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SF | NUTRITION
March 2021 | Vol. 21 No. 3 www.medicalacademic.co.za
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This article was independently sourced by Specialist Forum.
Fear of FATNESS FATNESS
March is eatin g disorde r awaren ess month
Eating disorders do not discriminate. They are complex psychiatric disorders that can affect anyone, regardless of age, sex, or race, states Eating Disorders South Africa.
T
he Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) and the 11th revision of the World Health Organisation’s International Statistical Classification of Diseases and Related Health Problems published in 2019, classify feeding and eating disorders as: 1. Anorexia nervosa 2. Bulimia nervosa 3. Binge eating disorder (BED) 4. Avoidant/restrictive food intake disorder (ARFID).
eating disorders is unknown. However, studies suggest an increase in bulimia and in BED. Increases in anorexia have also been noted – especially in young women. The estimated lifetime prevalence of anorexia is estimated to be 1.4% in women, and 0.2% in men. It is slightly higher for bulimia (1.9% in women and 0.6% in men). The lifetime prevalence for BED is 2.8% in women, and 1% in men. An Australian study found that the three‐month prevalence of ARFID was 0.3%.
Diagnostic features
The long road to recovery and stumbling blocks
People with an eating disorder have a “complex, problematic relationship with food” that are enhanced during difficult times such as we are currently experiencing, write Touyz et al. They caution that during Covid-19, patients with eating disorders should be even more closely monitored.
Prevalence According to Hay, the true prevalence of
The road to recovery is a long one. A 22‐year follow‐up study (n=228) in women with anorexia or bulimia, treated in a specialist centre, found that 66% of patients recover within nine years. Less is known about long‐ term outcomes for BED and other eating disorders, according to Hay. Patients with eating disorders often have concurrent depressed mood, higher body
Table 1: Key diagnostic features of the main feeding and eating disorders Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant/restrictive food intake disorder
Eating
Severe restriction
Irregular, skipping Irregular but meals common as no extreme well as restriction restriction
Severe restriction of all or selected foods
Weight
Underweight
Normal or above normal
Normal or above normal
Underweight and/or with nutrition deficiency
Body image
Overvaluation Overvaluation with or without ‘fear of fatness’
Overvaluation but not mandatory
No overvaluation
Binge eating
May occur
Regular without NA compensation
Purging, fasting, driven exercise weight control behaviour(s)
One or more is Regular as present compensatory behaviours
Regular and with compensation
Not regular
None
image concerns, and poor relationships, as well as other co‐morbidities. These factors negatively impact the recovery process and are often associated with poorer outcomes. According to Hay, a major challenge in the management of eating disorders is closing the ‘treatment gap’. Studies show that the majority of people with anorexia, bulimia and BED delay seeking care for a decade or longer. She notes that many factors contribute to this problem. The most important are low levels of health literacy, help‐seeking for weight loss management rather than the eating disorder, stigma, shame, as well as poor affordability and access to evidence‐based psychological therapies.
Treatment The authors of a 2018 consensus document about the nutritional evaluation and management of eating disorders, stress the importance of an individualised and multidisciplinary (registered dietitian, specialist physician/paediatrician, psychiatrist, nurse/s, an exercise therapist, activity/occupational therapist and social worker or family therapist) approach. According to Candela et al, patients with anorexia and bulimia are often malnourished, and have severe nutritional deficiencies. A nutritional approach is recommended, which should include individualised dietary advice, which guarantees an adequate nutritional state and nutritional education. The objective is to facilitate the voluntary adoption of eating behaviours that promote health and allow the long-term modification of eating habits, and the cessation of purgatory and bingeing behaviours, explain the authors. Psychological support (eg trans‐diagnostic cognitive behaviour therapy [Enhanced]) is a first-line treatment. Support must address
