10/27/2020

MEDICAL NUTRITION THERAPY FOR

WEIGHT MANAGEMENT

Asst . Prof. Diane M endoza - S ar mi ent o

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
GLOBAL ISSUE
National, regional, and global trends in adult overweight and obesity prevalences Gretchen A Stevens et al.for the Global
Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index)

• Increasing prevalence of
obesity is a serious health
problem.

• The condition is associated

with some lifestyle related
diseases or chronic
degenerative diseases.

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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LOCAL SCENARIO FR

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

Is this the new theory of Evolution?FR

Do we have role?

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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consequences

Intake Output
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

OVERWEIGHT AND OBESITYFR

 Overweight and obesity are the conditions wherein the body accumulates excess
body fat to the extent that it impairs physical function and increases the risks of
certain illnesses
 Imbalance in energy intake and energy expenditure

 obesity results from an interaction between an

individual’s genetic predisposition to weight gain
and environmental influences.

Changes in the food environment and food systems.

- Increased availability, accessibility, and affordability of energy-dense foods,
along with intense marketing of such foods
- reduced opportunities for physical activity (urbanization and other changes in
the built environment)
Purnell JQ. Definitions, Classification, and Epidemiology of Obesity. [Updated 2018 Apr 12]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
Helble, M. and K. Francisco. 2017. The Upcoming Obesity Crisis in Asia and the Pacific: First Cost Estimates. ADBI Working Paper 743. Tokyo: Asian Development Bank Institute.
Image from google search: ResearchGAte
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

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PATHOPHYSIOLOGY FR

 GENETICS
 BMR
 LIPOPROTEIN LIPASE
 LEPTIN
 GHRELIN
 FAT CELL DEVELOPMENT
 SET POINT THEORY
 FETAL ORIGIN OF ADULT DISEASE
 ENVIRONMENT
 PHYSICAL ACTIVITY

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Fat Cell Development
 The amount of fat reflect both the number and
size of fat cells
 Increase most rapidly during late adulthood
and early puberty
 Grow whenever energy balance is positive
 When cells enlarge they stimulate cell proliferation so that the numbers
increase again

 A decrease in body weight only changes fat cell size (becoming smaller),
whereas an increase in body weight causes elevation of both fat cell size and
number in adults

Arner P. Fat Tissue Growth and Development in Humans. Nestle Nutr Inst Workshop Ser. 2018;89:37-45. doi: 10.1159/000486491.
Epub 2018 Jul 10. PMID: 29991030.
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

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Fat Cell Metabolism
 Lipoprotein lipase (LPL) promotes fat storage in both adipose and
muscle cells
- In women, more LPL is found in breast, hips and thighs
- In men, LPL is in the abdomen

 Basal fat oxidation is lower in women than in men

 After weight loss, LPL activity increases

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Set Point Theory
 Proposes that the body tends to maintain a certain weight
by means of its own internal controls

 Energy expenditure increases after weight gain and

decreases after weight loss

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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Leptin
• A protein produced by fat cells under direction of the ob gene that
decreases appetite and increases energy expenditure
• Fat cells in obese rats injected with leptin not only lose fat, but they reduce in
number, which explains why weight gains are delayed when the mice are
fed again
• Obese people have high leptin, and weight gain increases leptin
concentrations
• When energy intake is low, leptin levels decline

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Ghrelin
• A protein produced by the stomach cells that enhances appetite
and decreases energy expenditure

• Blood levels of ghrelin rise before and fall rapidly after a meal
• Lean people have high ghrelin levels and obese people have low
ghrelin levels
• Ghrelin levels decline when the body is in positive energy balance

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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Uncoupling Proteins
• White adipose tissue: stores fat for other cells to use for energy
(coupling)
• Brown adipose tissue: releases stored energy as heat (uncoupling)
• Production of heat is important in newborns and adults who live in
extremely cold climates

• Uncoupling proteins are found in many tissues, and influence the

BMR and oppose the development of obesity

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Measures of obesity:

1. BODY MASS INDEX (wt (kg/m2)

WHO CLASSIFICATION
BMI= 25 ABOVE
Under weight <18.5
Normal weight 18.5-24.9
Overweight 25.0-29.9
Obesity Class 1 30.0-34.9
Obesity Class 2 35.0-39.9
Obesity Class 3 >40

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Body Mass Index (BMI)
• Below a BMI of 17, signs of illness, reduced
work capacity, and poor reproductive
function become apparent
• BMI reflect height and weight, but not
body composition: a person who is
overweight may not be overfat

