Eating Disorders in Severe Obesity
In this chapter, we review and recommend strategies for assessing eating disorders in patients with obesity who present for treatment in settings that are not specialized to treat eating disorders. Our purpose is to equip clinicians working with obese ind
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Susan Wnuk, Jessica Van Exan, and Raed Hawa
10.1 Introduction In this chapter, we review and recommend strategies for assessing eating disorders in patients with obesity who present for treatment in settings that are not specialized to treat eating disorders. Our purpose is to equip clinicians working with obese individuals or in general community practices with the tools to understand eating disorder symptoms and make appropriate recommendations to patients with obesity. A case example of a common clinical presentation will be used to illustrate the assessment and triage process. We will begin by reviewing prevalence data and providing an overview of the research literature on eating disorders typically found in individuals with obesity, namely binge eating disorder (BED)
S. Wnuk, B.A., M.A., Ph.D. (*) J. Van Exan, Ph.D., C.Psych. Toronto Western Hospital Bariatric Surgery Program, University Health Network, Toronto, ON, Canada e-mail: [email protected]; jessica.vanexan@ uhn.ca; [email protected] R. Hawa Toronto Western Hospital Bariatric Surgery Program, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8
and night eating syndrome (NES). We will then summarize recent diagnostic changes in the DSM-5 criteria for eating disorders. We discuss interview and self-report instruments and recommend how best to incorporate these into clinical practice so as to reliably and accurately assess for eating disorders. Although other chapters in this volume describe specific psychological treatments for obesity, we outline a plan for triaging patients with obesity who also suffer from eating disorders to more intensive treatment. Finally, we review medications for eating disorders found in patients with obesity.
Case Vignettes
Mark is a 48-year-old male with a body mass index of 43 kg/m2 (with a weight of 310 lbs and height of 5′11″). He was diagnosed with type 2 diabetes 3 years ago and is followed by an endocrinologist. His blood sugar is poorly controlled and his hemoglobin A1c is abnormally elevated. In addition, he was diagnosed with obstructive sleep apnea 7 years ago and uses a conti nuous positive airway pressure (CPAP) machine at night. Mark reports difficulty adhering to diet and exercise recommendations though he takes his medications as prescribed. Mark told his endocrinologist
Department of Psychiatry, University of Toronto, Toronto, ON, Canada e-mail: [email protected] © Springer International Publishing AG 2017 S. Sockalingam, R. Hawa (eds.), Psychiatric Care in Severe Obesity, DOI 10.1007/978-3-319-42536-8_10
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(continued) that he is frustrated by his increasing weight, especially since his diabetes diagnosis, and wants help with weight loss. Over the past 15 years he has repeatedly lost up to 50 lbs through various commercial weight loss programs and by exercising at a gym with a personal trainer. He has maintained this weight loss for up to 1 year, only to regain the weight plus an additional 10–15 lbs each time. Mark reported that his tendency
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