DDSEP Quick Quiz

DDSEP® 8 Quick quiz - November 2017 Question 2

A 26-year-old woman is evaluated for assistance with weight management. She denies any significant medical or surgical history, but her BMI is 42 kg/m2. She does not understand why she maintains this weight. She insists that she follows a careful diet of healthy foods, noting that she has several servings each day of fruits and vegetables. She does not go to a gym, but walks when she can and takes the stairs more frequently than the elevator. Upon further review, she does admit to “stress eating” episodes just once or twice each week, but dismisses this as noncontributory, since this has been normal behavior for her since high school, when she was not considered to be overweight. She describes these episodes as more typically occurring after a stressful work day, during which she may treat herself to a bag of cookies or a carton of ice cream, usually alone in her apartment in the evening after dinner. She denies nausea, vomiting, or using laxatives. She denies sleep disturbance, is usually well rested in the morning, and eats “a healthy breakfast.” A routine electrolyte profile and complete blood count are unremarkable. She seeks your advice on endoscopic devices for weight loss management.

This patient would appear to have which eating disorder?

Nocturnal eating syndrome

Anorexia nervosa

Binge eating disorder

Bulimia nervosa

Occult purging disorder

Answer: C

Rationale: Binge-eating disorder (BED) is a distinct clinical entity, which gastroenterologists are likely to encounter. A substantial fraction of patients evaluated for weight loss therapy will have BED, yet it can be difficult to recognize. Similar to bulimia, BED is characterized by binge-eating episodes, which must occur an average of once a week for at least 3 months. However, there are no recurrent inappropriate behaviors such as purging with laxatives, diuretics, or emetics (e.g., syrup of ipecac) or excessive exercise. BED patients most often do not have any specific symptoms or physical exam findings other than being overweight or obese. Very subtle characteristics include very rapid eating, eating despite satiety, eating alone due to feelings of shame, and a negative emotional context after binge eating. BED will negatively impact any interventions for obesity, unless recognized and addressed.

Nocturnal eating syndrome is similar, yet distinct, in that it is also characterized by binge eating without inappropriate compensatory purging behaviors, but prominent features include morning anorexia, nocturnal hyperphagia, and sleep disturbances. The sleep disturbances are characterized by an average of 3-4 awakenings per night, during which an average of roughly 1,100 calories might be consumed during half the episodes.

Anorexia nervosa is characterized by a restriction in food intake relative to needs which results in an inappropriately low body weight (below BMI of 17.5 kg/m2), a fear of gaining weight or being fat despite being underweight, and inappropriate perception/experience of body image. Roughly half of patient with anorexia nervosa may also engage in binge-eating behaviors or purging behaviors.

Purging disorder is a distinct variant recognized as purging behaviors in the absence of the binge-eating behavior.

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