|
|
|
|
BMH Medical Journal 2015;2(4):89-90 Editorial
Beena Johnson
Baby Memorial Hospital, Kozhikode, Kerala, India - 673004
Address for Correspondence: Dr. Beena Johnson, MBBS, DCH, MD, PhD, Senior Consultant in Child Guidance; Behavioural & Developmental Paediatrician, Baby Memorial Hospital, Kozhikode, Kerala, India. Email: jiacam@gmail.com
Key Words: eating disorder, adolescent
According to International Classification of Diseases by World Health Organization, eating disorders are behavioural syndromes associated with physiological disturbances [1]. Eating disorders include anorexia nervosa, atypical anorexia nervosa, bulimia nervosa, atypical bulimia nervosa, overeating associated with other psychological disturbances and vomiting associated with other psychological disturbances [1]. Maladaptive eating pattern and inadequate physical activity are seen in adolescents with eating disorders and obesity [2]. Those with comorbid eating disorder and obesity have a poorer prognosis and are at higher risk for future medical problems.
Prevalence
Eating disorders are more prevalent in adolescent girls [3]. Lifetime prevalence for anorexia nervosa is between 0.6% to 4% and bulimia nervosa is between 1.2% and 5.9% among females [4]. In a study on adolescents in Spain, the overall prevalence of eating disorders was found to be 4.11%. 5.46% of girls and 2.55% of boys had eating disorder. 0.19 % of adolescents had anorexia nervosa and 0.57% had bulimia nervosa [5].
Risk factors
Young females with a tendency for dieting are at increased risk for developing eating disorders [6]. Television viewing time is an important risk factor for development of eating disorders [7]. Adolescent who watch television for more than one hour a day have significantly higher risk for eating disorders irrespective of their initial weight. Bullying increases the risk for eating disorders [8]. Victims of bullying are at high risk of developing symptoms of anorexia. Bully-victims have more risk for binge eating and can develop vomiting as a compensatory behaviour. But bullys are more prone to develop symptoms of bulimia [8].
Clinical features
Anorexia Nervosa
Adolescents with anorexia nervosa have a restrictive eating pattern which leads to severe weight loss. They have distorted perception of body image. For a definitive diagnosis of anorexia nervosa, the body weight should be at least 15% below the expected weight for age. Weight loss is caused by self induced vomiting, self induced purging, excessive exercise or by the use of appetite suppressants. They also avoid fattening foods. Anorexia nervosa can lead to widespread endocrine problems and in adolescent girls it can lead to amenorrhea. If the onset of symptoms is prepubertal, the pubertal events can be delayed or even arrested. If not intervened in the early stage, anorexia nervosa can lead to severe malnutrition. They usually have anxiety and low self esteem.
Bulimia Nervosa
Adolescents with bulimia nervosa have overvalued ideas related to body weight and shape. Because of morbid fear of fatness, these patients set a weight threshold well below the optimal weight for age. They have disinhibited eating patterns. There is persisent preoccupation with eating and have irrestible craving for food. Binge eating is commonly seen in bulimia nervosa [9]. They counteract the fattening effects of food by self induced vomiting or self induced purging. Emotional disorders are often associated with bulimia nervosa.
Management of eating disorders
Once fully established, eating disorders are very difficult to treat [6]. Significant emotional and physical burden is associated with eating disorders in adolescents [10]. Hence it is important to prevent eating disorders [11]. Individual adolescent focused therapy should be started at the onset of symptoms. Family based treatment is found to be effective in the management of adolescents with anorexia nervosa [12,13,14]. It helps the families to actively work to cure the affected family member with eating disorder. Cognitive behavioural interventions are effective in the management of eating disorders [15]. Cognitive behaviour therapy has got long term effect in reducing the core symptoms of bulimia nervosa [16].
References
1. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-2015-WHO Version for 2015. Available at: http://apps.who.int/classifications/icd10/browse/2015/en#/F50. Accessed 9th September, 2015.
2. Rancourt D, McCullough MB. Overlap in Eating Disorders and Obesity in Adolescence. Curr Diab Rep. 2015 Oct;15(10):645.
3. Bould H, DeStavola B, Magnusson C, Micali N, Dal H, Evans J, Dalman C, Lewis G. The influence of school in the development of eating disorders: a record-linkage study. Lancet. 2015 Feb 26;385 Suppl 1:S24.
4. Reyes-Rodriguez ML, Franko DL, Matos-Lamourt A, Bulik CM, Von Holle A, Camara-Fuentes LR, Rodríguez-Anglero D, Cervantes-Lopez S, Suárez-Torres A. Eating disorder symptomatology: prevalence among Latino college freshmen students. J Clin Psychol. 2010 Jun;66(6):666-79.
5. Alvarez-Male ML, Bautista Castano I, Serra Majem L. Prevalence of eating disorders in adolescents from Gran Canaria. Nutr Hosp. 2015 May 1;31(5):2283-8.
6. Pratt BM, Woolfenden SR. Interventions for preventing eating disorders in children and adolescents. Cochrane Database Syst Rev. 2002;(2):CD002891.
7. Martínez-Gomez D, Veses AM, Gomez-Martínez S, Perez de Heredia F, Castillo R, Santaliestra-Pasias AM, Calle ME, Garcia-Fuentes M, Veiga OL, Marcos A. Television viewing time and risk of eating disorders in Spanish adolescents: AVENA and AFINOS studies. Pediatr Int. 2015 Jun;57(3):455-60.
8. Copeland WE, Bulik CM, Zucker N, Wolke D, Lereya ST, Costello EJ Does childhood bullying predict eating disorder symptoms? A prospective, longitudinal analysis. Int J Eat Disord. 2015 Sep 4. doi: 10.1002/eat.22459. [Epub ahead of print]
9. Burton AL, Abbott MJ, Modini M, Touyz S. Psychometric evaluation of self-report measures of binge eating symptoms and related psychopathology: A systematic review of the literature. Int J Eat Disord. 2015 Aug 27. [Epub ahead of print]
10. Bailey AP, Parker AG, Colautti LA, Hart LM, Liu P, Hetrick SE. Mapping the evidence for the prevention and treatment of eating disorders in young people. J Eat Disord. 2014 Feb 3;2:5.
11. Sanchez-Carracedo D1, Lopez-Guimera G, Fauquet J, Barrada JR, Pamias M, Punti J, Querol M, Trepat E. A school-based program implemented by community providers previously trained for the prevention of eating and weight-related problems in secondary-school adolescents: the MABIC study protocol. BMC Public Health. 2013 Oct 12;13:955.
12. Bulik CM, Berkman ND, Brownley KA, Sedway JA, Lohr KN. Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007 May;40(4):310-20.
13. Stiles-Shields C, Hoste RR, Doyle PM, Le Grange D. A review of family-based treatment for adolescents with eating disorders. Rev Recent Clin Trials. 2012 May;7(2):133-40.
14. Couturier J, Kimber M, Szatmari P. Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2013 Jan;46(1):3-11.
15. Gelin Z, Cook-Darzens S, Simon Y, Hendrick S. Two models of multiple family therapy in the treatment of adolescent anorexia nervosa: a systematic review. Eat Weight Disord. 2015 Jul 31. [Epub ahead of print]
16. Shapiro JR, Berkman ND, Brownley KA, Sedway JA, Lohr KN, Bulik CM. Bulimia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007 May;40(4):321-36.