Siti's dieting - Treatment and Management

Zhimei & Carr Men
Team members in treatment may include:
· Doctors specializing in relevant medical complications
· Dieticians
· Cognitive-behavioural therapists
· Psychotherapists
· Nurses

Goals of treating anorexia nervosa:
· Restore normal weight for anorexia nervosa
· Reduce binge eating and purging especially in bulimic
· Treat physical complications and associated psychiatric disorders
· Teach patients proper nutritional habits, eating patterns and meal plans
· Change patients’ dysfunctional thoughts about the eating disorder
· Improve self-control, self esteem and behaviour
· Encourage and motivate patients to cooperate in restoring normal eating patterns.
· Provide family counselling.
· Prevent relapse

Steps?
· First: identify it as a problem
· Second: restore body weight and eating habit
· Third: focus on psychological issues

Factors to be considered:
· Person’s age
· Current lifestyle
· Duration of Anorexia nervosa
· Overall medical condition
· Other eating disorders eg. Binge eating
· Results of previous treatments
· Severity of psychological condition

Treatment should be given as soon as possible to minimize the effects of anorexia as the treatment plans are usually extensive.

Types of treatment:

Drug therapy :
1. Antidepressant drug therapy for depression - Selective serotonin reuptake inhibitors (SSRIs)
· weight maintenance.
· resolve mood and anxiety symptoms associated with anorexia.
2. Cyproheptadin ( appetite stimulant )
· May help stimulate the patient’s appetite.
· Problem? Because it does not help anorexia nervosa, psychologically, this may cause the patient to binge eat instead and still feels guilty about it later.
3. Calcium (1000-1500 mg/d), vitamin D (400 IU) and oestrogen
· Prevent further bone and osteopenia.
4. Fluoxetine ( Prozac )
· Stabilize recovery of patients who have already attained 85% of their expected weight.
· Prevent relapse.
5. Zyprexa (olanzapine)
· for the obsessional thoughts that accompany anorexia.
· Potential side effect of Zyprexa is weight gain.
6. Seroquel
· Another atypical antipsychotic drug, but very little research has been done so far.

Nutritional care:
· Avoid caffeine, alcohol and tobacco
· Drink 6-8 glasses of water daily
· A balanced diet
· Avoid refined sugar
· Daily multivitamin intake
· Omega-3 fatty acids eg fish oil to help decrease inflammation and improve immunity
· Coenzyme Q10 for antioxidant, immune and muscular support
· Creatine to avoid muscle weakness and wasting
· Probiotic supplement
· L-glutaminefor gastrointestinal health and immunity
· Herbs:
o Strengthen and tone the body’s systems
o Ashwagandha (withania somniferum) for general health benefits and stress
o Fenugreek (trigonella foenum-graecum) to stimulate appetite
o Cayenne pepper (capsicum annuum) helps digestion
o Milk thistle (silybum marianum) for liver health
o Catnip (nepeta spp.) to calm nerve and soothe digestive system


Activity :
· Limited physical activity (sports, exercise classes) is recommended so that energy expenditure is limited, thus assuring a balanced weight.
· Limitation of activity may also motivate the patient to maintain healthy eating habits in order to ensure a rapid return to favourite activities.

Psychotherapy : can help patients with anorexia nervosa understand :
· Why have they gone through that experience in their illness.
· Understand how the distortions they see them to their behavior.
· How and why family and culture may have influenced them and led them to that behavior.
· How their illness may have been an attempt to regulate their emotions.
· How to minimize the risk of relapse.
· How to cope better with their development.

Individual therapy: for people who are beyond adolescence and who are not living at home; provides a safe place to learn how to identify concerns, solve problems, overcome fears, and test new skills.

Family therapy: for people who are young or living at home; useful to provide information about anorexia nervosa, assess the impact of the disorder on the family, help members overcome guilt, improve communication and decision-making skills, develop strategies for coping, and develop practical strategies for overcoming the disorder. However, family therapy should only be performed if the patient is close to the family, as negative feelings may disrupt the overall therapy.

Marital therapy: to strengthen the relationship; can provide practical suggestions on how to deal with the disorder; may also help identify and resolve communication problems.

Group therapy: in hospital treatment; may focus on food, eating, body image, interpersonal skills, and vocational training. Others may aim at understanding the psychological factors that may have led to the development and maintenance of the disorder.

