The Management of Eating Disorders and Obesity

431 Pages·2005·3.523 MB·English

by  Steven J. Romano MD (auth.), David J. Goldstein MD, PhD (eds.)

T M E D O
HE ANAGEMENT OF ATING ISORDERS AND BESITY
S E
ECOND DITION
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N H
UTRITION ◊ AND ◊ EALTH
Adrianne Bendich, Series Editor
The Management of Eating Disorders and Obesity, Second Edition, edited by David J.
Goldstein, 2005
Preventive Nutrition: The Comprehensive Guide for Health Professionals, Third Edition,
edited by Adrianne Bendich and Richard J. Deckelbaum, 2005
IGF and Nutrition in Health and Disease, edited by M. Sue Houston, Jeffrey M. P.
Holly, and Eva L. Feldman, 2005
Nutrition and Oral Medicine, edited by Riva Touger-Decker, David A. Sirois, and
Connie C. Mobley, 2005
Epilepsy and the Ketogenic Diet, edited by Carl E. Stafstrom and Jong M. Rho, 2004
Handbook of Drug–Nutrient Interactions, edited by Joseph I. Boullata and Vincent T.
Armenti, 2004
Nutrition and Bone Health, edited by Michael F. Holick and Bess Dawson-Hughes,
2004
Diet and Human Immune Function, edited by David A. Hughes, L. Gail Darlington,
and Adrianne Bendich, 2004
Beverages in Nutrition and Health, edited by Ted Wilson and Norman J. Temple, 2004
Handbook of Clinical Nutrition and Aging, edited by Connie Watkins Bales
and Christine Seel Ritchie, 2004
Fatty Acids: Physiological and Behavioral Functions, edited by
David I. Mostofsky, Shlomo Yehuda, and Norman Salem, Jr., 2001
Nutrition and Health in Developing Countries, edited by Richard D. Semba and
Martin W. Bloem, 2001
Preventive Nutrition: The Comprehensive Guide for Health Professionals, Second Edition,
edited by Adrianne Bendich and Richard J. Deckelbaum, 2001
Nutritional Health: Strategies for Disease Prevention, edited by Ted Wilson and
Norman J. Temple, 2001
Clinical Nutrition of the Essential Trace Elements and Minerals: The Guide for Health
Professionals, edited by John D. Bogden and Leslie M. Klevey, 2000
Primary and Secondary Preventive Nutrition, edited by Adrianne Bendich
and Richard J. Deckelbaum, 2000
The Management of Eating Disorders and Obesity, edited by David J. Goldstein,
1999
Vitamin D: Physiology, Molecular Biology, and Clinical Applications,
edited by Michael F. Holick, 1999
Preventive Nutrition: The Comprehensive Guide for Health Professionals, edited by
Adrianne Bendich and Richard J. Deckelbaum, 1997
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T M
HE ANAGEMENT
E D
OF ATING ISORDERS
O
AND BESITY
S E
ECOND DITION
Edited by
D J. G , ,
AVID OLDSTEIN MD PhD
Department of Pharmacology and Toxicology, Indiana University
School of Medicine and PRN Consulting, Indianapolis, IN
Foreword by
A J. S ,
LBERT TUNKARD MD
Weight and Eating Disorders Program, Department of Psychiatry,
University of Pennsylvania School of Medicine, Philadelphia, PA
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© 2005 Humana Press Inc.
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Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published
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new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions
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Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1
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Library of Congress Cataloging-in-Publication Data
The management of eating disorders and obesity / edited by David J. Goldstein.-- 2nd ed.
p. ; cm. -- (Nutrition and health)
Includes bibliographical references and index.
ISBN 1-58829-341-6 (alk. paper)
1. Eating disorders. 2. Obesity.
[DNLM: 1. Bulimia--therapy. 2. Anorexia Nervosa--therapy. 3. Obesity--therapy. WM 175 M266 2005]
I. Goldstein, David J. (David Joel), 1947- II. Series: Nutrition and health (Totowa, N.J.)
RC552.E18M364 2005
616.85'2606--dc22
2004009971
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Series Editor’s Introduction
The Nutrition and Health Series of books have had great success because each volume
has the consistent overriding mission of providing health professionals with texts that are
essential because each includes (1) a synthesis of the state of the science; (2) timely,
in-depth reviews by the leading researchers in their respective fields; (3) extensive,
up-to-date fully annotated reference lists; (4) a detailed index; (5) relevant tables and
figures; (6) identification of paradigm shifts and the consequences; (7) virtually no over-
lap of information between chapters, but targeted, interchapter referrals; (8) suggestions
of areas for future research; and (9) balanced, data-driven answers to patient/health
professionals’ questions that are based on the totality of evidence rather than the findings
of any single study.
