![]() ![]() Self-worth is overly based on body shape and weightīehaviors occur at least weekly for at least three months and are distinctly separate from anorexia nervosaĪlternative diagnoses: bulimia nervosa of low frequency and/or limited duration * purging disorder (i.e., recurrent purging to lose weight without binge eating) * Repeated use of unhealthy behaviors to prevent weight gain, such as vomiting, misuse of laxatives or diuretics, food restriction, or excessive exercise Types: restrictive or binge eating/purgingĪlternative diagnosis: atypical anorexia nervosa (i.e., weight is not significantly low) *īinge eating (i.e., eating more food than peers accompanied by a perceived loss of control) Intense fear of gaining weight or being “fat” Restriction of food eaten, leading to significantly low body weight ![]() Randomized controlled trial (disease-oriented outcome) and a systematic review of observational studiesĬaregivers and clinicians should focus on positive body image instead of weight or dieting to prevent disordered eating. 38, 46, 50 Ĭontraceptives should be offered to patients with disordered eating who want to prevent pregnancy, but they have not been associated with improved bone mineral density and may mask resumption of menses. Lisdexamfetamine (Vyvanse) can be effective in reducing binge-eating behaviors in persons with binge-eating disorder. Randomized controlled trials (limited-quality patient-oriented outcome) Medications should not be used as monotherapy in the treatment of anorexia nervosa or bulimia nervosa. Randomized controlled trials (patient-oriented outcome) 3, 33įamily-based therapy should be a first-line treatment for youths with anorexia nervosa and bulimia nervosa. The outpatient care team should include an experienced therapist, a dietitian, and a clinician knowledgeable about eating disorder–specific medical evaluations. Most patients with eating disorders receive optimal care in an outpatient setting. Observational studies and a meta-analysis of observational studies In patients with eating disorders, early intervention and symptom improvement decrease the risk of a protracted course with long-term pathology. Prevention should emphasize a positive focus on body image instead of a focus on weight or dieting. Remission is suggested by healthy biopsychosocial functioning, cognitive flexibility with eating, resolution of disordered behaviors and decision-making, and if applicable, restoration of weight and menses. Evidence supports select antidepressants or topiramate for bulimia nervosa and lisdexamfetamine for binge-eating disorder. Treatment options may include cognitive behavior interventions that address body image and dietary and physical activity behaviors family-based therapy, which is a first-line treatment for youths and pharmacotherapy, which may treat co-occurring conditions, but should not be pursued alone. Weight gain of 2.2 to 4.4 lb per week stabilizes cardiovascular health. A healthy weight range is determined by the degree of malnutrition and pre-illness trajectories. The escalation of care should be based on health status (e.g., acute food refusal, uncontrollable binge eating or purging, co-occurring conditions, suicidality, test abnormalities), weight patterns, outpatient options, and social support. Additional care team members (i.e., dietitian, therapist, and caregivers) should provide a unified, evidence-based therapeutic approach. After diagnosis, visits should include the sensitive review of psychosocial and clinical factors, physical examination, orthostatic vital signs, and testing (e.g., a metabolic panel with magnesium and phosphate levels, electrocardiography) when indicated. Clinicians should interpret disordered eating and body image concerns and carefully monitor patients' height, weight, and body mass index trends for subtle changes. Early intervention may decrease the risk of long-term pathology and disability. Eating disorders are potentially life-threatening conditions characterized by disordered eating and weight-control behaviors that impair physical health and psychosocial functioning.
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