12
Genetic Syndromes & Eating Disorders
Eating Disorders and Obesity
Diagnosis Treatment
Binge-eating Disorder
• Frequent episodes of consuming large
amounts of food more than once per
week for at least three months
▶ No self-induced vomiting (purging)
▶ No extra exercising
▶ Feelings of lack of self-control,
shame, and guilt
• Occurs in 3% of U.S. adults
• May occur in up to 50% of patients
with severe obesity
• Eating Attitudes Test may assist with
diagnosis
• Severity based upon episodes per
week:
▶ Mild = 1–3
▶ Moderate = 4–7
▶ Severe = 8–13
▶ Extreme = ≥14
• Often requires treatment
by a qualif ied clinician
• Cognitive behavior
therapy
• Lisdexamfetamine
dimesylate is the only
pharmacotherapy with
an FDA indication to treat
binge-eating disorder.
• Although not FDA
indicated for this use,
clinical trials suggest
other pharmacotherapies
may be eff icacious.
▶ Some selective
serotonin reuptake
inhibitors
▶ Topiramate
Bulimia Nervosa
• Cycle of recurrent binge eating and
compensatory purging, laxative abuse,
diuretic abuse, extra exercising, fasting,
or strict dieting
• Occurs in approximately 3% of adults
(mostly women) and reportedly higher
(as much as 10%) among college-aged
women
• Signs and physical f indings:
▶ Russell sign: Calluses and abrasions
on dorsum of the hands caused by
repeated contact with the teeth
during self-induced vomiting
▶ Enamel erosion of the teeth (usually
lingual surface)
▶ Sialadenosis (enlargement of the
salivary gland, such as the parotid
gland)
• Laboratory:
▶ Hypokalemia (promoted by
hypomagnesemia), hypochloremia,
metabolic alkalosis
▶ Elevated amylase suggests possible
vomiting and salivary gland irritation
• Cognitive behavior
therapy, possibly in
combination with drug
treatment
• Fluoxetine is an
FDA-approved
pharmacotherapy for
bulimia nervosa
• Although not FDA-
indicated for this
use, topiramate and
naltrexone may be
eff icacious in treating
bulimia nervosa