Cognitive behaviour therapy : Help patients change irrational thoughts and unhealthy behaviors

Interpersonal therapy : working on current relationships in terms of unresolved grief, role disputes, role transitions and more, and how these challenges contribute to distress.

Massage therapy : Massage therapy has been shown in some cases to improve body image, reduce stress hormone levels, and lower anxiety and depression.

Art therapy : Help patients express ideas and conflicts for which they have no words for.

Nutritional counselling :

Regular contact with a registered dietician is advised as they:
· Are an effective source of support and information for patients who are regaining weight or who are trying to normalize their eating behaviour.
· Can help patients to gain a fundamental understanding of adequate nutrition.
· May conduct dietary counselling - a process designed to help patients change the nature of their eating behaviour.

Monitoring the patient :
Monitoring of weight, vital signs, and serum electrolyte levels.
Outpatient treatment should only be done with very close monitoring, such as weekly weight measurement wearing only a gown.

Support groups:
· Best handled by professionals.
· Provide anorexics and their families with mutual support and advice about how to cope with the disorder
· Help one prepare for therapy
· Support one another in maintaining eating disorder behaviours.

Psychosocial interventions: (emotional support )
· People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment.
· Family members or other trusted individuals can be extremely helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation.

Hypnosis :
· May be helpful as part of an integrated treatment program for anorexia nervosa.
· Help the person strengthen both self-confidence and the ability to cope.
· Results : Healthier eating, improved body image, and greater self-esteem.

Hospitalisation :
(safe environment where food can be closely monitored)
· Below 30% of ideal weight for that age n height
· Continuous weight loss despite treatment
· Medical complications
· Severe depression eg. Suicidal

Difficulties encountered:
· Patients refused to admit and believe that emaciation is normal and attractive
· Family in denial
· Peer pressure. Believe in low body fat. Dancing and athletic coaches.
· Patients should get rid of expectations to be cured just through the ‘insights’ of a therapist.
· Patients must realise that it is hard work and a few methods may be tested before taking effect; it is also normal to relapse .

Treatment centres:
· ANAD is the National Association of Anorexia Nervosa and Associated Disorders.
· National Eating Disorders Association’s toll-free hotline at 1-800-931-2237
· Call for help today at 866.768.6719
· The Joy Project is a 501(c)3 non-profit, grassroots organization based on the philosophy of using real-world, workable solutions to end the epidemic of eating disorders. We work towards reducing the rate and severity of eating disorders by supporting and conducting research, education, and support programs.
· The Academy for Eating Disorders (AED) is a global professional association committed to leadership in eating disorders research, education, treatment, and prevention.

References :

http://www.nlm.nih.gov/medlineplus/ency/article/000362.htm
http://www.umm.edu/altmed/articles/anorexia-nervosa-000012.htm
http://www.ehealthmd.com/library/anorexia/ANO_treatment.html
http://health.nytimes.com/health/guides/disease/anorexia-nervosa/overview.html?inline=nyt-classifier
http://health.nytimes.com/health/guides/disease/anorexia-nervosa/treatment.html
http://www.bbc.co.uk/health/conditions/anorexia1.shtml
http://www.anorexia-nervosa-treatment.net/
http://www.anorexia-nervosa-treatment.net/treatment-centers.php
http://www.eatingdisordersonline.com/types-eating-disorders/anorexia-nervosa/anorexia-support
http://www.joyproject.org/
http://www.helpguide.org/mental/anorexia_signs_symptoms_causes_treatment.htm
http://psychcentral.com/disorders/sx2t.htm
http://www.psychiatryonline.com/content.aspx?aID=138722#138770
http://www.aedweb.org/eating_disorders/treatment.cfm
http://www.anad.org/2901.html
http://www.medicinenet.com/anorexia_nervosa/page5.htm
http://www.anorexianervosatreatment.com/index.php
http://books.google.com.sg/books?id=16qM2k9VPwIC&printsec=frontcover&source=gbs_v2_summary_r&cad=0
http://emedicine.medscape.com/article/912187-treatment
http://eatingdisorders.about.com/od/anorexianervosa/a/anorexiatherapy_2.htm
http://eatingdisorders.about.com/od/treatmentstrategies/a/anorexiameds.htm