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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2. WAIST CIRCUMFERENCE
3. WAIST TO HIP
RATIO
MEN ≥ 0.95
FEMALE ≥ 0.8

A waist circumference higher than the cut off

points increases your risk for metabolic disorders.
Obesity Pathophysiology and Management Kishore M. Gadde et al.,JOURNAL
OF THE AMERICAN COLLEGE OF CARDIOLOGY BY THE AMERICAN COLLEGE
OF CARDIOLOGY FOUNDATIONhttps://doi.org/10.1016/j.jacc.2017.11.011
UNIVERSITY OF SANTO TOMAS www.who.int
DEPARTMENT OF NUTRITION AND DIETETICS www.fnri.dost.gov.ph/

FR

http://apps.who.int/

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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Neck Circumference as a Screening Measure for Abdominal Obesity and its

Association with Metabolic Syndrome among High Risk Filipino Patients in Makati
Medical Center - a Pilot Study
FR
Nerissa S. Ang and Josephine Carlos Raboca
Section of Endocrinology, Diabetes and Metabolism, Makati Medical Center

Neck circumference showed a strong correlation with abdominal obesity, as well as with the
component risk factors of metabolic syndrome, and therefore with risk of cardiovascular disease.
Above the NC cut off levels, its predictive value for abdominal obesity is high; however, it has a poor
ability to detect patients with abdominal obesity in the general population and therefore, cannot be
Add a footer 28
used as a screening test.

FR

Obesity Pathophysiology and Management Kishore M. Gadde et al.,JOURNAL

OF THE AMERICAN COLLEGE OF CARDIOLOGY BY THE AMERICAN COLLEGE
UNIVERSITY OF SANTO TOMAS OF CARDIOLOGY FOUNDATIONhttps://doi.org/10.1016/j.jacc.2017.11.011
DEPARTMENT OF NUTRITION AND DIETETICS

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UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Fat Distribution
• Intra-abdominal fat that is stored around
the organs of the abdomen, independently
of total body fat, is associated with
increased risk of heart disease, stroke,
diabetes, hypertension, and some types of
cancer
• Abdominal fat is common in post-
menopausal women, and even more
common in men

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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HIGHER
HEALTH
RISK
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

FR
Fat Distribution
• Fat around the hips and thighs, common in women, seems relatively
harmless

• Women starting pregnancy need sufficient body fat to support

conception and fetal growth

• The waist circumference is the most valuable and practical indicator

of abdominal fat

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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TYPES OF FAT

VISCERAL FATS- fat stored within the

abdominal cavity in association with
the internal abdominal organs; also
called intra-abdominal fat.

SUBCUTANEOUS FAT- fat stored

directly under the skin.

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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CONSEQUENCES TO HEALTH FR

Increased plasma levels of free-fatty acids and

cytokines, intracellular non-adipose tissue lipids (e.g.,
liposomes), and ectopic adipose tissue depots (e.g.,
within the visceral compartment) can contribute to
systemic inflammation, insulin resistance, and
overactivity of the sympathetic nervous system. The
metabolic and anatomic effects of excess adiposity
can lead to the development of type 2 diabetes,
nonalcoholic fatty liver disease, obesity-related
dyslipidemias, high blood pressure, and osteoarthritis.
The cascade of these pathophysiological
mechanisms and associated diseases are the main
contributors to obesity-related heart failure.

HF- heart failure; RAS- renin-angiotensin aldosterone system; SNS- sympathetic

nervous system.
Obesity Pathophysiology and Management Kishore M. Gadde et al.,JOURNAL
OF THE AMERICAN COLLEGE OF CARDIOLOGY BY THE AMERICAN COLLEGE
OF CARDIOLOGY FOUNDATIONhttps://doi.org/10.1016/j.jacc.2017.11.011

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

CONSEQUENCES TO HEALTH FR

Role of lipotoxicity and inflammation on obesity. White adipose tissue (WAT) releases pre–fatty acids and
adipokines, which are lipotoxic and inflammatory and result in diverse effects, outlined in the left-hand
columns. Their correlation to the metabolic syndrome is shown on the right-hand column, whereas all the
effects culminate in atherosclerosis on the bottom of the figure.
*Perturbed glucose and lipid metabolism. DM-2=diabetes mellitus-2; FFA=free fatty acids; IL=interleukin; IRS=insulin receptor substrate; NF-KB=nuclear factor kappa beta; NS=nervous system;
PAI-1=plasminogen activator inhibitor-1; SMC=smooth muscle cell; TG=triglyceride; TNF=tumor necrosis factor

UNIVERSITY OF SANTO TOMAS Redinger R. N. (2007). The pathophysiology of obesity and its clinical manifestations. Gastroenterology & hepatology, 3(11), 856–863.
DEPARTMENT OF NUTRITION AND DIETETICS

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CONSEQUENCES TO HEALTH FR
 Obese chronic low-level inflammation,  cause
DNA damage cancer.

