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Eating Disorders and Obesity
Eating Disorders and Obesity
Binge-Eating Disorder (severity based upon episodes per week:
Mild = 1–3; Moderate = 4–7; Severe = 8–13; Extreme = ≥14)
➤ Diagnosis:
• 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 up to 3% of U.S. adults.
• May occur in up to 50% of patients with severe obesity.
• Eating Attitudes Test (EAT) or Binge-Eating Scale may assist with
diagnosis.
➤ Treatment:
• Often requires treatment by a qualif ied clinician.
• Cognitive behavior therapy with or without behavioral weight loss.
• 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 with or without phentermine
▶ Naltrexone-Buproprion
Bulimia Nervosa
➤ Diagnosis:
• Cycle of recurrent binge eating and compensatory purging,
laxative abuse, diuretic abuse, extra exercising, fasting, or strict food
restriction.
• Occurs in approximately 1% of adults (mostly women) and reportedly
higher (as much as 10%) among college-aged women.
• Signs and physical findings:
▶ 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.
