What is anorexia nervosa?

Anorexia nervosa is a complex disorder characterized by chronic and potentially fatal mental illness.

What are the main features of the disease?

According to the World Health Organization (WHO) in cases of anorexia nervosa weight loss exceeds 15% of normal limits depending on age, gender and height. The body mass index [BMI=weight (kg)/(height, cm) 2] is less than 17.5 kg/m2, with normal limits of 18.5-25 kg/m2, while amenorrhea is observed for at least 3 consecutive months in patients with stable menstruation.

Is Anorexia Nervosa Common? And if so, in which groups of people does it appear?

Anorexia nervosa occurs in 90% of the female population, mainly during adolescence (14-19 years), occupying the 3rd most common disease in the world with a mortality rate of 5-16% (1 in 6). 1/3 of deaths are caused by heart complications, while the mortality rate from suicides due to depression is very high. Appearance factors are mainly genetic, biological, psychological, cultural, family and social

What are the symptoms of anorexia nervosa?

Anorexia nervosa presents with electrolyte disturbances: decreased levels of potassium, sodium, phosphorus, calcium, magnesium, chlorine, steroid hormones and dehydration; heart disorders: bradycardia, decreased systolic and diastolic blood pressure; Abdominal pain and bloating, esophagitis, nausea; kidney disorders: elevated urea and creatinine levels, polyuria; general symptoms such as weakened immune system, bone loss, premature onset of osteoporosis, amnesia, hair loss, depression, inhibition of physical growth.

How is the disease treated and what role does diet play?

The treatment of the disease is based on the nutritional and psychological support of the patient. The goals of nutritional support are to restore the body’s metabolic function and weight, reverse the complications of the disease by improving the patient’s health, improve mood and learn the basic rules of proper nutrition.

Should the dietitian work with the psychologist to better treat the disease?

The treatment of all eating disorders (anorexia nervosa, bulimia) is based on a complex approach. Patients should be monitored by a team of specialists consisting of a clinical nutritionist-dietitian for nutrition education and meal planning, a psychiatrist-psychologist for psychological support, a pediatrician and in the case of minor patients, a child- and family- psychologist.

When should we ask for help?

The appropriate time to seek expert advice is when a relative or friend of the patient notices something inappropriate in the patient’s eating behavior. Unfortunately, the patient rarely decides on his own, while when he finally turns to the specialists he is already in the final stages of malnutrition, unable to consume more than 300-700 calories per day, although his energy needs range between 1,000-1,400 to 3,500-4,000 calories. In these cases, the patient may need to be admitted to a hospital unit, while treatment begins with the administration of a low number of calories that every 1-2 days gradually increases.

What happens when the patient refuses feeding?

An alternative treatment is the partial or total nasogastric feeding providing large amounts of calories that cannot be covered only through oral food intake. Calorie supplements are usually avoided because they are not conducive to learning proper eating behavior. During the first 5-7 days from the start of the nutritional treatment the patient does not show an increase in body weight, due to the fact that the body tries to balance and regain its strength (stabilization phase). At this stage the body changes from catabolic to anabolic.

What are the “golden” rules of nutrition?

The standard diet in nutritional support is based on the right ratio of macronutrients. The patient should consume 45-65% carbohydrates, 10-35% protein and 20-35% fat daily. Also, the daily intake of calcium should be taken into account for the strengthening of the bones and the restoration of the lost bone mass (1,200-1,500 mg for one adolescent).

It is usually recommended to take multivitamin tablets to provide a sufficient amount of fat-soluble vitamins (vitamins A, D, E, K), minerals and trace elements according to the recommended daily intake (RDA) values. The final stage of nutritional support is based on improving the patient’s psychological state and improving eating behavior. These goals are achieved mainly through the psychological support of the patient.

Let’s not forget that: More than 70% of patients manage to increase their body weight within the first 6 months of appropriate treatment while 15-25% of this population relapses within the first 2 years. Immediate and timely diagnosis of symptoms, proper and comprehensive treatment is the key to treating and combating the disease.

Advises Ms. Nikoli Thanopoulou, MSc Clinical Nutritionist-Dietitian