A comparison of nutritional management with stress management in the treatment of bulimia nervosa

Article Abstract:

Bulimia nervosa is characterized by binges of uncontrolled eating, followed by purging the ingesting food by vomiting or with laxatives. Sufferers are also often unusually concerned with their body shape or weight, and often undertake strict diets and rigorous exercise routines. Several interventions have been developed to treat bulimics. The most successful tend to focus on cognitive and behavioral aspects of the disorder, while others incorporate nutritional and stress-management training. In the current study, 55 female bulimics were randomly assigned to either a nutritional management (NM) or stress management (SM) treatment program consisting of 15 group therapy sessions over a three-month period. Patients were, on average, 24 years old and had suffered bulimia for an average of 7.5 years. Patients in NM treatment received information about the physical risks of bulimic behavior, the long-term ineffectiveness of purging for weight control, the psychological and biological effects of starvation, and the physiology of weight control. Those in the SM treatment program were taught to recognize cues that might lead to binging and new ways to cope with this compulsion. At the beginning of treatment, there were no significant differences between the two groups of patients. Within three weeks, patients in the NM group had fewer binging episodes than those in the SM group, 68.5 versus 31.9 percent, respectively. However, by the end of treatment, both groups showed an overall decrease in the frequency of binges of about 75 percent. At 12 months after termination of therapy, 56 percent of the NM group reported complete absence of binging and 25 percent of the SM group reported complete absence of binging. With regard to vomiting, 56 percent of NM patients were abstinent at 12 months compared with 33 percent of SM patients. It is recommended that NM be offered as a first-line treatment for bulimia because of its relatively quick initial effectiveness. Some patients may then benefit from additional treatment with SM, depending upon their particular needs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Health aspects, Evaluation, Bulimia, Stress management, Nutrition

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Anorexia nervosa: outcome and prognostic factors after 20 years

Article Abstract:

Anorexia nervosa is an eating disorder in which those affected refuse food, leading to severe weight loss. Other features include a morbid fear of gaining weight, a distorted body image, and depression. Longitudinal follow-up studies of patients with anorexia nervosa are relatively rare. The studies that do exist are difficult to interpret because of methodological problems. A group of anorectics were studied 20 years after they were identify in a previous study. The first study included a five-year follow-up. The purpose of the present study was to see how the findings of the five-year follow-up were associated with observations at 20 years, and if prognostic indicators identified at five years were predictive of outcome. Thirty-eight women and three men were included in the original sample; all were diagnosed as anorectic, with an average duration of illness prior to admission of 3.7 years. The new follow-up data were collected by tracking down the patients or next of kin if the patient could not be located or was dead. Average age at follow-up was 40.9 years. Assessment of outcome produced good, intermediate, and poor categories, with 12, 13, and 15 patients classified in each, respectively. Six patients died as a result of complications of anorexia nervosa, and were included in the poor outcome category. The results were generally consistent with the indicators identified at five-year follow-up. Poor outcome was found to be associated with patients who were older when their illness began, had a history of other psychiatric disturbances, a poor history of family relationships, or longer duration of illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

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To weigh or not to weigh? Frequency of weighing and rate of weight gain in patients with anorexia nervosa

Article Abstract:

Most clinicians agree that weight gain must precede psychological treatment of patients with anorexia nervosa or other eating disorders that result in massive weight loss. Behavior modification and information feedback techniques have been reported to facilitate weight restoration. Although many clinicians presume that weight feedback influences weight gain, there have been no published studies which support this conclusion. The rate of weight gain during refeeding therapy in a behavioral program for patients hospitalized with anorexia nervosa was compared between a group of 15 anorectic patients who were weighed daily, and 15 who were only weighed three times a week. All the patients were told that they had to gain a specific amount of weight each week, and that if they did, they would be free to move around the hospital unit, attend outings at a nearby shopping complex, or spend a few hours away from the hospital on weekends. Patients were told their exact weight immediately after each weighing. There were no significant demographic or clinical differences found between the two groups. No significant differences in weight gain developed between groups. These findings suggest that weighing patients less frequently does not adversely influence rate of weight gain. (Consumer Summary produced by Reliance Medical Information, Inc.)

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