 Fat tissue  produces excess amounts of estrogen,

(associated with increased risks of breast, endometrial,
ovarian, and some other cancers).
 increased blood levels of insulin and IGF-1.

 Fat cells produce adipokines,

- Leptin: promote cell proliferation,
- Adiponectin (less abundant in obese) may
have antiproliferative effects

 Increased oxidative stress

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

CONSEQUENCES TO HEALTH FR
 Arthritis: degeneration of joint: weight bearing and inflammation

 Obstructive sleep apnea: accumulation of extra adipose tissue in the upper respiratory
tract hypoxia, ventilation and even hypercapnia

 Gallstone: During fasting, there is enhanced mobilization of cholesterol from fat depots,
which pass through the liver into the biliary ducts

 PCOS: enhanced metabolic abnormalities of hyperandrogenemia, insulin resistance,

and, along with inflammatory adipokines, increase the incidence of diabetes mellitus
type 2

 Poor wound healing

 Depression
Redinger R. N. (2007). The pathophysiology of obesity and its clinical manifestations. Gastroenterology & hepatology, 3(11), 856–863.
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

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MANAGEMENT OF OBESITY
Goals: STRATEGIES:
- Attaining the best weight
possible in the context of  Lifestyle modifications
over-all health
 Diet
- An initial goal of 5-10%  Physical activity
weight loss over 6 months  Behavior Modification
– Limit associated morbidity  Drugs
and mortality  Surgery

Obesity Pathophysiology and Management Kishore M. Gadde et al.,JOURNAL OF THE AMERICAN

COLLEGE OF CARDIOLOGY BY THE AMERICAN COLLEGE OF CARDIOLOGY
FOUNDATIONhttps://doi.org/10.1016/j.jacc.2017.11.011
UNIVERSITY OF SANTO TOMAS Obesity: Pathophysiology and Management. J Am Coll Cardiol 2017;71:69-84
DEPARTMENT OF NUTRITION AND DIETETICS

FR
Reasonable
Weight Loss

• goal of weight loss of 5% to 10% within 6 months is recommended.

• realistic weight-loss goal such as one of the following: up to 2 lb per

week, up to 10% of baseline body weight, or a total of 3% to 5% of
baseline weight if cardiovascular risk factors (hypertension,
hyperlipidemia, and hyperglycemia) are present.

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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Assessment

• Anthropometric measures;
• biochemical data, medical tests and procedures;
• nutrition-focused physical findings; and
• client history
• energy intake and nutrient content of the diet.
• motivation, readiness and self-efficacy for weight management

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Dietary Intervention

• individualized diet
• maintain nutrient adequacy
• reduce caloric intake:
• 1,200 kcal to 1,500 kcal/day for women
• and 1,500 to 1,800 kcal/day for men;
• energy deficit of approximately 500 kcal/ day or 750 kcal/day;
• restrict certain food types in order to create an energy deficit by
reduced food intake.

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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Dietary Intervention
Small, food-based changes:

- small behavior changes, those that

shift energy balance by 100 to 200
kcal/day for weight management.

- more feasible and sustainable than

larger behavior changes, such as
changing macronutrient composition of
the diet.
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

FR
Dietary Intervention
Small, food-based changes:
Fruit and vegetable consumption
-reduce dietary energy density, enhance satiation, and assist with
decreasing overall energy intake,
- higher in energy density.

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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Dietary Intervention
Small, food-based changes:
SSB Consumption
-replacing caloric beverages with water or diet beverages
resulted in weight losses of 2% to 2.5% during a 6-month period.

