This document discusses different types of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. It provides details on the symptoms, health risks, and treatment options for anorexia nervosa and bulimia nervosa. The document also covers obesity as a complex disease and discusses pharmacotherapy and lifestyle interventions for treating obesity.

2. Types of Eating
 Anorexia Nervosa
 Bulimia Nervosa
 Binge Eating Disorder
 Not Otherwise Specified (NOS)

3. 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/relatives
Source: National Eating Disorders Association Website

4. Anorexia
 Heart failure
 Kidney failure
 Low protein stores
 Digestive problems
 Electrolyte imbalance

5. Treatment for Anorexia
1. Hospitalization
 First consideration- return the patient’s
nutritional state
 Inpatient psychiatric treatment
 Behavioral management
 Individual psychotherapy
 Family education and therapy
 In some cases psychotropics

6. 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

7. 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.

8. Bulimia Nervosa
 DSM-IV-TR
 Defined as binge eating combined with
inappropriate ways of stopping weight gain

9. 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/relatives
Source: National Eating Disorders Association Website

10. 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

11. 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

12. Bulimia Nervosa
 Health Risks
 Electrolyte imbalance
 Laxative dependence
 Dental problems
 Stomach rupture
 Menstruation
irregularities

13. Treatment for Bulimia
Nervosa
 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.

14. Obesity
 Complex disease resulting from:
 Genetic succeptibility
 Increased availability of high-energy foods
 Decreased physical activity

15. Obesity
 Accounts for:
 25% of body weight in men
 18% of body weight in women

16. Obesity
 Treatment
 Obesity treatment is multifactorial
 Treatment include
 Diet
 Exercise
 Psychotherapy
 Pharmacotherapy
 In extreme cases:
 Surgery

17. 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

18. 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.

19. 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

20. 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

21. 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

22. 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
 FDA's 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.

23. 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/