The series volumes are not the outcome of a symposium. Rather, each editor has the
potential to examine a chosen area with a broad perspective, both in subject matter as well
as in the choice of chapter authors. The editors, whose trainings are both research- and
practice-oriented, have the opportunity to develop a primary objective for their book,
define the scope and focus, and then invite the leading authorities to be part of their
initiative. The authors are encouraged to provide an overview of the field, discuss their
own research, and relate the research findings to potential human health consequences.
Because each book is developed de novo, the chapters are coordinated so that the resulting
volume imparts greater knowledge than the sum of the information contained in the
individual chapters.
The Management of Eating Disorders and Obesity, Second Edition, edited by David
J. Goldstein clearly exemplifies the goals of the Nutrition and Health Series. The first
edition was widely acclaimed for its emphasis on data-driven clinical applications of the
newest scientific discoveries in the areas of bulimia, anorexia, binge eating, and the
complex, chronic disease of obesity. Dr. Goldstein, who is an internationally recognized
leader in the fields of obesity and eating-disorder research, has enhanced the contents of
the first edition even further with the addition of three timely, new chapters. The first two
new chapters cover the internet and its value in the education and potential treatment
of eating disorders in one chapter, and the use of the internet in education and treatment
of obesity in a second chapter. The third critically important chapter reviews the role of
hunger and satiety in obesity treatment. All of the original chapter authors, the most
authoritative leaders in obesity and eating-disorder research, have updated the contents
and have included recent references, figures, and graphs. Thus, Dr. Goldstein has devel-
oped a second edition that is destined to be the benchmark in the field because of its
extensive, in-depth chapters covering the most important aspects of eating disorders and
obesity, with emphases on human physiology, treatment, and disease prevention.
The book chapters are logically organized to provide the reader with a basic
understanding of the clinical conditions of bulimia nervosa, anorexia nervosa, and
obesity in the first chapter of each of the book’s three major sections. Each section also
v
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vi Series Editor’s Introduction
contains chapters that address treatment options as well as prevention strategies. This
logical sequence of chapters provides the latest information on the current standards of
practice for clinicians, related health professionals including the dietitian, nurse, pharma-
cist, physical therapist, behaviorist, psychologist, and others involved in the team effort
required for successful treatments. This comprehensive volume also has great value for
academicians involved in the education of graduate students and postdoctoral fellows,
medical students, and allied health professionals who plan to interact with patients with
eating disorders including obesity.
Cutting-edge discussions of the roles of growth factors, hormones, cellular and nuclear
receptors and their ligands, gene promoters, adipose tissue, and all of the cells directly
involved in fat metabolism are included in well-organized chapters that put the molecular
aspects into clinical perspective. Of great importance, the editor and authors have
provided chapters that balance the most technical information with discussions of its
importance for clients and patients as well as graduate and medical students, health
professionals, and academicians.
Separate chapters in the three sections include specific, detailed information on the
counseling of patients with bulimia and the pharmacological treatment of bulimia. There
is a unique chapter that looks at the role of nutrition and dietary factors in the prevention
of eating disorders. The anorexia section includes four chapters devoted to basic infor-
mation, treatment strategies, detailed information on pharmacological therapies, and the
new chapter on internet resources. The third section is the largest and contains three
chapters on general aspects of obesity including the etiologies of obesity, medical
consequences of obesity, as well as benefits of weight loss and a very practical chapter
on binge eating in the obese.
