Although psychotherapy is the cornerstone, nutritional education and pharmacotherapies can also help patients recover
In 2019, 14 million individuals, including almost 3 million children and adolescents, experienced eating disorders. Such disorders often coexist with other mental health disorders, including mood and anxiety disorders, obsessive compulsive disorder, and alcohol and substance use disorders.2 Eating disorders, such as anorexia nervosa and bulimia nervosa, involve abnormal eating and preoccupation with food, as well as prominent body dysmorphia. The symptoms or behaviors related to these diseases may result in a significant risk of damage to health, distress, or functional impairment.
Treatment plans for eating disorders are multifaceted and include psychotherapy, medical care and monitoring, nutritional counseling, medications, or a combination of these approaches. Typical treatment goals include restoring adequate nutrition bringing weight to a healthy level, and reducing binging behaviors.
ANOREXIA NERVOSA
Anorexia nervosa is an eating disorder marked by severe nutritional restriction coupled with a desire to alter the body in some way. There are 2 subtypes of anorexia: restricting type, in which patients lose weight primarily by dieting, fasting, or excessively exercising; and binge eating/purging type, in which patients also engage in intermittent binge eating and/or purging behaviors.
Kathleen Kenny, PharmD, RPh, earned her doctoral degree from the University of Colorado Health Sciences Center in Denver. She has more than 30 years’ experience as a community pharmacist and works as a clinical medical writer based in Homosassa, Florida
One common feature of anorexia is an intense fear of gaining weight or becoming overweight. Anorexia can also be related to an intent to disassociate from the body or to exert control over feelings of instability.2 Anorexia often has its onset during adolescence or early adulthood and is associated with premature death due to medical complications or suicide.3
Individuals with anorexia may experience brittle hair and nails, thinning bones, and infertility. Severe cases can result in heart, brain, or multiorgan failure and death.4
BULIMIA NERVOSA
Bulimia nervosa is a condition in which patients have recurrent episodes of consuming large amounts of food uncontrollably in a short amount of time. Following the bingeing episodes, the patient will engage in behaviors that compensate for overeating to prevent weight gain, such as forced vomiting, the use of laxatives or diuretics, fasting, and/or excessive exercise.
Severe bulimia can result in imbalances of electrolytes, such as sodium, potassium, and calcium, which can result in cardiac arrhythmias and cause stroke or heart attack. Individuals with bulimia are also at a significantly increased risk for substance use, suicidality, and health complications.1
BINGE EATING DISORDER
Binge eating disorder (BED) is characterized by uncontrollably eating large amounts of food in a short amount of time. To be diagnosed as having BED, one must do this chronically, such as once weekly for 3 months or longer. This differs from bulimia because there is no purging associated with BED.5
BED is the most common eating disorder in the US.6 This disease can lead to weight gain and obesity and result the comorbidities associated with being overweight and obese, including diabetes and cardiovascular disease.6
Treatment of eating disorders employs a multifaceted approach that includes psychotherapy, nutrition education, continuous monitoring, and sometimes medications. Therapy can also help a patient deal with other mental health issues, such as depression, anxiety, obsessive-compulsive disorder, and substance abuse.
PSYCHOTHERAPY
Psychotherapy is the most important part of eating disorder treatment. It involves regular visits to a psychologist or other mental health professional with specialized training in eating disorder care. Treatment may involve one of several types of proven eating disorder treatments, including the following7:
Patients will often be asked to keep a food journal to review during therapy sessions. This is a valuable tool to discern the reasons behind bingeing, purging, or other unhealthy eating behaviors.7
NUTRITIONAL EDUCATION
When finding a nutritionist or dietitian, seeking an expert specializing in eating disorders is important because this training is not standard. The goals of working with a nutritionist are to work toward a healthy diet, set regular eating patterns, and take steps to discontinue bingeing and/or purging and correct health problems caused by poor nutrition. In addition, patients can learn how nutrition or lack thereof affects the human body.7
MEDICATIONS
There are no medications to cure an eating disorder, and most pharmacologic treatments are focused on comorbid conditions such as anxiety and depression. The goal of pharmacotherapy is to improve eating disorder pathology outcomes and increase adherence to long-term treatment.
In patients with anorexia who have attained 85% of their expected weight, fluoxetine (Prozac; Eli Lilly and Co) has been used to stabilize recovery. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors may be more helpful for addressing concurrent obsessive-compulsive issues.8 Olanzapine (Zyprexa; CHEPLAPHARM Arzneimittel GmbH), a second-generation antipsychotic, shows a trend in adults with an overall increase in body mass index at the end of therapy. However, more studies are needed to establish efficacy.9
The only FDA-approved treatment for bulimia is fluoxetine in higher doses than those used to treat depression. It is only approved for this use in adults.10 Lisdexamfetamine (Vyvanse; Takeda Pharmaceutical Co Ltd) is the first FDA-approved medication to treat BED. It is not clear how the drug works to treat BED, but it is thought to control the impulsive behavior associated with binge eating.11
PHARMACISTS’ ROLE
Pharmacists are the most accessible health care providers available to the public, making them uniquely positioned to recognize patients with eating disorders. Often, patients with eating disorders will misuse OTC products such as laxatives, diet pills, or other medications to lose weight.12 By monitoring the use of prescription and nonprescription drugs, pharmacists can detect a patient with an eating disorder.12 Pharmacists can also provide resources and help educate patients and caregivers about these challenging disorders.
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