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22 Cards in this Set
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Diagnostic criteria for anorexia nervosa
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•Refusal to maintain body weight above 85% of ideal weight for height and age
•Intense fear of weight gain •Inaccurate perception of own body weight or shape, denial of seriousness of low body weight •Amenorrhea (absence of 3 consecutive menstrual cycles) |
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2 Major types of anorexia nervosa
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•Restricting type – severely limits food intake
•Binging/purging type – regularly engages in vomiting, laxatives, etc. 95% of patients are female |
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Who does it affect? Anorexia nervosa
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•Affects about 1% of women between ages 12 and 25 years – average onset at 17 years, rare after age 40
•≥10% mortality – cardiac arrhythmia |
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Medical Complications of Anorexia Nervosa
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•Muscle wasting
•Dehydration •Dry scaly skin •Dry hair, hair loss •Intolerant of cold temperatures •Increased risk of bone fracture •Advanced cases suffer from hypotension (abnormally low blood pressure), bradycardia (abnormally slow heartbeat) |
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Common oral complications in anorexia nervosa
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•Xerostomia – dry mouth
•Bleeding gums – possible nutritional deficiencies, or impulsive behaviors •Moderate to severe gingival recession and periodontal pockets (>3 mm) •Unilateral or bilateral enlargement of parotid glands •Dry, glossy atrophic mucosa •Angular cheilitis •Inflamed, fissured tongue with partial or total papillary atrophy |
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Diagnostic Criteria for Bulemia Nervosa
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•Recurrent episodes of binge eating
•Within a 24-hour period, amount of food consumed much larger than normal •Sense of lack of control over eating •Self-image depends strongly on body weight and shape •Recurrent use of vomiting, medications, laxatives, etc. •Behaviors occur at least 2X per week for more than 3 months |
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Bulemia Nervosa - who does this affect?
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•Occurs in 1 to 3% of population
•90-95% cases are female, in 20s and 30s •Often normal or high body mass index •>30% abuse alcohol and stimulants •50% have other personality disorders •High rate of relapse (67%) |
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What are some medical complications of bulemia nervosa?
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•Aspiration
•Hypokalemia (low potassium level), causes cardiac arrhythmia •Pancreatitis •Russell’s sign – abrasions or calluses on back of hand due to manually inducing vomiting |
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Common Oral Complications in Bulemia Nervosa
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•Xerostomia
•Cracked lips, fissures at corners of mouth •Enlargement of parotid salivary glands •Erosion of dental enamel (due to vomiting) •Irritation of esophagus •Thermal hypersensitivity of teeth •Dental caries •Enlarged parotid glands |
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Describe the female athlete triad
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•Disordered eating patterns similar to anorexia nervosa or bulemia
•Restricted calories •Weight loss •Low body fat •Oral effects include enamel erosion, poor periodontal health |
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Describe binge eating
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•Common among chronic dieters
•Often normal weight or overweight •Very large amount of calories in one sitting (up to 10 times daily recommendations) – eat rapidly, until uncomfortably full, eat when not hungry, eat alone, feel guilty & self-disgust •Occurs at least 2X /week for 6 months or more •Common oral complication: dental caries |
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Dental Management of Eating Disorders
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•Dentist may be first to see signs of disorder
•Signs of erosion •Dietary history during 1-week period •Rule out excessive carbonated drinks, acidic foods •Encourage good oral prophylaxis habits – rinse with baking soda after vomiting •Fluoride treatment •Restorations after binge/purge cycle has stopped •Treat pain •REFER for medical, psychiatric evaluation |
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Health Consequences Associated with Overweight and Obesity
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•Premature death – 300,000 deaths per year attributed to being obese
•Heart disease – increased if BMI > 25 •High blood pressure and stroke – HBP two times more common in obese than normal weight •Type 2 diabetes – 80% of diabetics are overweight or obese •Gall bladder disease •Cancer of the breast, prostate, colon •Osteoarthritis •Sleep apnea •Asthma •Irregular menstrual cycles and infertility in women •Limited mobility and endurance •Depression •Job and social discrimination •Periodontal disease |
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What is metabolic syndrome and what are the factors that help you diagnose it?
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A group of metabolic abnormalities of blood sugar, blood lipids and obesity, when occurring together, is thought to increase risk of CVD and other diseases more than expected from the individual abnormalities.
MetS component Revised ATP III Criteria : ≥3 components: Waist Circumference, cm >102 (Men)/ >88 (Women) Triglycerides, mg/dL ≥150, or treatment HDL cholesterol, mg/dL <40 (Men)/ <50 (Women), or treatment Systolic/diastolic Blood Pressure, mm Hg ≥130/≥85, or treatment Fasting Glucose, mg/dL ≥100 or previously diagnosed type 2 diabetes |
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What is negative energy balance?
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Decrease energy intake = increase energy expenditure -Decrease kcal intake; decrease total amt of food eaten; decrease proportion of fat and alcohol in diet. -may increase RME, TEF, and physical activity |
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What must you do to gain one pound of weight?
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•To gain 1 pound of weight, you have to eat 3,500 more Calories than you burn off
•To lose 1 pound (454 g) of weight, you have to burn off 3,500 Calories more than you eat •Assume adipose tissue is approx 85% fat, 15% water •85% of 454 g=386 g of stored fat available to be burned •386 g of fat X 9 Kcal/g has potential of 3474 kcal |
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What are some disadvanatges to rapid weight loss?
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•Difficult to maintain diet of 1000 Kcal or less for long period of time
•Weight rebounds when strict regimen is relaxed •After fast or low calorie diet, fat and liver tissue “hyper-react” - increase production and storage of fat in animal studies •Weight regain seems to continue until fat cells reach original size |
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Describe weight rebound?
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•We use calories more efficiently after significant weight loss.
•In severely obese subjects after weight loss, RME decreases and energy needed to perform activities decreases compared to before weight loss • Animals fasted, lost 10% of original weight. When refed, could maintain new weight on 60% of original Kcalorie need |
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What are some advantages of slow weight loss?
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•Normal dietary intake patterns
•Nutritional adequacy •Variety •Less feeling of deprivation •Sustainable for long run •Slower rate of weight loss •Minimizes rebound weight and yo-yo effect •Physical activity and adequate protein intake maintain muscle mass |
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Describe the different diets that may exist
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•Several randomized controlled trials published comparing low-fat vs. low carb diet
•Weight loss similar regardless of type, but are there other health concerns? •Examples of diets •Atkins - < 20 grams carbohydrate per day initially, gradually increased to 50 g/d •Zone – 40% calories from carbohydrate, 30% from fat, 30% from protein •Weight watchers – overall reduction in calories, lower fat •Ornish - vegetarian diet, 10% calories from fat |
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Describe some characteristics of people that maintain weight loss
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•National Weight Control Registry
•>4000 men and women lost at least 30 lb and kept it off > 1 year •44% lost weight on their own, 55% received medical/behavioral help •89% used diet (majority: low calorie, low fat) and exercise (1 hr/day in moderate activity), 10% used diet only •78% eat breakfast every day •44% weigh themselves every day |
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Describe 3 mechanisms for why some people may maintain weight loss?
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•Adpiose tissue produces pro-inflammatory cytokines, associated with insulin resistance
•Obese persons more likely to be glucose intolerant •People who exercise regularly, eat according to Food Pyramid guidelines, maintain weight (overall healthy lifestyle) less likely to have periodontal disease |
