C. L. Birmingham

Pilot study of a graded exercise program for the treatment of anorexia nervosa.

OBJECTIVE To determine whether a graded exercise program used in the treatment of anorexia nervosa improves quality of life and does not decrease the rate of gain of body fat. METHODS A randomized controlled trial with outcome measures: change in percent body fat, body mass index (BMI), and Medical Outcomes Survey Short Form 36-item Quality of Life questionnaire. RESULTS Fifteen females and one male meeting the DSM-IV criteria for the diagnosis of anorexia nervosa were randomized. There was no difference in change in BMI or percent body fat at 3 months. Quality of life outcomes improved from baseline in the experimental group compared with the control group. However, this difference was not statistically significant. DISCUSSION Incorporation of a graded exercise program may increase compliance with treatment, but it did not reduce the short-term rate of gain of body fat or BMI. Longer studies with more subjects are necessary to determine the usefulness of a graded exercise program in anorexia nervosa.

The reliability of bioelectrical impedance analysis for measuring changes in the body composition of patients with anorexia nervosa.

OBJECTIVE To determine whether bioelectrical impedance analysis (BIA) is a valid measure of change in body fat in anorexia nervosa (AN) patients during refeeding, as compared to skinfold calipers (SF). METHODS Prospective cohort study with measures of BIA and SF performed once a month for 3 months on patients meeting the DSM-III-R criteria for AN who received treatment from the Eating Disorders Clinic of a university teaching hospital as inpatients or outpatients. RESULTS Twenty patients completed the study. Comparison of the two methods by the Pearson correlation coefficient showed a weak negative correlation of r = -.305. Analysis by a graphical method confirmed the poor agreement that exists between the two methods. DISCUSSION The inability of BIA to detect changes in body composition due to altered hydration, and to accurately assess the distribution of water between intracellular and extracellular compartments, limits its clinical usefulness in AN. It appears that SF measurements are preferable to BIA as a measure of body fat change in patients with AN.

Disordered eating attitudes and behaviours in the high-school students of a rural Canadian community

Background: Most surveys of disordered eating attitudes in teenagers target females in urban areas. To help plan the distribution of treatment resources for eating disorders in British Columbia we studied male and female students in all of the high schools of a rural community. Methods: Three hundred and ninety-six of the 2,589 students attending the four high schools within the rural community completed the EAT-26 and a demographic questionnaire. Results: Three hundred and eighty-one of the 396 students (96%) satisfactorily completed and returned the survey. Their ages ranged from 12 to 19 years with a mean of 15.2 years (SD=1.5 years). Fifty-nine percent of participants were female. On average, males wanted to be 6.2 kg (SD=1.2 kg) heavier and females wanted to be 2.8 kg (SD=6.5 kg) lighter and 8.3 percent of males and 17.3 percent of females scored twenty or above on the EAT-26. Interpretation: The prevalence of disordered eating attitudes and behaviours in this rural setting was similar to that reported in urban communities in Canada. Disordered eating attitudes and behaviours were common in males. We conclude that there is need for treatment resources for males and that the need for treatment is as great in rural as urban communities.

Hypomagnesemia during refeeding in anorexia nervosa

Background: Magnesium deficiency can cause weakness, constipation, seizures and arrhythmias. We frequently observe hypomagnesemia during refeeding in AN. Objective: To determine the incidence and time of onset of hypomagnesemia during refeeding in anorexia nervosa (AN). Design: Observational cohort study. Setting: University teaching hospital in Vancouver, Canada. Patients: Patients with AN (DSM-IV criteria) admitted for refeeding. Intervention: All patients were admitted for supervised refeeding by meal support, in conjunction with our standard medical and psychological treatment. Measurements: Serum magnesium was measured daily for 5 days and then 3 times a week. Results: Fifty patients were admitted for an average of 24 days. Sixty percent (30/50) had low serum magnesium during their admission. Hypomagnesemia was present on admission in 16% but as late as the third week of refeeding in others. Conclusion: Serum magnesium should be measured on admission and rechecked weekly for the first 3 weeks of refeeding as a minimum.

Anorexia nervosa: The cost of longterm disability

This study was performed to estimate the cost of long-term disability in people who have anorexia nervosa (AN) that live in the province of British Columbia (BC), Canada. Canada provides universal socialized health and welfare services, and each of the 10 provinces is responsible for its own funding. As the provincial government of BC does not categorize its disability payments by the cause of the disability, a survey was used to determine the rate of disability from AN. A sensitivity analysis was performed to assess the influence of variations on the yearly cost of disability in BC: the number of patients with AN was varied between 1.0 and 2.0% of the female and 0.05 and 0.1% of the male population; the percentage of patients with AN receiving disability payments was determined by the survey to be 35%; the cost of these payments was varied between the lowest and highest benefits a single person can receive from the BC provincial government; and finally, to allow for possible sampling bias and a possible lower prevalence of AN, the lower limit of the sensitivity analysis was derived by dividing the lowest estimate above by seven. The sensitivity analysis revealed that the total estimated cost of long-term disability in BC could be as low as

Chest pain in anorexia nervosa.

2.5 million (Canadian) or as high as

Is there evidence that religion is a risk factor for eating disorders

101.7 million per year, which is a cost of up to 30 times the total yearly cost of all tertiary care services for the treatment of eating disorders in BC. In view of this finding, an increase in funding is warranted for primary, secondary and tertiary prevention programs for AN in BC.

Kidney stones in anorexia nervosa: A case report and review of the literature

OBJECTIVE To determine the incidence and characteristics of chest pain in patients with anorexia nervosa. METHOD A cross-sectional survey of 54 patients. A pain history according to a diagnostic algorithm that was constructed from a Medline search (1966-1996) was used. RESULTS Eighty-seven percent of patients had experienced chest pain. The most common diagnosis was idiopathic, occurring in 38% of participants. The incidence of typical and atypical angina was 11% and 9%, respectively. Increasing age, smoking history, and a family history of chest pain were more common in those with the atypical or typical angina. CONCLUSIONS Chest pain is a common symptom in patients with eating disorders, and the incidence of typical and atypical angina is surprisingly high. All patients with eating disorders should be screened for chest pain and other risk factors for coronary heart disease.

Electrocardiographic abnormalities in anorexia nervosa

Objective: Is there evidence that religion is a risk factor for eating disorders? Methods: A literature search was performed to examine whether there is an association between religion and eating disorders. Results: There were some cross-sectional studies, case studies, and anthropological commentaries reporting eating disorders in various cultures and religions. Religious affiliation was usually reported as an incidental finding but not analyzed. A number of prevalence studies were reported from Islamic communities. This raises the possibility that young Muslim women have a higher prevalence of elevated EAT scores compared to non-Islamic women. Conclusion: This literature search raises the possibility that there is an association between Islamic affiliation and positive screening for eating disorder behaviors. This supports the hypothesis that the effect of culture on eating disorders may be religious as well as secular. Carefully designed studies of the prevalence of eating disorders in multicultural populations with multiple religious affiliations may help further clarify the relationship between religion and eating disorders.

Long-Term Effect of Ileogastrostomy Surgery for Morbid Obesity on Diabetes Mellitus and Sleep Apnea

Nephrolithiasis (kidney stones) is a recognized complication of anorexia nervosa (AN). We present the case of a 41-year-old woman with a 25-year history of AN. Between 1978 and 1986, she had two episodes of calcium oxalate kidney stones. Proper management of kidney stones in AN requires collection of the stone, laboratory analysis of the stone to determine its composition, and laboratory evaluation of the urine and blood to determine what treatment is necessary to prevent recurrent kidney stone formation.