Eating Disorders and Obesity (original) (raw)
Nutrition intervention in the treatment of eating disorders, from bench to bed
Eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS) are a group of mental illnesses that have challenged treatment providers, caregivers, and indeed, people diagnosed with an eating disorder. These disorders are defined by clinical criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1). Presently, the definitions of EDs are being redefined as the DSM task force works on creating the DSM-V criteria, which may include specific criteria for binge eating disorder (BED) and revised thresholds for diagnoses. A discussion of the American Psychiatric Association proposed changes to the DSM diagnostic criteria for eating disorders can be found in the American Dietetic Association (ADA) Position Paper "Nutrition Intervention in the Treatment of Eating Disorders" (2). In both AN and BN there are alterations in brain serotonin, neuropeptide systems, and also brain neurocircuitry, which are present when the disorder is in its active state as well as in apparent recovery (7,8). Alteration in brain serotonin function seems to play a role in the odd appetite, mood, and impulse control observed in EDs. Consistent personality traits seen in AN and BN such as perfectionism, obsessive compulsiveness, and dysphoric mood sometimes seen in a child before the ED sets in, and persisting after weight restoration, suggest heritability (9). Taken together these data provide reasons for clinicians describing EDs as "brain disorders." There is evidence that the hypothalamus plays a role in appetite regulation. Animal studies have shown an intense hunger drive when the lateral hypothalamus is stimulated by glutamate and glutamate agonists, suggesting a role for glutamate in hunger sensations (10). Individuals with BN or BED may have a higher expected sense of reward from food intake, leading to overeating, and the overeating may lead to habitual use of compensatory behaviors (11). From the early starvation study by Ancel Keys came the understanding that starvation in and of itself produces many of the cognitive changes, mood disturbances, and peculiar behaviors characteristic of AN (12). Underweight adolescents with AN score higher on measures of depression and anxiety than when weight restored (13). The idea that families cause EDs has been dispelled (14). Recent research has shown that once the emotional impact of the ED is controlled there are no differences between families of girls diagnosed with AN and those diagnosed with insulin dependent diabetes mellitus, another childhood disease that can cause family distress. This Family/Friends observations Behavioral Rituals when eating Physiological Medical findings Reduced spontaneity and flexibility concerning food intake Avoidance of specific foods Poor food variety Statements about being or eating "healthy" Avoidance of social situations with food Abnormal speed of eating a meal Attempt to "bargain" about foods (eg, I will eat this if I do not have to eat that) Inability to identify hunger or satiety Unusually small portions Inability to define or eat a balanced meal Active and restless, stands frequently when most people would sit Disproportionate time spent thinking about food and body weight Interest in recipes, food channels, and food shopping Prepares food for other people without eating themselves Subjective or objective binge eating Hoards food or rations until the end of the day Food seems to go missing, especially sweets, cereals, high-carbohydrate foods Appears to be angry, tense, or hostile at meals Abnormal timing of meals and snacks "Debiting" food intake (eg, with exercise/food choices) Excessive use of condiments (eg, salt, hot sauce) Cutting food into very small pieces before eating Inappropriate food utensils with preference for eating with fingers Picks, blots, and tears food apart Inappropriate food combinations and concoctions Eats food in a certain order Hides food in napkins, handbags, gives to dog, throws food away Doesn't let food touch lips General: Marked weight changes or absence of expected weight gain in children or adolescents, growth delay in child/ adolescent; weakness, fatigue, or lethargy. Cardio pulmonary: Low pulse, dizziness, low blood pressure, slow capillary refill Gastrointestinal: Abdominal pain, constipation, reflux, vomiting, delayed gastric emptying (feels full immediately after eating small amounts) Endocrine: loss of menstrual cycle, delayed menarche, or hypogonadism for boys/men Neuropsychiatric: Poor concentration, memory loss, insomnia, depression, anxiety, obcessiveness, over concern with weight and shape Integument: Dry skin, brittle nails, hair loss, yellow orange skin tone, white downy hair growth (lanugo), dull eyes, pale skin, cold intolerance Anorexia Nervosa: Bradycardia, orthostasis by pulse or blood pressure, hypothermia, cardiac murmur, atrophic breasts and vaginitis (postpubertal), pitting edema of extremities, emaciated, cold extremities, slowed capillary refill time Bulimia Nervosa: Sinus bradycardia, orthostatic by pulse or blood pressure, dry skin, parotid gland swelling, Russell's signs, mouth sores, dental enamel erosion, cardiac arrhythmias, may be normal weight Binge Eating Disorder: Weight-related hypertension, abnormal lipid profile, and diabetes Figure 1. Warning signs, observations, and medical findings in eating disorders. Data from references 27, 31.
Night eating syndrome in class II–III obesity: metabolic and psychopathological features
International Journal of Obesity, 2009
Objective: To investigate the relationship of metabolic disorders and psychological features with the night eating syndrome (NES) in individuals with moderate-to-severe obesity. Design: Cross-sectional observation. Subjects: A total of 266 consecutive participants with class II-III obesity, entering an inpatient weight loss program. Measurements: Participants who reported consuming either a large amount of their caloric intake after the evening meal (roughly self-assessed as X25% of daily calories) or the presence of nocturnal feeding at the Night Eating Questionnaire (NEQ) (N ¼ 49) were interviewed by the Night Eating Syndrome History and Inventory (NESHI). Assessment also included the clinical/ biochemical parameters of the metabolic syndrome and several questionnaires of psychopathology. NES was diagnosed by NESHI criteria (evening hyperphagia (X25% of daily food intake after the evening meal) and/or waking at night to eat at least three times a week) in the last 3 months. Results: Twenty-seven participants (10.1%) met NESHI criteria. Differences were not observed between participants with and without NES as to age, body mass index (BMI), prevalence of metabolic syndrome, Binge Eating Scale and Body Shape Questionnaire. NES participants had significantly higher scores of Beck Depression Inventory (BDI) and Impact of Weight on Quality of Life (IWQOL). Among NES cases, the BDI score was indicative of moderate depression in 18.5% of cases and of severe depression in 44.4%. Logistic regression analysis, adjusted for confounders, identified the BDI score as the only variable significantly associated with the diagnosis of NES. Conclusion: Diagnosing NES does not help identify obese individuals with specific medical complications, but indicates more severe psychological distress and depression.
