RESUMO
Eating disorders are prevalent, serious conditions that affect mainly young women. An early and enduring sign of anorexia is amenorrhea. There is no evidence for benefits of hormone therapy in patients with anorexia; however, hormone medication and oral contraceptives are frequently prescribed for young women with anorexia as a prevention against and treatment for low bone mineral density. The use of estrogens may create a false picture indicating that the skeleton is being protected against osteoporosis. Thus the motivation to regain weight, and adhere to treatment of the eating disorder in itself, may be reduced. The most important intervention is to restore the menstrual periods through increased nutrition. Hormone and oral contraceptive therapy should not be prescribed for young women with amenorrhea and concurrent eating disorders.
Assuntos
Anorexia Nervosa/terapia , Anticoncepcionais Orais Hormonais , Estrogênios , Amenorreia/etiologia , Amenorreia/terapia , Anorexia Nervosa/complicações , Densidade Óssea , Contraindicações , Feminino , Humanos , Dispositivos Intrauterinos , Menstruação , Estado Nutricional , Osteoporose/prevenção & controleAssuntos
Anorexia Nervosa/tratamento farmacológico , Densidade Óssea/efeitos dos fármacos , Terapia de Reposição Hormonal , Amenorreia/complicações , Amenorreia/etiologia , Anorexia Nervosa/complicações , Anorexia Nervosa/metabolismo , Densidade Óssea/fisiologia , Anticoncepcionais Femininos/uso terapêutico , Estrogênios/uso terapêutico , Medicina Baseada em Evidências , Feminino , Humanos , Osteoporose/etiologia , Osteoporose/prevenção & controle , Aumento de PesoRESUMO
We report the results of a study based on 1,428 patients with eating disorders treated at 6 clinics. These patients were consecutively referred over 18 years and used inpatient and outpatient treatment. The subjects were diagnosed with anorexia nervosa, bulimia nervosa, or an eating disorder not otherwise specified. Patients practiced a normal eating pattern with computerized feedback technology, they were supplied with external heat, their physical activity was reduced, and their social habits restored to allow them to return to their normal life. The estimated rate of remission for this therapy was 75% after a median of 12.5 months of treatment. A competing event such as the termination of insurance coverage, or failure of the treatment, interfered with outcomes in 16% of the patients, and the other patients remained in treatment. Of those who went in remission, the estimated rate of relapse was 10% over 5 years of follow-up and there was no mortality. These data replicate the outcomes reported in our previous studies and they compare favorably with the poor long-term remission rates, the high rate of relapse, and the high mortality rate reported with standard treatments for eating disorders.