bypass
- 11. II. ANOREXIA NERVOSA Itis characterized by a significant weight loss resulting from excessive dieting. Persons are motivated by the strong desire to be thin and a fear of becoming obese. INCIDENCE • Females > males • < Adolescence (13-19 yrs) • 10 to 20% will eventually die from complications • In India 0.2 to 10 / lac • Approximately one in 250 girls at puberty
- 12. ETIOLOGY Psychological theories Personal andfamily characteristics Life events
- 13. CLINICAL FEATURES ♠ Noticeableweight loss ♠ Becoming withdrawn ♠ Excessive exercise ♠ Fatigue ♠ Always being cold ♠ Muscle weakness ♠ Obsession with food, calories, recipes ♠ Excuses for not eating meals ♠ Unusual eating habits
- 14. • Feel "toofat", • Cooking for others, but not eating themselves • Restricting food choices • Guilt or shame about eating • Depression, mood swings • vomiting, laxative, diet pills or diuretics abuse. • Irregular menstruation • Wearing baggy clothes to hide weight loss • Frequently checking weight
- 16. PHYSICAL/MEDICAL COMPLICATIONS • Fatigue •Amenorrhea • Skin problems • Dizziness and headaches • Dehydration • Shortness of breath • Irregular heartbeats • Cold hands and feet • Bloating • Constipation • Hair loss • Edema • Lanugo • Loss of bone mass • Kidney & liver damage • Electrolyte imbalance • Osteoporosis • Insomnia • Infertility • Depression • Anorexia Tardive
- 17. • Refusal tomaintain weight gain over a minimal of weight for age and height. • Intense fear of weight gaining • Disturbance in the one’s body weight & shape. • In female, absence of at least 3 menstrual cycles Diagnosis: DSM III-R Criteria
- 18. MANAGEMENT i) Behaviour therapy ii)Individual psychotherapy iii) Hospitalization vi)Drugs ♠ Chlorpromazine ♠ Antidepressants (e.g Fluoxetine,clomipramine) ♠ Cyproheptadine-Dose is 8-32 mg/day in dived dose. v) Family therapy & group therapy vi) Electro convulsive therapy
- 19. III. BULIMIA NERVOSA Bulimiais characterized by a cycle of binge eating followed by purging to try and rid the body of unwanted calories. Purging methods usually involve vomiting and laxative abuse. EPIDEMIOLOGY • Exact prevalence is not known • More common in females than male • Usually begins in adolescence or early adulthood • More in upper and middle socioeconomic
- 20. SIGNS AND SYMPTOMS •Binge eating • Secretive eating • Bathroom visits after eating • Vomiting • Laxative, diet pill or diuretic abuse • Weight fluctuations • Swollen glands • Broken blood vessels • Harsh exercise regimes
- 21. • Fasting • Moodswings • Depression • Severe self-criticism • Fear of not being able to stop eating voluntarily • Self-deprecating thoughts following eating • Fatigue • Muscle weakness • Tooth decay
- 23. Physical/Medical Complications • Fatigueand lack of energy • Amenorrhea • Dizziness • Headaches • Dehydration • Constipation and diarrhea • Shortness of breath • Irregular heartbeats • Depression • Tears of esophagus vv • Hair loss • Bloating • Erosion of teeth enamel • Chronic sore throat • Kidney & liver damage • Parotid gland enlargement • Anemias • Cardiac arrest
- 24. MANAGEMENT i) Hospitalization ii) Behaviourtherapy iii) Cognitive therapy vi) Drugs ♦TCA (E.g: Imipramine, clomipramine) ♦ MAO inhibitors (Moclobemide) ♦ Lithium ♦ Carbazepine
- 25. IV) BINGE-EATING DISORDER Binge-eatingdisorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control over his or her eating. Unlike bulimia, binge-eating episodes are not followed by purging, excessive exercise or fasting. COMPLICATIONS • Psychological distress • Cardiovascular disease and hypertension
- 26. TREATMENT • Smilar tothose used to treat bulimia. • Antidepressants • Aappetite suppressants. • Psychotherapy, especially CBT, & individual or group environment.
