2024-02-03 08:24:38
Anorexia nervosa…a complication that leads to heart failure
Eating disorders are an abnormal pattern of eating that leads to health problems, and they represent the relationship between the psychological state and the intense desire to eat or abstain from eating.
Disruption of eating habits
The most important characteristic of these disorders is the presence of chronic disruption of eating habits and weight maintenance behaviors, which negatively affects nutritional status and impairs physical health and psychosocial functions.
What is the normal pattern of eating? What are eating disorders and their types? How is it dealt with?
“Your Health” met with Dr. Khalid bin Ali Al-Madani, clinical nutrition consultant, vice president of the Saudi Society for Environmental Sciences and member of the board of directors of the Saudi Food and Nutrition Society, to answer these questions. He defined normal eating behaviors as the state in which the following natural functions can be performed:
– Eating when feeling hungry and abstaining from it when feeling full.
– The ability to choose the food and quantity eaten.
– Distinguishing between overeating and undereating so that it is clear based on the feeling of balance in the body.
– The ability to be flexible with regard to eating schedule. There are usually three basic meals per day, and the individual may eat one or two snacks between the main meals.
– Allowing oneself to eat (in case of normal appetite) a piece of chocolate, ice cream, candy, or fruit in acceptable quantities.
Types of eating disorders
• Anorexia Nervosa (AN): Although it constitutes 4 percent of eating disorders, its complications are serious and may lead to heart failure and death if treatment is neglected. Therefore, in this topic we will discuss this type in detail:
• Bulimia Nervosa (BN): 18 percent.
• Binge Eating Disorder (BED): 45 percent.
• Other eating disorders (OED): 33 percent.
Anorexia nervosa
Dr. Khaled Al-Madani says that anorexia nervosa (AN), also called (anorexia nervosa), represents 4 percent of all eating disorders, and that it occurs most often (more than 90 percent) in teenage girls, when you think about The girl’s weight is more than the normal weight, or as a result of the sports coach’s pressure on the athletic girls to maintain the weight, especially in gymnastics, ballet, or athletics, where the athlete’s body weight is important for good performance, so she tries to practice a kind of strict restriction in the amount of food that she You eat it, and strictly avoid high-calorie foods such as fat. This situation continues until the girl reaches the point where she completely hates eating, and her weight gradually decreases to the point that it sometimes threatens her life.
The disease is more common in a certain type of girl who suffers from some obsessive or hysterical traits. When such girls are exposed to some psychological pressures or frustrations, symptoms of the disease begin to appear. The girl’s body image becomes disturbed, such that she imagines that her body is always full even though others see her as very thin.
Diagnosis
Dr. Al-Madani adds that criteria have been set for diagnosing anorexia nervosa, such that the weight is less than 15 percent of the normal body weight, or the body mass index (BMI) is equal to or less than 17.5 for adults. The American Association has divided anorexia nervosa into two subtypes:
– The first type: Restriction, as in the case of anorexia nervosa, there is usually no occurrence of bulimia behaviors, then emptying the intestines with laxatives, self-induced vomiting, or taking diuretics and enema.
– Type: The second: binging and then binging, which usually occurs in the case of anorexia nervosa, i.e. the occurrence of binging behaviors and then emptying the intestines with laxatives, self-vomiting, taking diuretics, or enema.
Dr. Khaled Al-Madani comments on the diagnostic criteria issued by the Diagnostic Statistical Manual of Mental Disorders (DSM) for anorexia nervosa (see attached table) that they show the minimum level of severity of the disease, which depends on the body mass index. The increasing level of severity of the condition may reflect clinical symptoms, the degree of functional disability, and the need for monitoring. The minimum level of severity of the disease can be evaluated as follows:
• Simple condition: BMI is 17 or more.
• Average condition: BMI is between 16 and 16.99.
• Severe condition: BMI is between 15 and 15.99.
• Extreme condition: BMI is less than 15.
Dietary regulation for treating patients
How is the diet organized for patients with anorexia nervosa?
• Nutritional regulation goals. Dr. Al-Madani answers that nutritional regulation for patients with anorexia nervosa aims to:
– Restoring normal physiological functions by correcting the starvation process and the associated changes, which include electrolyte imbalance, decreased heart rate, and low blood pressure.
– Avoid the occurrence of refeeding syndrome, while avoiding the occurrence of incomplete and insufficient feeding as a result of severe restriction of the feeding rate. The condition may require a gradual diet while avoiding eating a high percentage of calories from carbohydrates.
– Monitor weight and growth to achieve acceptable goals; This is done by promoting weight gain within the treatment centers, from half a kilogram to one and a half kilograms per week, and about half a kilogram per week if staying at home, in order to reach a healthy body mass index.
– Strengthening psychological treatment from specialists, and medical treatment from doctors, by using medications to protect the heart, fluids, and electrolytes, which are important in this treatment stage.
– Evaluate the occurrence of inflammation, vomiting, or the use of laxatives or diuretics.
– The patient with anorexia nervosa appears to agree to the compulsory treatment necessary to preserve life. However, he refuses to force-feed; Refusal to eat is part of the disease, and therefore it is better to promote eating behaviors naturally.
– Coordinating nutritional assessment and consultations with the treatment team for the treatment plan.
– Promoting the normal occurrence of the menstrual cycle for young women.
– Support bone health.
• Nutritional recommendations. Dr. Al-Madani recommends that the diet include the following:
– Start with fluid replacement, then start with caloric intake around 30 to 40 calories/kg of weight (about 1000 to 1600 calories per day) and increase according to possibility.
– Promote weight gain gradually weekly, and achieve an increase in intake up to 70 to 100 calories/kg for some patients.
– Provide attractive and palatable meals in small quantities, noting the type of preferred food.
It is preferable to serve small meals, increase the number of meals eaten, and encourage variety.
Building proteins requires a long period of time. Complete proteins may not yet be available to body tissues.
– Exhaustion until the weight returns to normal body weight, and monitoring leads to improvement in the levels of albumin and blood urea nitrogen.
– Monitoring serum cholesterol levels; Low cholesterol is linked to the occurrence of suicides.
– Helping the patient to restore normal eating habits, as well as helping him measure and record the foods he eats, and then gradually teaching him how to eat a healthy, balanced diet.
– It may be useful to avoid caffeine; To avoid its stimulant and diuretic effect.
The patient may need some nutritional supplements of vitamins and minerals, such as zinc and other nutrients.
To maintain weight, the patient may need to eat 40 to 60 calories/kg of weight.
Anorexia nervosa occurs most often in teenage girls
Rehabilitation and preventing complications
• Nutritional rehabilitation for the patient. It depends on treatment with fluids containing electrolytes, and the patient may need intravenous nutrition. During the treatment period, he is given light meals consisting of fruit juice and milk, which contain additional nutritional elements, such as some vitamins and mineral salts. The number of meals increases gradually, and traditional foods such as meat, eggs, fruits, etc. are added to them.
• Psychotherapy. It begins with the process of diagnosing hidden psychological disorders, conflicts and accumulated frustrations, through psychological therapeutic sessions that gradually increase in depth.
• Are there complications from anorexia nervosa if treatment is neglected?
Dr. Khaled Al-Madani answers that not treating anorexia nervosa ultimately leads to a lack of energy and other nutrients that the body needs to carry out its normal functions. Therefore, the body uses stored fat and other tissues such as muscles and organs as a source of energy, in order to maintain brain functions and vital body functions. It will also lead to the cessation or reduction of non-vital body functions to conserve energy. An electrolyte imbalance can lead to heart failure and death.
* Community medicine consultant
#control #blood #sugar #naturally