Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: bulimia nerviosa, trastorno por atracón y otros

Abstract

Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness.

The experience in pediatric patients with eating disorder for 10 years

“…The mean age of onset of ED obtained through our data analysis was 11.3 years, which contrasts with other studies also carried out in children and adolescents, which states this age between 14 and 18 years (12,19). This reported average can be conditioned by the lack of studies exclusively focus to pediatric age.…”

“…the main therapy being weight gain (12,19). In this sample of children, no alterations were found in the count of blood or electrolytic cells, described above all in patients with purgative behaviors (3,5,19). Clinical symptoms such as lanugo, dry and scaly skin, brittle hair and nails, bradycardia and hypotension and delayed pubertal development of secondary sexual characteristics were also observed in these patients (12,21,31).…”

“…the main therapy being weight gain (12,19). In this sample of children, no alterations were found in the count of blood or electrolytic cells, described above all in patients with purgative behaviors (3,5,19).…”

“…It seems that there is a positive relationship between excessive control, the application of strict dietary rules, and the individualization of food with the appearance of ED( 4) with an influence of the genetic load (heritability of AN around 48-74%) that condition the beginning before puberty or during adolescence (11,14). Other risk factors found in the sample and reported, are the medium-high socio-economic level, insecure personality with low self-esteem, dependency, obsessive-compulsive tendencies, and identity problems (19). It is also worth noting the effects of cultural aspects related to the search for perfection and an ideal of beauty-focused on thinness, as well as the membership in certain groups where the key to success is related to weight control: social, modeling or sport clubs (4,32).…”

“…Complications can occur in children with ED even at non-alarmingly low weights, with chronicity markers being important (2,8,19). At the first visit, most of the data was normal except for hormone levels and some biochemical markers, affected in approximately half of the patients.…”