The pandemic we are currently experiencing will have brought, as we all know, an increase in anxiety, depression and anxiety among people struggling with eating disorders. Requests for assistance from ANEB (Anorexia and Bulimia Quebec) have more than doubled in the past year, reaching an increase of up to 131%.

The isolation, the loss of routine, the desire to want to keep control, and the time spent on social networks have had a definite impact on the changes in their habits and the relapses, and on the obsession that accompanies these disorders .

According to Dr. Mimi Israel, head of the department of psychiatry at the Douglas Institute and associate professor in the Department of Psychiatry at McGill University, "with eating disorders most often occurring in adolescence, parents need to be careful about the messages they convey. Do not be obsessed with food, do not put pressure on children by talking to them about their weight or by stigmatizing them for unhealthy eating habits. Self-esteem is paramount. What matters is not how we look or how much we weigh, but who we really are. »

So this is the first article in a series on eating disorders.

Definition of anorexia nervosa

Anorexia nervosa is an eating disorder recognized and listed in theDiagnostic and statistical manual of mental disorders fifth edition (DSM-5) which defines and categorizes mental disorders. This disorder is characterized by the desire to be thin, fear of obesity, distorted body image and restriction of food intake, which leads to weight loss and low body weight.

Different types of anorexia nervosa

There are two types of anorexia nervosa: the restrictive type and the binge/elimination behavior type.

In the first case, individuals limit their food intake and may engage in excessive physical activity. They do not exhibit binge eating or elimination behavior on a regular basis.

In the second case, in addition to reducing their food intake, individuals regularly present with binge eating, where they eat frantically, and then an elimination behavior, where they make themselves vomit or take various purgatives (e.g. laxatives, diuretics, enemas).

Etiology of anorexia nervosa

The causes of anorexia nervosa are unknown. One of the only recognized risk factors is being female. However, other factors could also favor the development of this disease, such as having already followed a diet or having an excessive concern for one's weight. There could also be genetic predispositions and social factors. Indeed, many individuals affected by this disease come from the middle or upper class. Finally, the valuation of thinness in Western society could also have a role to play in the development of this disease.

Symptoms of anorexia nervosa

Symptoms of anorexia nervosa can include bloating, abdominal pain, andconstipation. People with anorexia may also have a low heart rate, low blood pressure, low body temperature, excessive body and facial hair, swelling, and depression. In women, cessation of menstruation is common. In individuals with binge eating/elimination behavior type anorexia and frequent vomiting, symptoms may also include erosion of tooth enamel and inflammation of the esophagus. Anorexia nervosa can also cause hormonal changes, such as a decrease in sex hormones (estrogen and testosterone) and an increase in cortisol. These changes can lead to a decrease in bone density, which increases the risk ofosteoporosis. Significant weight loss can also impact the body's fluids and electrolytes, which can lead to dehydration and fainting. Finally, in severe cases of anorexia nervosa, all major organs of the body can be affected.

Diagnosis of anorexia nervosa

Diagnostic criteria for anorexia nervosa include:

• Restriction of food intake resulting in low body weight
• Fear of gaining weight or obesity
• Distortion of body image and/or denial of disease severity

Treatment of anorexia nervosa

The treatment of anorexia nervosa generally requires the intervention of a multidisciplinary team including several health professionals, such as doctors, psychologists, psychiatrists and nutritionists. The initial goal of treatment is to restore weight. This phase of treatment may require hospitalization. During this phase, individuals also receive psychiatric and nutritional recommendations. Then, long-term treatment begins, which mainly includes psychotherapy aimed at normalizing eating behavior and weight. This therapy lasts between one to two years after the weight is restored. In adolescents, family therapy may also be part of the treatment. Regular follow-ups with various health professionals (doctors, psychologists, nutritionists, etc.) also take place throughout the treatment. Finally, medication can also be prescribed.

Nutritional approach for anorexia nervosa

The primary goal of treatment for anorexia nervosa is to restore weight. Weight restoration is done through nutritional supplementation. The ideal is to use solid foods by mouth, but liquid supplements can also be used. In some severe cases, tube feeding may also be required. The speed of weight regain may vary depending on the severity of weight loss. In very severe cases, more gradual weight gain may be required to prevent refeeding syndrome. This syndrome refers to a set of complications that can occur with too rapid weight restoration in individuals who are very underweight. When restoring weight, it is also recommended to stop physical activity, as it can prevent weight gain. Finally,supplements calcium andvitamin D are often prescribed for people with reduced bone mass.

Once weight is restored, long-term treatment aims to normalize eating behavior and weight. During this phase of treatment, individuals generally undergo behavioral therapy and have regular follow-ups with a team of health professionals, including a nutritionist. The nutritionist can intervene to establish a food plan, provide food recommendations and offer nutritional education to help normalize weight.

Nutrition education for anorexia nervosa

In the case of anorexia nervosa, the role of the nutritionist is in particular to provide education on normal eating. This teaching may include the following recommendations:

• Plan three regular meals a day.
• Consume normal portions.
• Expand food repertoire. People with anorexia nervosa often eat a small variety of foods.
• Avoid slimming or diet foods.
• Discourage the adoption of vegetarianism or veganism, which can often be used to camouflage dietary intake restriction.
• Avoid weighing yourself frequently. Limit weighing to those performed during follow-ups with health professionals.
• Teach how to keep a food diary.
• Educate and reassure individuals about gastrointestinal symptoms that may occur at the start of refeeding. These symptoms fade after a few weeks of refeeding.

References

1. https://quebec.huffingtonpost.ca/entry/food-troubles-requests-aid-aneb_qc_60185fdac5b63b0fb2836d08
2. https://www.merckmanuals.com/en-ca/home/mental-disorders/eating-behaviour-disorders/anorexia-mental
3. https://www.merckmanuals.com/en-ca/professional/psychiatric-disorders/eating-behavior-disorders/anorexia-mental
4. https://www.merckmanuals.com/en-ca/home/mental-disorder-quick-facts/eating-behaviour-disorders/mental-anorexia
5. https://www.unlockfood.ca/en/Articles/Adolescence/When-food-and-body-weight-takes-all-the-place---coup-d%E2%80%99% C5%93il-about-eating-disorders.aspx
6. https://www.inserm.fr/information-en-sante/dossiers-information/anorexie-mentale
7. Coughlin, Janelle W., et al.Modern Nutrition in Health and Disease, by A. Catharine Ross, Wolters Kluwer/Lippincott Williams & Wilkins, 2014, p. 13241325..

Article written by:

Marie-Noël Marsan, Nutritionist