EATING DISORDERS

A s’eclairer teaching topic

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

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

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

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

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

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

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)

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.

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)

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

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

OTHER WEIGHT LOSS MEDS

• APPETITE SUPPRESSANTS-Wellbutrin-Prozac-Topamax

• SUGAR SUBSTITUTES-Sweet ‘N Low (saccharin)-Splenda (sucralose)-Neotame

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

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.