RCT Study by Tate and colleague

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Dietary Intervention
Small, food-based changes:
Fast Food Consumption
-generally high in energy density and
commonly purchased in large portion
sizes,

UNIVERSITY OF SANTO TOMAS Image from google search (The Sun and New York Times)
DEPARTMENT OF NUTRITION AND DIETETICS

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Dietary Intervention
Portion Control:
: using packages containing a
defined amount of energy (eg,
complete meals, individual
food; portion-controlled utensils;
food is delivered in specific
serving sizes; or communication
strategies

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Dietary Intervention
• Energy density
• DASH eating plan
• Mediterranean Diet
• Eating frequency
• Time of Eating
• Breakfast consumption

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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Be Physically Active.

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR

Sedentary behavior is defined as sitting activities with a very low level of

energy expenditure (<1.5 METs).

-greater time spent in sedentary behavior,

independent of time performing MVPA, has been
associated with increased risk of obesity

*MVPA is defined as activity that is 3.0 metabolic equivalent units (METs; a

MET of 1 is generally considered the RMR)
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

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Reduction of sedentary activity:

 Reallocation of to light physical activity (1.5 to 2.9 METs)
 may increase overall energy Expenditure

for weight-loss maintenance, research has consistently

demonstrated that a high level of MVPA is imperative.

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR

current recommendation:
minimum of 30 minutes of moderate-intensity activity
on most days of the week (150 min/wk).

weight-loss maintenance:
higher levels of MVPA (>250 min/week)

To enhance cardiovascular outcomes: increasing MVPA,

accumulated in bouts of at least 10 minutes.
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

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Enjoy leisure and recreational activities,

Aerobics, Strength and Flexibility FR
Activities as often as you can

DAY-TO-DAY
ACTIVITIES
HABITUALLY AND
REGULARLY
FOR METABOLIC
EFFICIENCY

30-45
minutes a day
10-15
minutes at a time 3-5
days a week Images from google search (cdc and heart.org)

FR

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WT-MGT: gradually accumulate 150 to 420 minutes or

more of physical activity per week, depending on intensity.

WT-Maintenance: gradually accumulate 200 to 300

minutes or more of physical activity per week, depending
on intensity.
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

FR
BEHAVIOR AND ATTITUDE.
 Make a plan to address interfering issues
 Assess readiness to change  Invite the patient to let you know when he or she is ready
 Build the patient’s confidence to make an effort toward
 Solve problem/s together
weight loss
with the patient
 Agree on goals For the patient who expresses readiness to change, simple
 Teach Self monitoring and steps include:
Stimulus control  Praise patients who have had recent or past weight loss
even if their BMI is still in the overweight or obese range
 Ask the patient about past and current weight loss
 Empower the client to change strategies and what is working and not working for them
behavior (adapt healthier lifestyle)  Ask the patient how you may help in their weight loss
 Teach them to make informed efforts
choices  Acknowledge their values in linking weight to health
 Provide motivation issues

UNIVERSITY OF SANTO TOMAS The American Journal of Medicine (2016) 129, 115.e1-115.e7
DEPARTMENT OF NUTRITION AND DIETETICS

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Behavior-Change Intervention:
Theoretical framework that proposes that with the use of learning
principles, such as classical and operant conditioning, healthy
behaviors can be learned.

Cognitive-Behavioral Therapy:
uses a directive, action-oriented approach and provides skills to help
individuals learn to develop functional thoughts and behaviors.
- proposes that thoughts, feelings, and behaviors interact to impact
health outcomes.

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR

Motivational Interviewing:
focuses on the style of interaction between a practitioner and client.

- Collaboration guides practitioners to be “supportive partners” rather than

“persuasive experts,”

- Evocation encourages the practitioner to draw out the client’s personal

motives and values regarding behavior change.

- autonomy emphasizes a client’s personal choice, in which the responsibility

and decisions about behavior changes fall under the client’s, rather than
practitioner’s, control

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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Acceptance and commitment therapy:

shift the focus from reducing the occurrence of aversive internal
thoughts and feelings to being able to experience these thoughts and
feelings to assist with promotion of behavior that is congruent with
personal values.

