Nancy met with her Physician and a multidisciplinary team for Nancy’s case was formed.  They were all in agreement that Nancy should refrain from sports until she was cleared for return-to-play.

Nancy went to all her appointments to satisfy her mother and family doctor.  However, she continued to binge and purge behind her mother’s back.

Eating Disorders

Eating disorders are persistent eating behaviours that negatively impact your health, emotions, & your ability to function.

• Focuses on weight, body shape & food, leading to dangerous eating behaviours.
• Eating disorders can harm the heart, digestive system, bones, teeth & mouth, & lead to other diseases.

Most common eating disorders are:

Anorexia nervosa

• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• Preoccupation with weight, food, calories, fat grams, and dieting. Makes frequent comments about feeling “fat.’
• Resists or is unable to maintain a body weight appropriate for their age, height, and build
• Maintains an excessive, rigid exercise regime – despite weather, fatigue, illness, or injury

Bulimia Nervosa

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
• Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of mouthwash, mints, and gum
• Has calluses on the back of the hands and knuckles from self- induced vomiting
• Dental problems, such as enamel erosion, cavities, discoloration of teeth from vomiting, and tooth sensitivity
• Metabolic alkalosis from excessive vomiting is possible

Binge Eating Disorder

• Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
• Feelings of disgust, depression, or guilt after overeating, and/or feelings of low self-esteem
• Steals or hoards food in strange places
• Creates lifestyle schedules or rituals to make time for binge sessions
• Evidence of binge eating, including the disappearance of large amounts of food in a short time period or a lot of empty wrappers and containers indicating consumption of large amounts of food

Complications of Binge Eating Disorder

• Serious health problems
• Depression & anxiety
• Suicidal thoughts or behaviour
• Problems with growth & development
• Social & relationship problems
• Substance use disorders
• Work & school issues
• Death

Causes of ED

Genetics & biology

Certain people may have genes that increase their risk of developing eating disorders. Biological factors, such as changes in brain chemicals, may play a role in eating disorders.

Psychological & emotional health

People with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behavior and troubled relationships.

Risk Factors

Family history

Eating disorders are significantly more likely to occur in people who have parents or siblings who’ve had an eating disorder.

Other mental health disorders

People with an eating disorder often have a history of an anxiety disorder, depression or obsessive-compulsive disorder.

Dieting & starvation

Dieting is a risk factor for developing an eating disorder. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. There is strong evidence that many of the symptoms of an eating disorder are actually symptoms of starvation. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.

Stress

Whether it’s heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress, which may increase your risk of an eating disorder.

How do lab techs screen for ED?

• CBC → performed to check for anemia and other possible hematologic issues
• Urinalysis → specific gravity to determine state of hydration. Patients with eating disorders tend to load up on water
• Urine Tox Screen → performed to rule out any substance abuse
• Pregnancy test → applicable for patients presenting  with amenorrhea
• Chemistry panel (including electrolytes) → check for electrolyte depletion, and metabolic complications associated with eating disorders. i.e. excessive vomiting can lead to metabolic alkalosis
• Amylase → to check for hyperamylasemia which can give a rough estimate of purging frequency. Common in patients with significant purging due to hypersecretion of salivary glands

Alkalosis vs. Acidosis & Metabolic vs. Respiratory

It is important to be able to distinguish between 4 main acid-base balance disorders:

• Respiratory Alkalosis
• Respiratory Acidosis
• Metabolic Alkalosis
• Metabolic Acidosis

Use blood gas results:

• Alkalosis/Acidosis → Based on pH
• Metabolic/Respiratory → Based on pCO2 (respiratory component)
• HCO3 → (metabolic component)

Q&A

What can cause metabolic alkalosis in eating disorders?

Excessive vomiting

What results would you expect to see if Nancy was diagnosed with a metabolic alkalosis from excessive vomiting?

Nancy is not dying from the vomiting so her body is likely compensating → she is likely to have a metabolic alkalosis with compensation so pH and HCO3- in same direction (both elevated) and pCO2 elevated

What is compensation?

Our bodies try to restore normal acid-base balance through compensation

• Metabolic disorder → compensation through lungs via hypo/hyperventilation
• Respiratory disorder → compensation through kidneys via bicarb loss/gain

If they both go in the SAME direction, primary disorder = METABOLIC

If they both go in DIFFERENT directions, primary disorder = RESPIRATORY

Compensation is evident when BOTH pCO2 and HCO3- are ABNORMAL. Next, check if abnormal HCO3- goes in the same, or opposite direction as the pH

Nancy’s Story Continues

 

The multidisciplinary team assigned to Nancy’s case came up with a treatment program that Nancy could adhere to.

It took three years of hard work for Nancy to get to a healthy weight, eat well, and have a healthy outlook on exercise and activity, however Nancy continued with oligomenorrhea.

Nancy’s Treatment

Establish nutritional eating patterns

• Sit during meals and snacks – set limits
• Observe following meals 1-2 hours
• Weigh daily
• Alert for attempts to hide/discard food or inflate weight
• Discuss foods that are soothing and relieve anxiety

Help identify emotions & develop non-food related coping strategies

• Ask to identify feelings
• Self-monitoring – journal
• Relaxation techniques
• Distraction
• Assist to change stereotypical beliefs

Help deal with body image issues

• Recognize benefits of more near-normal weight
• Assist to view self in ways not related to body image
• Identify personal strengths, interests, talents
• Client/family teaching – nutrition, meds, problem-solving strategies

Maudsley Approach Family Based Therapy

The primary purposes of including parents in this approach are to incorporate and encourage participation in their child’s recovery journey.

The Three Phases of the Maudsley Family Approach are as follows:

Phase I – Weight Restoration

In Phase I, a professionally trained therapist concentrates on the various effects associated with anorexia nervosa, particularly physiological, cognitive, and emotional.  A major focus of this phase is the restoration of the patient’s weight and the “re-feeding” component.  A crucial psychological feature of this primary phase is substantiating the illness.

Phase II – Returning control over eating to the adolescent

Phase II encompasses the patient learning to progressively regain control over their individual eating habits again.  This typically commences when the patient’s weight has reached approximately 87% of their ideal body weight.

Phase III – Establishing healthy identity

This phase is initiated when the patient is sufficiently able to sustain their weight above 95% of ideal body weight independently and refrains from engaging in restrictive eating behaviors.  Focuses of treatments are primarily on the psychological consequences the eating disorder has had on the patient and the establishment of a healthier identity.