Eating disorders such as Anorexia Nervosa
and Bulimia Nervosa are more common in women, but men sometimes
develop these disorders too. Patients with these two eating
disorders display a broad range of symptoms that occur along
a continuum. The primary symptoms are a preoccupation with weight,
and excessive self-evaluation of weight and body shape. The
lifetime prevalence of both disorders is 1-3%. Early intervention
may prevent an eating disorder from becoming chronic and life
threatening. 15% of those Americans with Anorexia will die from
it. Warning signs can include preoccupation with weight, food,
calorie intake, dieting, and cooking; obsessing over food labels;
skipping meals; eating smaller portions; always finding a reason
not to be hungry; using laxatives or diet pills to get rid of
calories; disappearing to the bathroom after meals; fear of
eating around others; hiding food in strange places; and wearing
baggy clothes to hide “the fat”. A complete medical
assessment should include a review of the patient’s height
and weight history; restrictive and binge eating; exercise patterns
and their changes; core attitudes regarding weight, shape, and
eating; and associated psychiatric conditions including substance
abuse.
On the other end of the spectrum is the
ongoing epidemic of obesity. Although not included in the DSM-IV-TR
as an eating disorder, obesity is a complex disorder in which
lifestyle, diet, and exercise also play major roles. In the
United States approximately 35% of women and 31% of men are
significantly overweight (BMI 27 or above). If one defines obesity
as a BMI over 25, there are now more obese than non-obese Americans.
The prevalence of obesity in America has tripled since the early
1900s. Overweight adolescents have a 70% chance of becoming
overweight or obese adults. This increases to 80% if one or
more parent is overweight or obese.
Reliable studies indicate that the more
overweight a person is, the higher is that person’s risk
for death from heart disease, type 2 diabetes, high blood pressure,
and some forms of cancer. Doctors, including psychiatrists,
should routinely assess these risk factors as part of a comprehensive
medication management, especially with those psychotropic medications
which are associated with weight gain. With only a 5-10% weight
loss, patients can expect improved insulin sensitivity, blood
pressure, and dyslipidemia. A ten-pound loss may reduce type
2 diabetes risk by 30%.
Behavior modification has been the
most successful of the psychotherapies for treatment of obesity
and is considered the treatment method of choice. Eating is
controlled by many factors including appetite, food availability,
family and peer influence, habit, cultural practices, convenience
and emotional eating. The only way to reach and maintain a healthy
weight is to encourage healthy lifestyle changes and take the
focus away from dieting to accomplish short-term weight loss.
The most immediate consequence of being overweight, as perceived
especially by children, is social discrimination resulting in
poor self-esteem and depression. For this reason, individual
or group psychotherapy may be an important adjunct for some
patients. Other more aggressive or extreme treatments may include
the use of medications or gastric bypass surgery.
Cristobal Nogues, M.D.
is the Executive Medical Director of Riverside Behavioral Health
Center and the Medical Director of our Residential Services.
He is a board- certified psychiatrist with a passion for working
with children and their families. He can be reached at Cristobal.Nogues@rivhs.com
Always
Consult Your Physician before beginning any Diet or Exercise Program.
