Gangguan Makan

Ada banyak faktor yang berperan dalam gangguan perilaku makan, di antaranya:

•       Serotonin , yaitu NT yang berperan dalam pengaturan keinginan untuk makan

•       Major depression (association between anorexia and major depression 65% cases, with social phobia 34%, with OCD 26%)

•       Familial, sangat erat kaitannya antara orang tua baik dengan gangguan mood ataupun eating disorder, terhadap anak dengan gangguan eating disorder juga

•       Social (life style, role model, social demand and body image)

•       Epidemiology 4% in adolescent and young adults

•       10-20 times more in girls/women

Eating disorder diklasifikasikan menjadi 2 macam, yaitu anoreksia nervosa dan bulimia nervosa

Anoreksia Nervosa

Menurut DSM – IV – TR, kriteria diagnosis untuk anoreksia nervosa ialah sbb :

1.       Refusal to maintain body weight at or above a minimally normal weight for age and height  (<85%)

2.       Intense fear of becoming fat or gaining weight, even though underweight

3.       Disturbed body image, undue influence of shape or weight on self evaluation, or denial of the seriousness of the current low body weight

4.       Amenorrhea or absent of at least 3 consecutive menstrual cycles

Ada dua type anoreksia :

·         Tipe Restricting – no regular bingeing or purging (self-induced vomiting or use of laxative and diuretics)

·         Tipe Binge eating/ purging – regular bingeing and purging in a patient who also meet the above criteria for anorexia nervosa

Bulimia Nervosa

Kriteria diagnosis berdasar DSM – IV – TR :

1. Recurrent episodes of binge eating, characterized by:

Eating a substantially larger amount of food in a discrete period of time (ie in 2 hr),  than would be eaten by most people in similar circumstances during that same time period

2.       Recurrent inappropriate compensatory behavior to prevent weight gain, ie, self-induced vomiting, use of laxatives, diuretics, fasting, or hyperexercising

3.       Binges or inappropriate compensatory behaviors occurring, on average, at least twice weekly for at least 3 months

a.        Self evaluation unduly influenced by body shape or weight

b.       The disturbance does not occur exclusively during episodes of anorexia nervosa

Dan bulimia nervosa ini juga memiliki dua tipe :

·         Purging – regularly engages in self-induced vomiting or use of laxatives or diuretics

·         Non-purging – uses other inappropriate compensatory behaviors, ie, fasting or hyperexercising, without regular use of vomiting or medications to purge

Terapi

•       Cognitive Behavior therapy

•       Family therapy

•       Pharmacotherapy

Ada beberapa aspek yang perlu diperhatikan dalam nutrisi pasien dengan eating disorder :

GOAL ESTABLISHMENT

·         Daily gain during life threatening phase of malnutrition: 0.3-0.4 lb/d

·         Weekly gain in acute outpatient phase of malnutrition: 1-2 lb/wk

·         Intermediary goals (10^th, 15^th, 25^th, 50^th percentile) until normal weight-for-height is reached, with normal menstrual status for pubertal stage

·         Dietary intake to support adequate gain and health

DIETARY GUIDELINES

·         Early stages – educate and counsel to support patient normalizing  food consumption – crisis stage plan menu or patient chooses food, determined by team approach to intensive treatment

·         Rehabilitation phase – enable patient to replace outside control with self management

·         Dietary prescriptions (above) are guides to nutrient needs at various stages of disorder

·         Food types and composition equivalents translate prescriptions into dietary pattern

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