Thirteen chapters are devoted to the treatment of obesity. These include an overview
of current treatment options as well as a discussion of future treatments that are already
in development. Critical to any weight-reduction program is exercise, and there is a
comprehensive chapter on the role of physical activity, exercise, and nutrition in weight
control. The importance of a team approach to the treatment of obesity as a chronic
disease is extensively discussed in the chapter on lifestyle modification in the treatment
of obesity. Specific treatment modalities are reviewed in separate chapters on very low-
calorie diets, pharmacotherapies, combination therapies, the potential for genetic inter-
ventions, the new chapter on hunger and satiety, and surgical interventions that are
discussed in detail, including drawings that depict the specific types of surgeries
currently available. Each of these chapters presents an objective evaluation of the
treatment and identifies the positives and negatives that have been seen during clinical
studies, as well as cumulative data derived from clinical practice.
The final four chapters in the obesity treatment section examine the clinical experi-
ences in a comprehensive weight-management program, the importance and value of a
multidisciplinary team in the management of obesity, the potential for the internet to help
in obesity treatment, and a most candid chapter on the barriers to obesity treatment. The
final book chapter reviews the most medically relevant alternative to treatment–preven-
tion of obesity—and examines the signs that could alert the health professional to the
potential for the development of obesity, as well as outlines the steps to take to help
prevent the overweight patient from moving to frank obesity.
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Series Editor’s Introduction vii
There is a clear, data-driven message throughout the obesity section of the volume that
obesity is a chronic disease. As with hypertension that can be controlled by drug therapy,
so with obesity—therapy cannot stop once a particular weight-loss goal is reached. Like
hypertension that reappears without chronic treatment, obesity can easily reappear if not
treated as a chronic disease.
Detailed tables and figures assist the reader in comprehending the complexities of the
disturbances in eating behaviors. Modulators of eating responses that are covered in this
section include adrenergic receptors, cholecystokinin, γ-aminobutyric acid, histamine
and serotonin receptors, insulin, leptin, neuropeptide Y, galanin, ghrelin, growth
hormone, as well as substances that can be consumed in diet and/or supplements such as
caffeine, ephedrine, aspirin and lithium, olestra, and yohimbine. Novel treatment options
that are of great interest to clients and patients are included in several chapters that review
more than 50 therapeutic agents. In-depth descriptions of behavioral modification
programs, mental states, evaluation tools for documentation of patient eating habits, and
many other valuable treatment aids are included in numerous chapters. Thus, The
Management of Eating Disorders and Obesity, Second Edition is focused on answering
questions commonly asked by clients and patients about why some diets do not work and
why some “professional” sources advocate certain products that are available over the
counter but may not “work.” The overriding goal of this volume is to provide the health
professional with the balanced documentation to assure the client/patient that eating
disorders and obesity are complex states that transcend the simplistic view of just losing
a few pounds.
Hallmarks of all chapters include bulleted key points at the beginning of each chapter
as well as a detailed table of contents; complete definitions of terms with the abbrevia-
tions fully defined for the reader and consistent use of terms between chapters. There are
numerous relevant tables, graphs, and figures as well as up-to-date references; all
chapters include a conclusion section that provides the highlights of major findings. The
Management of Eating Disorders and Obesity, Second Edition contains a highly
annotated index and within chapters, readers are referred to relevant information in other
chapters.
This important text provides practical, data-driven resources based on the totality of
the evidence to help the reader understand the basics, treatments, and preventive
strategies that are involved in bulimia, anorexia, and obesity. The overarching goal of the
editor is to provide fully referenced information to health professionals so they may have
a balanced perspective on the value of various treatment options that are available today
as well as in the foreseeable future.
In conclusion, The Management of Eating Disorders and Obesity, Second Edition,
edited by David J. Goldstein provides health professionals in many areas of research and
practice with the most up-to-date, well-referenced and easy-to-understand volume on the
importance of identifying and treating those already suffering from bulimia, anorexia,
and/or obesity as well as providing strategies to prevent the development of these chronic,
serious diseases. This volume will serve the reader as the most authoritative resource in
the field to date and is a very welcome addition to the Nutrition and Health Series
Adrianne Bendich, PhD, FACN
Series Editor
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Foreword
The 6 years since the publication of the first edition of The Management of Eating
Disorders and Obesity has seen a sea change in our view of obesity. At the time of the
first edition, obesity was still viewed as a fairly simple problem, with unfortunate, but not
necessarily dire, consequences. Since that time, the importance of obesity has broken into
our general awareness and into the medical literature in particular. The enormous
increase in obesity, to the extent that two-thirds of Americans are overweight or obese, is now
termed an “epidemic.” This epidemic is destined to become even more severe as the huge
increase in childhood obesity has its impact on obesity in later life. The serious health
consequences of obesity are being increasingly recognized and Syndrome X has become
a household word.
