Food and health: Eating disorders
Anorexoid syndromes, such as anorexia nervosa and bulimia, are characterized by chronicity, resistance to treatment, and frequent relapses. The first impression, both for the doctor and for the nutritionist and also for the patient, it is that it is a "nonsense II or" a passing game ", which will spontaneously disappear. This rarely happens; rather, they must be approached with the seriousness that a potentially fatal disease deserves.
Ideally these patients they must be treated by an interdisciplinary team with special experience in the field of eating disorders. Intimate family members should be informed about the nature and seriousness of the illness to gain their understanding and support.
Once an alliance with the patient is achieved, the psychological and emotional aspects that initiated and perpetuate the disease begin to be explored. It is important to emphasize, more than ever, that no two patients are totally alike and that all treatment must be adapted to each one in particular.
With the dynamic explanation of the nature of the disease, one gradually moves from attention and discussion focused on food and weight, to the most profound problems: insecurity, feeling of lack of control, social inadequacy, continuous need for being accepted by others, compulsions, depression, etc.
The treatment of these patients is long and often frustrating.
Anorexia nervosa is a characteristic disease of puberty and occurs almost exclusively in girls. Its main symptoms are: progressive and pronounced loss of weight, great reduction in intake, not due to lack of appetite but due to resistance to eating, amenorrhea, constipation and hyperactivity. But the most important characteristic feature is the relentless pursuit of extreme thinness.
In the last 20 years the occurrence of the syndrome has increased dramatically. Attacks young upper-class girls; This social distribution of NA is related to fashion that underlines the importance of thinness and to social changes that give women more freedom and rights, but in turn demand greater performance from them. Anorexia nervosa is a symptom of intense fear of dealing with the social and sexual complications of adult life.
Their physical manifestations correspond to those of insufficient nutrition. A girl with advanced anorexia has the same appearance as a person interned in a concentration camp, her skin is dry, grayish and wrinkled, her expression is sad, overwhelmed, as from old age or misfortune. The gums are swollen, the hair is thin, the fat pad disappears, and the muscles can atrophy.
Amenorrhea is the main symptom and of great diagnostic value, it usually precedes anorexia itself and is related to a serious alteration of the hormonal balance.
Regarding the psychological aspects, Anorexia Nervosa is characterized by a terrifying fear of being fat. The apparent main problem is the control of weight and the achievement of mastery over the body.
There are three areas of altered psychic functioning (the same as “'7- are damaged in obesity): 1) body image disorder; 2) confused perception of stimuli arising from the body; 3) paralyzing sense of inefficiency.
The criteria for the diagnosis of AN is based on the presence of one or more of the following nutrition-related problems: dramatic loss of body weight (about 25% of body weight), distorted body image, excessive worry about. food and weight gained, chaotic eating habits, and behaviors related to physical practices with significant energy expenditure.
Due to the complex etiology of these eating disorders, the most effective method of treatment is an interdisciplinary approach that includes individual and family psychotherapy, nutritional and medical care.
If the intervention is early and timely, in few cases it requires hospitalization. Severe and / or late-treated forms require hospitalization and can lead to death.
Bulimia is a syndrome characterized by binge-eating episodes followed by induced vomiting, fasting, and the use of laxatives and diuretics.
Bulimic symptoms can be part of the syndrome of anorexia nervosa. E150% of anorexic individuals develop bulimia. Bulimics try to restrict their food intake in a way that leads to physical and psychological urges. The food is then purged by forceful vomiting or through the use of laxatives.
Non-life-threatening physical complications include: tooth damage, tracheal irritation, esophageal inflammation, lip tears and injuries, ruptured blood vessels in the face, and calluses on the fingers that are placed in the mouth to induce vomiting.
Acute symptoms such as dehydration and electrolyte imbalance, gastrointestinal fistulas, kidney damage, and reversible myopathies caused by diuretic ingestion are rarer. Calcium deficiency as a result of long-term abuse of laxatives can be a specific nutritional consequence.
Bulimics are usually close to normal weight, but are afraid of gaining weight.
Unlike anorexics, they have psychosocial problems. They are unable to tolerate frustration and try to ease their sensation with "filling" and "purging."
In contrast to anorexics, bulimics tend to have poor control drives, but abuse and steal. One of the main psychological characteristics is the feeling of guilt when the binge-vomiting cycle is done in absolute secrecy.
While anorexics always revolve around food, bulimics revolve around themselves. Bulimic individuals binge eat to escape the painful problem of gaining weight and the shame of not being able to control their behavior eliminates food before it is absorbed by the body.
The treatment of bulimia is similar to that of the recovery of the anorexic.
There are fewer bulimics than anorexics in poor physical condition.
Psychological treatment should be aimed at developing the ability to accept the body's configuration to stop vomiting or purging and to adopt a more normal diet.
Significant progress is made when the ability to distinguish or separate the goal of stopping vomiting from that of losing weight is envisioned.
Disclosure seems to be an important fact for these patients, and it occurs when they can say that they feel disgust at the habit itself and a desire to eat normally.
The focus of dietary treatment is behavior change.
Body condition characterized by the storage of an excessive amount of fat in adipose tissue under the skin and inside certain organs such as muscle. All mammals store fat: this constitutes 25% of body weight in normal women, and 15% in men.
Fat storage, whose energy capacity is twice that of protein or carbohydrates, is a form of energy storage for future needs. However, when these fat reserves are excessive they represent a health problem. Data from insurance companies show that people whose weight exceeds the ideal weight by 30% have a greater risk of suffering from diseases (diabetes, gout, biliary diseases, atherosclerosis and hypertension, respiratory insufficiency, asthma, etc.). In short: "Obesity reduces the life expectancy of those who suffer from it."
La obesidad es consecuencia de trastornos del work endocrino sólo en contadas ocasiones. No es un trastorno congénito, y los bebés obesos no siempre lo son durante todo su desarrollo. La obesidad es la consecuencia de un aporte de energía a través de los alimentos que supera al consumo de energía a través de la actividad. Se ha demostrado que obesos y personas de peso normal pueden comer lo mismo, pero mientras las personas no obesas reducen la ingesta más tarde para compensar este aporte excesivo, los obesos no lo hacen. La obesidad puede también deberse a la falta de actividad, como sucede en las personas sedentarias o postradas en cama.
Defining the objectives well is a priority condition of treatment. It is very important to note that in the case of obesity, the objective of treatment is not only to lose weight, but to maintain weight at a certain lower level, close to the ideal.
The objectives of the treatment, then, will be:
- Reduce body weight.
- Decrease appetite
- Correct metabolic disturbances.
- Promote food reeducation, to maintain the weight achieved.
In this sense, programs to increase physical activity should be pleasant, easy to do and maintain, and should not constitute an extra or excessive expense. The incorporation of walks or the use of stairs, in daily activity, meet these requirements.
Because obesity is considered by many to be an alteration in the eating habits of those who suffer from it, there are therapies that try to modify this pathological behavior. Patients are taught to eat only at certain times of the day or in specific places, to eat slowly, and to keep a written record of the food eaten. Only 15% of the patients treated in this way achieve an acceptable and maintained weight loss.