Eating disorders in teens
1 / 36

Eating Disorders in Teens - PowerPoint PPT Presentation

  • Updated On :

Eating Disorders in Teens. Maj Anisha Abraham, MD, MPH. Objectives. To identify the risk factors for eating disorders To perform an evaluation of the physical, emotional and nutritional status of a teen To establish the diagnosis of anorexia or bulimia

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Eating Disorders in Teens' - elina

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Eating disorders in teens l.jpg

Eating Disorders in Teens

Maj Anisha Abraham, MD, MPH

Objectives l.jpg

  • To identify the risk factors for eating disorders

  • To perform an evaluation of the physical, emotional and nutritional status of a teen

  • To establish the diagnosis of anorexia or bulimia

  • To manage a patient with an eating disorder using a multi-disciplinary team

The drive for thinness l.jpg
The Drive for Thinness

  • 63% of women feel that body weight determines how they feel

  • Americans spend 33 billion dollars on dieting and diet-related products

  • The average female starts dieting at age 9yrs

The drive for thinness4 l.jpg
The Drive for Thinness

  • Started when Twiggy replaced Marilyn Monroe in the 60’s

  • The average woman is 5’4 and 140 lbs

  • The average model is 5”11 and 117 lbs

Scope of the problem l.jpg
Scope of the Problem

  • The incidence of eating disorders has increased five times since 1955

  • More than 1/2 of high school girls have dieted

  • Anorexia is the third most common chronic disease in teens

Scope of the problem6 l.jpg
Scope of the Problem

  • 10-50% of teens engage in binge eating or vomiting

  • 1-5% have bulimia .5-1% develop anorexia

  • 1 in 5 females 19-25yrs have an eating dx

Culture and eating disorders l.jpg
Culture and Eating Disorders

  • One anthropological study found:

    • when women are more financially dependent and marital ties are paramount, the standard is to be curvaceous

    • When independence for women is possible, the standard for female attractiveness is towards thinness

Culture and eating disorders8 l.jpg
Culture and Eating Disorders

  • There is an increase in eating disorders among Black, Hispanic and Asians

  • Linked to the pressure to integrate and be a ‘smart,beautiful and thin career woman”

  • In Argentina, China, and Japan similar pressures have developed

Eating disorders in the military l.jpg
Eating Disorders in the Military

Study by Mayo researchers at Madigan Army Medical Center: 8% of active duty women were reported to have eating dxs compared to 1-3% in general population

Study conducted among active duty males in the Navy: 2.5% of male doctors were anorexic and 11% were bulimic (Mcnulty, 1994)

Eating disorders in the military10 l.jpg
Eating Disorders in the Military

  • Anorexia-1.3%(Army), 1.1%(Navy), and 0.8%(AF)

  • Bulimia-4.3%(Army), 5.2%(Navy), 9.3% (AF)

  • Diet pill usage in the Army-8.6%(year-round)

    • Increased by 3.9% at PT time

    • Vomiting,laxative use and diurectic use showed similar patterns

Risk factors for eating disorders l.jpg

Ethnic and socioeconomic status

Cultural influence

Low self-esteem/perfectionistic

Difficulties with communication, separation and conflict resolution w/ family

Anxiety or depressive disorder

Family history

A drive to excel in sports

Early puberty

Winter season

Sexual Abuse

Risk Factors for Eating Disorders

Case1 eating disorders l.jpg
Case1-Eating Disorders

  • Ellen is a 14 yo Caucasian female w/ a 6 mo hx of wt loss who is referred to you by her primary care provider. Her last visit to the physician’s office was over 6 mo’s ago for a camp physical at which time she was doing well.

  • Her wt was 53kgs and her ht was 160cm. Her mother brought her into the doctor’s last month because she was losing weight and becoming isolated and withdrawn. The primary care provider was surprised at her appearance.

Case1 eating disorders13 l.jpg
Case1-Eating Disorders

  • She appeared cachetic and pale. Her wt was 40kgs and her height was 160 cm. He followed her over the next four weeks and she continued to lose weight. The family physician did a preliminary work up and refers her to you.

Case1 eating disorders14 l.jpg
Case1-Eating Disorders

  • Ellen was angry about having to come into the hospital for an evaluation as she did not feel that anything was wrong with her. The patient tells you that she was in good health till 6 mo’s ago when following a move with her family to a different city, she voluntarily restricted her intake and began a regular strenuous exercise program.

Case1 eating disorders15 l.jpg
Case1-Eating Disorders

  • Her mother was concerned because she was no longer eating breakfast and only eating a small salad and a cup of tea for dinner. As she lost increasing amounts of weight, her appetite diminished and she found it easier to diet. She seems neither surprised nor concerned when she is told that has lost over 25% of her body weight.

Case1 eating disorders16 l.jpg
Case1-Eating Disorders

  • What further information do you need to help understand Ellen’s problem?

  • What further evaluation would help you to make the diagnosis?

  • How will you manage Ellen?