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

PHARMACOLOGIC. FR

Obesity Pathophysiology and Management Kishore M. Gadde et al.,JOURNAL OF THE AMERICAN

UNIVERSITY OF SANTO TOMAS COLLEGE OF CARDIOLOGY BY THE AMERICAN COLLEGE OF CARDIOLOGY
DEPARTMENT OF NUTRITION AND DIETETICS FOUNDATIONhttps://doi.org/10.1016/j.jacc.2017.11.011

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SURGERY: FR

Vertical
Banded
Gastroplasty

Roux-en-Y
Gastric Bypass

Gastric
Banding

Obesity Pathophysiology and Management Kishore M. Gadde et al.,JOURNAL OF THE AMERICAN

UNIVERSITY OF SANTO TOMAS COLLEGE OF CARDIOLOGY BY THE AMERICAN COLLEGE OF CARDIOLOGY
DEPARTMENT OF NUTRITION AND DIETETICS FOUNDATIONhttps://doi.org/10.1016/j.jacc.2017.11.011

FR
When to consider gastric bypass:

 Obesity Class 3
(WHO / NIH = BMI 40; AP > 35)
 Obesity Class 2 with co-morbid conditions
(WHO / NIH = BMI 35; AP  30)
 Consider if other weight loss attempts have failed
 Lifelong medical monitoring

Adapted from NIH/NHLBI – The Practical Guide Identification, Evaluation

and Treatment of Overweight and Obesity in Adults, October, 2002.
UNIVERSITY OF SANTO TOMAS
DEPARTMENT OF NUTRITION AND DIETETICS

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Eating
Disorders

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
Definition
Psychiatric conditions characterized by severe disturbance in eating
behavior, resulting in a significant physiologic impairment and even death.

serious and often fatal illnesses that are associated with severe disturbances
in people’s eating behaviors and related thoughts and emotions and not a
lifestyle choice

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

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Anorexia Nervosa
refusal or inability to maintain minimally normal body
weight, leading to a body weight that is <85% of what is
expected for age and height.
 Restricting type
 Binge-eating/purging type
 see themselves as overweight, even
when they are dangerously underweight
 typically weigh themselves repeatedly,
 severely restrict the amount of food they
eat,
 often exercise excessively,
 and/or may force themselves to vomit
 or use laxatives to lose weight.
UNIVERSITY OF SANTO TOMAS Understanding Normal and Clinical Nutrition
DEPARTMENT OF NUTRITION AND DIETETICS https://www.nimh.nih.gov/

FR
Bulimia Nervosa
characterized by repeated episodes of binge eating followed by
abnormal compensatory weight-loss behaviors such as self-
induced vomiting, fasting, excessive exercise and misuse of
laxatives and diuretics.
 Purging type
 Nonpurging type

recurrent and frequent episodes of eating unusually large amounts of food and feeling a
lack of control over these episodes followed by behavior that compensates for the
overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting,
excessive exercise, or a combination of these behaviors.
People with bulimia nervosa may be slightly underweight, normal weight, or over
overweight.

UNIVERSITY OF SANTO TOMAS Understanding Normal and Clinical Nutrition

DEPARTMENT OF NUTRITION AND DIETETICS https://www.nimh.nih.gov/

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DIAGNOSTIC CRITERIA FOR AN AND BN FR

ANOREXIA NERVOSA BULIMIA NERVOSA
Refusal to maintain body weight Recurrent episodes of binge eating

Intense fear of gaining weight Recurrent inappropriate

compensatory behavior in order to
prevent weight gain
Disturbance in the way one’s body Occurs twice a week for three
weight or shape is experienced months

amenorrhea Self evaluation is not influenced by

body shape

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

HEALTH IMPLICATIONS: FR

ANOREXIA NERVOSA
•BRADYCARDIA
•HYPOTENSTION
•ORTHOSTATIC HYPOTENSION
•HYPOTHERMIA
•AMENORRHEA
•OSTOPENIA/OSTEOPOROSIS

BULIMIA NERVOSA
•ESOPHAGITIS
•GERD
•CARDIAC ARRHYTMIAS
UNIVERSITY OF SANTO TOMAS
•DEHYDRATION
DEPARTMENT OF NUTRITION AND DIETETICS

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NUTRITION THERAPY:
ANOREXIA NERVOSA
GOAL: to restore patient’s weight (90%)
- cessation of weight loss behaviors
- improvement in emotional and psychological health

Management:
•Initial kcal= 30-40 kcal/kgbw
slowly progressing
•Vitamin and mineral supplements

UNIVERSITY OF SANTO TOMAS

DEPARTMENT OF NUTRITION AND DIETETICS

FR
NUTRITION THERAPY:

BULIMIA NERVOSA
GOAL: to reduce chaotic cycle of binging and purging
- normalize eating habits

Management:
•Three meals with 1-3 snacks/day
•Counseling

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DEPARTMENT OF NUTRITION AND DIETETICS

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For your
future patients.
80

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