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Gregory Zhdanov
Gregory Zhdanov

Management Of Eating Disorders [CRACKED]

Purpose of review: Identifying medications that may be used as therapeutic agents for eating disorders is a longstanding focus of research, with varying degrees of success. The present review consolidates the most recent findings on pharmacological treatment of three eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).

Management Of Eating Disorders

Recent findings: Recent research suggests that olanzapine demonstrates positive effects on weight gain among outpatients with AN. There are fewer recent advances in psychopharmacological treatment for BN and BED, likely due to the relative success of prior medication trials. Olanzapine is the first medication to safely promote weight gain among individuals with AN. Fluoxetine is FDA-approved for BN treatment, and lisdexamfetamine is FDA-approved for BED treatment. BN and BED also generally respond well to SSRIs prescribed off-label. Research on psychopharmacological treatments for other eating disorders, such as avoidant-restrictive food intake disorder and other specified feeding and eating disorders, are sorely needed.

Turner H, Marshall E, Wood F, Stopa L, Waller G. CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression. Behaviour Research and Therapy. 2016;77:1-6. doi:10.1016/j.brat.2015.11.011

Dingemans AE, Danner UN, Donker JM, et al. The effectiveness of cognitive remediation therapy in patients with a severe or enduring eating disorder: a randomized controlled trial. PPS. 2014;83(1):29-36. doi:10.1159/000355240

Couturier J, Kimber M, Szatmari P. Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders. 2013;46(1):3-11. doi:10.1002/eat.22042

Ozier AD, Henry BW. Position of the American Dietetic Association: Nutrition intervention in the treatment of eating disorders. Journal of the American Dietetic Association. 2011;111(8):1236-1241. doi:10.1016/j.jada.2011.06.016

Pacanowski CR, Diers L, Crosby RD, Neumark-Sztainer D. Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial. Eating Disorders. 2017;25(1):37-51. doi:10.1080/10640266.2016.1237810

Avoidant/restrictive food intake disorder (ARFID). This condition is characterized by eating very little and/or avoiding certain foods. It usually begins in childhood. People with ARFID may avoid certain foods because of their texture or odor.

Bulimia nervosa. The condition is marked by cycles of extreme overeating, known as bingeing, followed by purging or other behaviors to compensate for the overeating. It is also associated with feelings of loss of control about eating.

Eating disorders tend to develop during the teenage and young adult years, and they are much more common in girls and women. No one knows the precise cause of eating disorders, but they seem to coexist with psychological and medical issues such as low self-esteem, depression, anxiety, trouble coping with emotions, and substance abuse.

People with bulimia nervosa have episodes of eating large amounts of food (called bingeing) followed by purging (vomiting or using laxatives), fasting, or exercising excessively to compensate for the overeating.

Rather than simply eating too much all the time, people with binge eating disorder have frequent episodes where they binge on large quantities of food. Like people with bulimia, they often feel out of control during these episodes and later feel guilt and shame about it. The behavior becomes a vicious cycle, because the more distressed they feel about bingeing, the more they seem to do it. Because people with binge eating disorder do not purge, fast, or exercise after they binge, they are usually overweight or obese.

Unlike other eating disorders, binge eating disorder is almost as common in men as it is in women. According to statistics from the National Institute of Mental Health, the average age at onset for binge eating disorder is 25, and it is more common in people under age 60.

Because binge eating leads to obesity, it can have serious health consequences if left untreated. Behavioral weight reduction programs can be helpful both with weight loss and with controlling the urge to binge eat. The stimulant drug Vyvanse is FDA-approved for the treatment of binge eating disorder. Also, because depression often goes hand in hand with binge eating disorder, antidepressants and psychotherapy may also help.

Recognizing the signs and symptoms of an eating disorder is the first step toward getting help for it. Eating disorders are treatable, and with the right treatment and support, most people with an eating disorder can learn healthy eating habits and get their lives back on track.

My Administration is taking action to address eating disorders. Through the National Institute of Mental Health, we are working to develop better therapies and interventions. Through the Substance Abuse and Mental Health Services Administration (SAMHSA) and funding for the National Center of Excellence for Eating Disorders, we are also helping health care providers, families, caregivers, and community members access new tools and trainings to help detect and treat eating disorders.

This week, let us acknowledge the families of those struggling with eating disorders as they care for their loved ones. Let us recommit to celebrating and supporting our fellow Americans who are on their road to recovery. And let us spread the word that help is just a phone call away: The SAMHSA National Helpline at 1-800-662-4357 is a confidential, free, 24-hours-a-day, 365-days-a-year information and referral service. For anyone experiencing a crisis, immediate and confidential help is also available by calling or texting 988, the National Suicide and Crisis Lifeline.

NOW, THEREFORE, I, JOSEPH R. BIDEN JR., President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim February 26 through March 4, 2023, as National Eating Disorders Awareness Week. I encourage citizens, government agencies, private businesses, nonprofit organizations, and other interested groups to join in activities that will increase awareness of what Americans can do to prevent eating disorders and that will improve access to care and other support services for those currently living with an eating disorder.

An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health.[1] Types of eating disorders include binge eating disorder, where the patient eats a large amount in a short period of time; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders.[1] Anxiety disorders, depression and substance abuse are common among people with eating disorders.[2] These disorders do not include obesity.[1] People often experience comorbidity between an eating disorder and OCD. It is estimated 20-60% of patients with an ED have a history of OCD.[9]

The causes of eating disorders are not clear, although both biological and environmental factors appear to play a role.[2][4] Cultural idealization of thinness is believed to contribute to some eating disorders.[4] Individuals who have experienced sexual abuse are also more likely to develop eating disorders.[7] Some disorders such as pica and rumination disorder occur more often in people with intellectual disabilities.[1]

Treatment can be effective for many eating disorders.[2] Treatment varies by disorder and may involve counseling, dietary advice, reducing excessive exercise, and the reduction of efforts to eliminate food.[2] Medications may be used to help with some of the associated symptoms.[2] Hospitalization may be needed in more serious cases.[2] About 70% of people with anorexia and 50% of people with bulimia recover within five years.[10] Only 10% of people with eating disorders receive treatment, and of those, approximately 80% do not receive the proper care. Many are sent home weeks earlier than the recommended stay and are not provided with the necessary treatment.[11] Recovery from binge eating disorder is less clear and estimated at 20% to 60%.[10] Both anorexia and bulimia increase the risk of death.[10] When people experience comorbidity with an eating disorder and OCD, certain aspects of treatment can be negatively impacted. OCD can make it harder to recover from obsession over weight and shape, body dissatisfaction, and body checking.[12] This is in part because ED cognitions serve a similar purpose to OCD obsessions and compulsions (e.g., safety behaviors as temporary relief from anxiety).[13] Research shows OCD does not have an impact on the BMI of patients during treatment.[12]

Estimates of the prevalence of eating disorders vary widely, reflecting differences in gender, age, and culture as well as methods used for diagnosis and measurement.[14][15][16]In the developed world, anorexia affects about 0.4% and bulimia affects about 1.3% of young women in a given year.[1] Binge eating disorder affects about 1.6% of women and 0.8% of men in a given year.[1] According to one analysis, the percent of women who will have anorexia at some point in their lives may be up to 4%, or up to 2% for bulimia and binge eating disorders.[10] Rates of eating disorders appear to be lower in less developed countries.[17] Anorexia and bulimia occur nearly ten times more often in females than males.[1] The typical onset of eating disorders is in late childhood to early adulthood.[2] Rates of other eating disorders are not clear.[1] 041b061a72




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