The interview l.jpg
The Interview

  • Perception of illness

  • History of Illness

  • Weight and height

  • Body image

  • Means of weight control

The interview18 l.jpg
The Interview

  • Menstrual Function

  • Past Medical History

  • Family History

  • Psychosocial History

Differential diagnosis l.jpg
Differential Diagnosis


  • CNS tumors

  • Endocrinologic disorders-IDDM, Hyperthyroidism, Addison’s

  • GI disorders-IBD,malabsorption

  • Chronic infections,SLE,Malignancy

Diagnostic criteria anorexia l.jpg
Diagnostic Criteria-Anorexia

  • Refusal or inability to maintain body weight over a minimum normal weight

  • Intense fear of gaining weight despite being underweight

  • Disturbance in perception of body shape

  • Absence of three consecutive menstrual cycles

Diagnostic criteria bulimia l.jpg
Diagnostic Criteria-Bulimia

  • Minimum of 2 binge-eating episodes weekly for 3 months/recurrent binge eating

  • A feeling of lack of control over binge-eating behavior

  • Regular use of self-induced vomiting, laxatives,diuretics,strict dieting,fasting,or vigorous exercise to prevent weight gain

  • Disturbance of body shape perception

Diagnostic criteria eating disorder not otherwise specified l.jpg
Diagnostic Criteria-Eating Disorder Not Otherwise Specified

  • All of the criteria for Anorexia Nervosa are met except the individual has regular menses or weight is in the normal range.

  • All of the criteria for Bulimia Nervosa are met except binges less than twice a week or less than 3 months.

    3. Binge eating disorder- recurrent episodes of binge eating in the absence of the regular use of purging,etc

Physical examination l.jpg
Physical examination

  • Vital signs

  • Weight and height percentiles, BMI and weight percentile for ht

  • HEENT-dental erosion,parotid swelling

  • Thyroid

  • Cardiovascular-poor cap refill,bradycardia

  • Breasts-loss of fat

Physical examination24 l.jpg
Physical examination

  • Genitourinary-tanner stage

  • Abdominal-organomegaly

  • Skin-color,loss of fat,edema,lanugo,bruises on mcp joint

  • Mental state-apathy, depression, anxiety,obsessive-compulsive

Laboratory evaluation l.jpg
Laboratory evaluation

  • CBC

  • Urine dip

  • Electrolytes,BUN,creatine, Ca,Mg,Phos

  • T4 and TSH,serum protein and albumin

  • EKG

  • ?Stool for occult blood, ESR

  • ?FSH,LH,Prolactin

Management mild stage l.jpg
Management-Mild Stage

  • Set goal weight-usually BMI>18

  • Refer to nutritionist

  • Aim for wt gain of .5-1 kg weekly

  • Check weights with gown,pt facing away from scale and empty bladder.

  • Check hr,temp,and urine PH. If ph>7=metabolic alkalosis

  • Consider calcium and iron supplementation

  • Reevaluate regularly

Ways to develop a good body image l.jpg

Question whether there is one ideal body shape

Cultivate the ability to appreciate uniqueness

Take care of your body

Surround yourself with people who feel good about their body

Learn to respect internal cues

Value body movement and competence

Cultivate role models with appearances that are not the ideal

Bond with friends on issues other than dieting

Ways to Develop a Good Body Image

Management moderate stage l.jpg
Management-Moderate Stage

  • Set goal weight

  • Refer to psychology/ psychiatry and nutrition

  • Provide structure to daily activities and meals.

    • Consider restriction of excercise

  • Increase calories by 200 every 2-3 days

  • Follow up frequently

    • Stress medical markers of starvation, consequence of failure to gain wt to patient

Indications for hospitalization l.jpg
Indications for Hospitalization

  • Electrolyte abnormalities

    • hypokalemia,hypophosphatemia

  • Physiologic decompensation

    • Temp <36 degrees

    • Pulse < 45

    • Altered mental status

  • Acute medical complications

    • arrhythmias,syncope,seizures

Indications for hospitalization30 l.jpg
Indications for Hospitalization

  • Inability to break cycle as outpatient (>3-6mo’s)

  • Acute psychiatric emergency- ie.suicidal

  • Rapid or excessive weight loss

    • >10% in 2mos’s

    • weight <75% for IBW

Medical therapy l.jpg
Medical Therapy

  • Bulimia

    • Fluoxetine is the only drug which is approved-60mg/day. Use w/ CBT

  • Anorexia-

    • TCA’s may improve wt gain/has side effects

    • SSRI’s showed no change vs placebo on hospitalized AN patients Did improve weight for outpt wt recovered patients

Medical concerns in eating disorders l.jpg
Medical Concerns in Eating Disorders

  • Cardiac-,bradycardia, arrythmias

  • Pulmonary-pneumomediastinum

  • GI-Delayed emptying, constipation,SMA syndrome,Mallory-Weiss tear,dental erosion

  • Metabolic-Osteoporosis (consider OCP’s, bone density), increased cholesterol, low bg, hypercarotenemia

Medical concerns in eating disorders33 l.jpg
Medical Concerns in Eating Disorders

  • Hematologic-Leukopenia, anemia, thrombocytopenia, decreased ESR, low wbc’s

  • Dermatologic-Lanugo,dry skin,brittle nails,acrocynanosis

  • Other-ammenorhea-need 90% of IBW to reestablish menses

Prognosis l.jpg

  • Associated with length of illness

  • Worsening occurs in 15-25% of patients

  • Mortality is 5% for anorexia

  • Poorer prognosis for bulimia with hx of sexual abuse,coexistent personality disorder or depression,substance abuse

Summary l.jpg

  • Eating disorders are common in teens

  • Screen for eating disorder risk factors

  • Check physical exam for evidence of abnormalities,consider routine labs

  • Rule out organic disease, use criteria to diagnose anorexia/bulimia

  • Use a team approach in treating eating disorders!