Last week we brought you the first article in the Eating Disorders series:Eating disorders: Anorexia nervosa.

As we have mentioned, the pandemic will have led to a meteoric increase in requests for help from ANEB (Anorexie et Boulimie Québec). In fact, in the past year, requests have more than doubled, reaching an increase of up to 131%.

The more we talk about eating disorders, the more aware society will be. Hopefully, this awareness leads to reflection, discussion, as well as awareness among teenage girls, friends and families of young girls who are affected by this eating disorder.

Here is the second part of this series: bulimia nervosa.

Definition of bulimia nervosa

Bulimia 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 binge eating attacks followed by compensatory behaviors (see explanations below).

Symptoms of bulimia nervosa

Individuals with bulimia nervosa experience repeated episodes of binge eating where they consume large amounts of food. These episodes, which are accompanied by a feeling of loss of control, are often caused by aemotional stress and usually take place in secret. The foods eaten are generally high in fat and sugar. The seizures are followed by compensatory behaviors which may include induced vomiting, misuse of laxatives or diuretics, fasting or dieting, and excessive physical activity.

The majority of people with bulimia are at normal weight. Only a minority are overweight or obese. However, people with bulimia are concerned about their weight and shape and feel that they should lose weight. Unlike people with anorexia, people with bulimia nervosa are often more aware of their condition, feel more guilty about their behavior and are more likely to recognize their illness. Depression and anxiety are also common in people with bulimia nervosa.

In terms of the physical symptoms of bulimia nervosa, they are mainly caused by compensatory behaviors. Self-induced vomiting can lead to erosion of tooth enamel, swelling of the salivary glands, inflammation of the esophagus, and scarring of the fingers, which are used to induce vomiting. Vomiting can also cause a decrease inpotassium blood, which may affect the heart rate.

Diagnosis of bulimia nervosa

The diagnostic criteria for bulimia nervosa are as follows:

• Binge eating with a feeling of loss of control and which occurs at least once a week over a period of three months.
• Repetitive compensatory behaviors aimed at preventing weight gain.
• Self-esteem mainly based on body weight and figure.

Treatment of bulimia nervosa

The main treatment for bulimia nervosa is cognitive behavioral therapy. Therapy can be individual or group. The goals of therapy are to promote change, to establish regular and flexible eating habits, to reduce worries about weight and figure and to prevent relapses. Treatment may also include interpersonal psychotherapy and sometimes the prescription of selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication.

Nutritional approach for bulimia nervosa

A dietitian may also be involved in the treatment of bulimia nervosa. It can help build healthy eating habits and provide recommendations for maintaining a healthy weight properly. Similar to the nutritional approach for anorexia nervosa, the role of the dietitian in the treatment of bulimia nervosa involves teaching a normal diet. This teaching may include the following recommendations:

• Plan three regular meals every day.
• Consume normal portions.
• Expand the food repertoire, which is often restricted in individuals with eating disorders such as bulimia nervosa.
• Avoid slimming or diet foods.
• Discourage adoption of vegetarianism or veganism, which can often be used to camouflage compensatory behavior (eg: diet).
• Avoid weighing yourself frequently. Limit the weighings to those carried out during follow-ups with the various health professionals.
• Keep a food journal.
• Aim to maintain body weight. The initial goals of treatment are to stop the binge eating behavior and to maintain body weight. At the start of treatment, restricting food intake for the purpose of weight loss may maintain or exacerbate the bulimic behavior. It is therefore best to wait after a period of remission of at least six months before aiming for weight loss in individuals with bulimia nervosa who are overweight or obese.

References

1. https://www.merckmanuals.com/fr-ca/professional/troubles-psychiatriques/troubles-du-comportement-alimentaire/boulimie
2. https://www.merckmanuals.com/fr-ca/accueil/troubles-mentaux/troubles-des-conduites-alimentaires/boulimie-mentale
3. https://www.merckmanuals.com/fr-ca/accueil/les-faits-en-bref-troubles-mentaux/troubles-des-conduites-alimentaires/boulimie-mentale
4. https://www.unlockfood.ca/fr/Articles/Adolescence/Quand-la-nouriture-et-le-poids-corporel-privez-toute-la-place---coup-d%E2%80%99% C5% 93il-on-les-les-de-l% E2% 80% 99alimentation.aspx
5. Coughlin, Janelle W., et al.Modern Nutrition in Health and Disease, by A. Catharine Ross, Wolters Kluwer / Lippincott Williams & Wilkins, 2014, pp. 13241325..

Article written by:

Marie-Noël Marsan, Nutritionist