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Obesity Overview - OMA Obesity 2021

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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

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