- 27. V) PICA It isdefined as persistent eating of non-food products such as dirt, clay, paper, plaster, string, hair or cloth. EPIDEMIOLOGY • Uncommon disorder • Estimated between 20-30% with peak at 20-26 months. • Common in both sexes
- 28. ETIOLOGY i) Cultural acceptance ii)Emotional factors iii) Organic factors ♣ Mental retardation ♣ Iron deficiency anemia and worm infestation
- 29. COMPLICATIONS • Led poisoning •Hair ball in the stomach • Iron & Zinc deficiency • Other diseases Management – Dangerous objects should be removed – Infant stimulation programs – Guidance to the parents – Training if child MR – Correct emotional causes.
- 30. VI) COMPULSIVE OVEREATING Compulsiveovereating is characterized by uncontrollable eating and consequent weight gain. Compulsive overeaters use food as a way to cope with stress, emotional conflicts and daily problems. ETIOLOGY ♠ More in males ♠ Victims sexual abuse ♠ Improper coping of stressful situations
- 31. SIGNS AND SYMPTOMS •Binge eating • Fear of not being able to stop eating voluntarily • Depression • Withdrawing from activities • Going on many different diets • Eating little in public • Believe better person when thin • Feelings about self based on weight • Weight is focus of life
- 32. PHYSICAL/MEDICAL COMPLICATIONS • Weightgain • Hypertension or fatigue • Heart ailments • Mobility problems • Diabetes • Arthritis • Sciatica • Varicose veins • High blood pressure • Shortness of breath • High Cholesterol levels • Cardiac arrest and death • Hiatus hernia • Embolism
- 33. VII) COMPULSIVE WATERDRINKING Uncommon disorder characterized by drinking an excessive amount of fluids, far above their daily requirements, secondary to psychological rather than physical pathology. It results in water intoxication. ETIOLOGY ♠ Disturbances e.g. Anxiety neurosis ♠ Delusional hypochondriasis ♠ Personality disorder ♠ Chronic schizophrenia ♠ Depression ♠ MR and compulsion eating
- 34. MANAGEMENT • Correct identificationand treatment of underlying psychiatric condition • Hypertonic saline (IV) brings about rapid symptomatic improvement.
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- 36. NURSING DIAGNOSIS • Imbalancednutrition less than body requirements related to refusal to eat INTERVENTIONS • Dietician will determine number of calories required to provide adequate nutrition and realistic weight gain. • Explain to the client that privileges and restrictions will be based on compliance with treatment and direct weight gain. • Weight client daily, immediately upon arising and following first voiding. • Stay with client during established time for meals. • If weight loss occurs use restrictions. (Tube feeding)
- 37. NURSING DIAGNOSIS Ineffective denialrelated to retarded ego development and fear of losing the only aspect of life over which he or she perceives some control (eating) INTERVENTIONS • Develop a trusting relationship. Convey positive regard • Avoid arguing or bargaining with the client who is resistant treatment • Encourage the clients to verbalize the feelings regarding role within the family, issues and sexuality.
- 38. NURSING DIAGNOSIS Disturbed bodyimage/low self-esteem related to retarded ego development, dysfunctional family system, or feelings of dissatisfaction with body appearance INTERVENTIONS • Help client to develop a realistic perception of body image and relationship with food. • Promote feelings of control within the environment through participation and independent decision making. • Help clients realize that perfection is unrealistic, and explore this need with him or her.
- 39. NURSING DIAGNOSIS • Imbalancednutrition more than body requirements related to compulsive overeating. INTERVENTIONS • Encourage the client to keep a dairy of food intake • Discuss feelings and emotions associated with eating • Formulate a eating plan by patient input level • Identify realistic increment goals for weekly weight loss • Plan progressive exercise program tailored to individual goals and choice • Provide instruction about medications to assist with weight loss if ordered by physician.
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