Interdisciplinary Care

Nutrition care is but one part of treatment for AN or BN. These complex disorders require multidisciplinary and integrated care, due to the multifactorial etiology and wide scope of signs and symptoms. The obstetrician, nurse practitioner, psychologist or psychiatrist, dietitian, dentist, social worker, family therapist, occupational therapist, pharmacist, certified exercise physiologist, and other allied health care professionals must openly and cohesively interact with one another and most importantly with the patient to provide effective treatment. Cognitive-behavioral therapy is used to modify anorexic and bulimic behaviors. Medications may be used in treatment, but a risk-benefit assessment for use during pregnancy should be completed (Table 9.7). An increased frequency of prenatal visits is warranted in these high-risk conditions. Monitoring of fetal heart rate and more frequent ultrasounds may shift the center of attention from the mother's AN or BN

Table 9.7

Selected Medications Used in the Treatment of Anorexia Nervosa or Bulimia Nervosa

Food and Drug Administration

Medication Classification Drug-nutrient interactions pregnancy category*

Table 9.7

Selected Medications Used in the Treatment of Anorexia Nervosa or Bulimia Nervosa

Food and Drug Administration

Medication Classification Drug-nutrient interactions pregnancy category*

• Desipramine

• Antidepressant, tricyclic

  • Limit caffeine
  • Increase riboflavin intake
  • Avoid alcohol
  • Incompatible with lactation

B

• Fluoxetine

• Antidepressant, antibulimic, selective serotonin reuptake inhibitor

  • Avoid tryptophan supplements
  • Avoid alcohol
  • Incompatible with lactation

C

• Nortriptyline

• Antidepressant, tricyclic

  • Limit caffeine
  • Increase riboflavin intake
  • Avoid alcohol
  • Incompatible with lactation

C

• Paroxetine

• Antidepressant, selective serotonin reuptake inhibitor

  • Avoid tryptophan supplements
  • Avoid alcohol
  • Incompatible with lactation

C

• Phenelzine

• Antidepressant, monoamine oxidase inhibitor

  • Avoid high-tyramine-containing foods, such as aged cheeses, avocados, grapes, prunes raisins, beef liver, soy sauce, nuts, chocolate, and Chianti wine, among other foods
  • Limit caffeine
  • Avoid tryptophan supplements
  • Increase pyridoxine (B6) intake
  • Avoid alcohol
  • Incompatible with lactation

C

• Tranylcypromine

• Antidepressant, monoamine oxidase inhibitor

  • Avoid high-tyramine-containing foods
  • Limit caffeine
  • Avoid tryptophan supplements
  • Avoid alcohol
  • Incompatible with lactation

C

  • Category A includes drugs which were shown to have no increased risk of fetal abnormalities in well-controlled studies including pregnant women; Category B includes drugs which failed to demonstrate any risk to the fetus in well-controlled studies including pregnant women, although animal studies demonstrated an adverse effect or animal studies resulted in no harm to the fetus, but well-controlled studies including pregnant women were not available; Category C includes drugs which resulted in harm to the fetus in animal studies and well-controlled studies including pregnant women were not available or no animal and well-controlled studies including pregnant women have been conducted; Category D includes drugs which resulted in risk to the fetus in well-controlled or observational studies including pregnant women; however, the benefits of the drag may outweigh risk of harm to the fetus; Category X includes drags which produced fetal abnormalities in well-controlled studies including pregnant women or animals, and the use of the drag is not recommended during pregnancy or by women who may become pregnant.
  • Category A includes drugs which were shown to have no increased risk of fetal abnormalities in well-controlled studies including pregnant women; Category B includes drugs which failed to demonstrate any risk to the fetus in well-controlled studies including pregnant women, although animal studies demonstrated an adverse effect or animal studies resulted in no harm to the fetus, but well-controlled studies including pregnant women were not available; Category C includes drugs which resulted in harm to the fetus in animal studies and well-controlled studies including pregnant women were not available or no animal and well-controlled studies including pregnant women have been conducted; Category D includes drugs which resulted in risk to the fetus in well-controlled or observational studies including pregnant women; however, the benefits of the drag may outweigh risk of harm to the fetus; Category X includes drags which produced fetal abnormalities in well-controlled studies including pregnant women or animals, and the use of the drag is not recommended during pregnancy or by women who may become pregnant.

behaviors to the growing fetus. An informal or formal support network that includes friends, family members, and possibly other patients can provide more constant reassurance, advice, assistance, and positive reinforcement, often valued by women with AN or BN.

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Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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