Revision of ICD – status update on feeding and eating disorders
TheWorld Health Organization is currently revising the International Classification of Diseases and Related Health Problems (ICD-10). A central goal for the revision of the ICD classification of mental and behavioural disorders is to improve its clinical utility. Global representation and cultural sensitivity and relevance are important across all mental disorders, but are especially critical to advancing our understanding, diagnosis and treatment of feeding and eating disorders (FED). This paper summarises the current status of the Eating Disorders Consultation Group (EDCG) considerations regarding diagnostic categories for FEDs in ICD-11 and represents work in progress. The recommendations of the EDCG are informed by relevant research evidence, and the consultation group is striving to find a balance between clinical utility and diagnostic purity. Provisional recommendations of the EDCG include: (1) merger of previous FEDs categories in one group; (2) inclusion of six main FED categories that include anorexia nervosa (AN), bulimia nervosa (BN), pica, regurgitation disorder, binge-eating disorder (BED) and avoidant/restrictive food intake disorder, the last two representing new categories; (3) broadening of categories with the aim of reducing the use of the unspecified ED category (e.g. dropping the amenorrhea requirement, increasing the body mass index cut-off for low weight and rewording the cognitive and behavioural features of AN to be more culturally-sensitive). In line with this last recommendation, one point that require further analysis pertain to frequency and severity of the binge-eating and purging behaviours in BN and BED, as the EDCG is considering reducing or eliminating the frequency criterion and broadening the binge-eating criterion to include ‘subjective’ binge episodes.
IJEDO, 2023
Obesity is the medical condition most frequently observed in people with eating disorders. It often coexists with binge-eating disorder and with some cases of bulimia nervosa, night eating syndrome, and atypical anorexia nervosa. Obesity can precede the onset of eating disorders, sometimes representing a risk factor for their onset, or can be in part the consequence of recurrent binge-eating episodes. Eating disorders and obesity, when they coexist, tend to interact negatively with each other and make treatment more problematic. Weight loss is always contraindicated when obesity coexists with bulimia nervosa and atypical anorexia nervosa. Still, it is not contraindicated when it coexists with binge-eating disorder or night eating syndrome. However, the weight loss outcome with current treatments is often unsatisfactory. A potential strategy to improve this poor outcome is an integrated treatment combining the new incretin-based medications for the treatment of obesity with enhanced cognitive behavior therapy (CBT) of eating disorders and CBT of obesity.
Eating Disorder or Disordered Eating? Non-normative Eating Patterns in Obese Individuals**
Obesity, 2004
TANOFSKY-KRAFF, MARIAN AND SUSAN Z. YANOVSKI. Eating disorder or disordered eating? Nonnormative eating patterns in obese individuals. Obes Res. 2004;12:1361-1366. Binge eating disorder (BED) and night eating syndrome (NES) are putative eating disorders frequently seen in obese individuals. Data suggest that BED fulfills criteria for a mental disorder. Criteria for NES are evolving but at present do not require distress or functional impairment. It remains unclear whether BED and NES, as they are currently defined, are optimally useful for characterizing distinct patient subgroups. We propose that a distinction be made between "eating disorders" and "non-normative" eating patterns without associated distress or impairment. Although nonnormative eating patterns may not be considered mental disorders, they may be very important in terms of their impact on body weight and health. More precise behavioral and metabolic characterization of subgroups with eating disorders and non-normative eating behaviors has important implications for understanding the etiology, pathophysiology, and treatment of obesity. Ultimately, better understanding of the many pathways to increased energy intake may lead to targeted strategies for prevention of overweight and obesity in at-risk individuals and populations.
Olejniczak et al 2018 Risk assessment of night eating syndrome
Introduction: Night-eating syndrome (NES) involves uncontrolled and most often repeated binge eating during the night. It is related with mood disorders as well as sleep disorders and it may cause obesity. Risks related to NES are obesity, binge eating disorder, bulimia nervosa, affective disorders, and sleep disorders. The objective of this study is to analyze eating habits in terms of the risk assessment of NES occurrence in the population of women in the Masovian Voivodeship (in Poland). Patients and methods: Six hundred and eleven women living in the Masovian Voivodeship participated in the study. The average age of the respondents was 22.7 years (median = 23.0; interquartile range = 3.0). The Night Eating Questionnaire (NEQ) was used to assess the risk of NES. Results: In the studied group of women, 1.3% of cases (N = 12) reached a NEQ total score of 25,whichindicatesaprobabilityof40.725, which indicates a probability of 40.7% for NES, while 0.7% (N = 4) reached a score of 25,whichindicatesaprobabilityof40.730, which indicates a probability of 72.2% for occurrence of this syndrome. The highest average total score was observed in the group of obese people. The level of education of the participants did not significantly affect the NEQ score. A weak correlation was observed between the place of residence variable and the mood/sleep subscale (r = 0.11, P , 0.01). Conclusion: NES may be one of the causes of overweight and obesity; therefore, the need for further studies on this health issue is justified. It is worth pointing out that knowing the conditions responsible for the occurrence of NES, it is possible to suggest a prevention procedure for this condition.