This situation in the treatment of obesity is a major reason for the consternation caused
by the removal of fenfluramine from the market just as the first edition of this volume was
published, because fenfluramine was the most effective pharmacological agent for the
treatment of obesity yet employed and was a sound basis for medical treatment of the
disorder. No other medication for obesity has yet taken its place.
In the face of the uncontrollable increase in obesity, the public is turning increas-
ingly to popular fads. The explosion of interest in the Atkins Diet, and “low carbs”
illustrates a near hysteria on the part of the general public. Forty million Americans are
said to be currently following the not entirely benign Atkins Diet. In these frantic days,
an important task of the practitioner is to forestall the more needless, and even harmful,
results of the hysteria.
As befits an epidemic, public health efforts are being introduced in increasing measure
to schools, communities, and in public communication, as through the internet. The focus
of these methods is on the favorable changes in lifestyle that may help to prevent obesity
from developing, control it when it develops, and, in some cases, reduce it. As outlined
in Food Fight by Brownell and Horgen (1), the beginning of this effort is to think differ-
ently about foods, not as “good” or “bad,” but in total calories of food intake. Next, public
health and medical efforts should be combined to increase physical activity and to
establish simple but sound eating habits that include smaller portion sizes. These
activities had not been ones that, until now, the practitioner would have been able to
pursue under the circumstances prevailing because they require services that had not been
reimbursed. Awareness of the epidemic nature of obesity has led to the salutary conse-
quence of the US Food and Drug Administration labeling obesity “a disease.” This long-
delayed action has important consequences. It makes it possible for the treatment of
obesity to be reimbursed. For the first time, practitioners may be able to devote the time
necessary for the successful treatment of obesity. Furthering at the individual level the
efforts made at the public health level means that the practitioner can, for the first time,
be able to advise patients on favorable lifestyle changes.
ix
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x Foreword
The eating disorders, in contrast to obesity, have been the subject of only modest
change since the first edition of this volume. The greatest improvement has been in the
management of bulimia nervosa. Intensive research has produced improvements in both
the pharmacological and behavioral treatments of bulimia nervosa, and in their combi-
nation. The treatment of bulimia nervosa is still largely the province of specialists
devoted to treatment of the disorder. But there is a critical role for the clinician in diag-
nosing it and referring patients for treatment. The earlier the treatment begins, the better
its results, both in the short term and in the long term. Patients with bulimia nervosa
should not be allowed to suffer without the effective help that is now available.
Binge-eating disorder has received increasing attention in recent years and it is now
recognized as a widespread problem. A number of studies of pharmacological and psy-
chological treatment have shown that these agents improve the symptoms of binge eating.
This improvement, however, has not produced weight loss and the usefulness of this
diagnosis has been questioned (2).
The problem of anorexia nervosa is the most challenging among the eating disorders.
Despite continuing research, little progress in treatment has been made. The most effec-
tive treatment for anorexia nervosa may well be Russell’s (3) decades-old program of
family therapy for young anorectics. As with bulimia nervosa, the practitioner can pro-
vide a valuable service in identifying patients with anorexia nervosa and carrying out the
difficult task of getting them into treatment. The current status of the disorder is well
described in the four chapters devoted to it.
Albert J. Stunkard, MD
Weight and Eating Disorders Program
Department of Psychiatry
University of Pennsylvania School of Medicine
Philadelphia, PA
REFERENCES
1. Brownell KD, Horgen K. Food Fight. Contemporary Books, Chicago, IL, 2004.
2. Stunkard AJ, Allison KC. Binge eating disorder: disorder or marker? Int J Eat Disord 2003;34:5107–
5116.
3. Russell GFM, Szmukler GI, Dare C, Eisler I. An evaluation of family therapy in anorexia nervosa and
bulimia nervosa. Arch Gen Psychiatry 1987;44:1047–1056.
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