Behavioral eating disorders among Adolescents

Adolescence is transition period for physical growth & sexual maturation. Nutrition being determinant of physical growth of adolescents is an important area that needs attention. Growth is one of the most important health concerns for adolescents & their parents as well as health care workers. The eating disorders, anorexia nervosa , bulimia nervosa  and binge eating disorder, manifest through distorted or chaotic eating and in the case of Anorexia nervosa and Bulimia Nervosa are characterized by a morbid preoccupation with weight and shape. Eating disorders and partial syndromes, including avoidant/restrictive food intake disorder, remain relatively common and early recognition and intervention is helpful. Aetiology is multifactorial, with high heritability. Prognosis overall is good but treatment can be long and intensive, significantly impacting families. An integrated multidisciplinary approach is essential, working collaboratively with families and young people. Psychological interventions focus on the eating disorder, supported by medical monitoring and dietetic guidance. Although working with families is the backbone of treatment for Anorexia Nervosa, young people also need opportunities for confidential discussion. For Bulimia nervosa, family or individual approaches may be equally effective. Evidence for effectiveness of psychopharmacological agents is limited in both Anorexia Nervosa and Bulimia Nervosa. Psychological and pharmacological approaches may both be of benefit for Behavioral Eating Disorder.
Treatment most often involves a combination of the following strategies:
Psychotherapy          
This is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations. There are several types of psychotherapy including:

• Acceptance and Commitment Therapy. This therapy’s goal is to develop motivation to change actions rather than your thoughts and feelings.
• Cognitive Behavioral Therapy (CBT). This therapy’s goal is to address distorted views and attitudes about weight, shape and appearance and practice behavioral modification (if “X” happens, I can do “Y” instead of “Z”).

• Cognitive Remediation Therapy. This therapy uses reflection, and guided supervision to develop the capability of focusing on more than one thing at a time.
• Dialectical Behavior Therapy (DBT), is CBT plus insight. In other words, this therapy helps the individual not just develop new skills to handle negative triggers, but also helps the person develop insight to recognize triggers or situations where a non-useful behavior might occur. Specific skills include building mindfulness, improving relationships through interpersonal effectiveness, managing emotions and tolerating stress.
• Family-based Treatment (also called the Maudsley Method). This therapy involves family-based refeeding, which means putting the parents/family in charge of getting the appropriate nutritional intake consumed by the individual with the eating disorder. It is the most evidence-based method to physiologically restore health to an individual with anorexia nervosa who is under 18 years of age.
• Interpersonal Psychotherapy. This therapy is aimed at resolving an interpersonal problem area. Improving relationships and communications, and resolving identified problems has been found to reduce eating disorder symptoms.
• Psychodynamic Psychotherapy. This therapy involves looking at the root causes of anorexia nervosa – what are the patient’s true underlying needs and issues — as the key to recovery.

Medication

The antipsychotic olanzapine (Zyprexa) may be helpful for weight gain. Although there is no clear evidence that antidepressant medications can help individuals gain weight, some doctors may prescribe these drugs to help control anxiety and depression associated with an eating disorder.

Nutrition counseling

This strategy is designed to teach a healthy approach to food and weight, to help restore normal eating patterns, and to teach the importance of nutrition and a balanced diet.

Group and/or family therapy

Family support is very important for success of the treatment. It is important that family members understand the eating disorder and recognize its signs and symptoms. People with eating disorders might benefit from group therapy, where they can find support, and openly discuss their feelings and concerns with others who share common experiences and problems.

Hospitalization

Treatment can take place outside the hospital or in inpatient facility. To be considered for outpatient therapy, patients need to be medically and psychiatrically stable, have symptoms under control and not require daily medical monitoring. Hospitalization might be needed to treat severe weight loss that has resulted in malnutrition and other serious mental or physical health complications, such as heart disorders, serious depression and suicidal thoughts or behaviors.

Among the risk factors for eating disorders, social and family environment and the media were the most important ones. The influence of the media and social environment has been related to the worship of thinness. Life style family environment mealtimes appeared to be fundamental in shaping eating behavior and the development of disorders. Eating disorders were associated with nutritional problems (growing impairment and weight gain), oral health (cheilitis, dental erosion, periodontitis, and hypertrophy of salivary glands), and social prejudice. Health care personnel is of particular value in the assessment and management of acute malnutrition and complications secondary to disordered eating behaviors, in the early stages of re-feeding, and in the monitoring and management of long-term complications such as growth retardation, pubertal delay and osteopenia. Nutrition is fundamental for children’s current & future health as well as their development & learning. Nutrition education is an important element in an overall strategy aimed at improving food security & preventing all form of malnutrition. Diet counseling makes the individual aware of the fact that diet plays important role in the treatment of the behavioral eating disorder. With today’s emphasis on prevention of disease, diet counseling helps to reduce the risk of some illness by appropriate counseling.