Bulimia nervosa: when the quest for beauty becomes a disease

Patients with bulimia nervosa present a eating behavior that constitutes a cycle that alternates in fasting or severe food restriction, followed by episodes of binge eating and use of purgatory methods, such as self-induced vomiting, use of laxatives, diuretics, and intense physical exercises to avoid weight gain.

Bulimic behavior depends on a series of factors, including the opportunity for purging, the type of food available, and the mood of the patient. Exaggeration in food consumption triggers anxiety and fear of gaining weight, leading to the practice of compensatory behaviors that are inadequate for weight control, setting up a cycle of food restriction, binge eating and purging. The initial advice for nutritional rehabilitation of the bulimia nervosa patient is to monitor episodes of binge eating and purging. Regularity in eating habits aims to control the periods of restriction and consequent binge eating, contributing to the interruption of the cycle of compulsion, purging and fasting.

The objectives of nutritional therapy have as basic principles: to minimize food restrictions, explaining to the patient that there are no forbidden foods and that the prohibition / restriction subsequently leads to bouts of binge eating; establish a regular model of non-compulsive meals (three meals a day, plus two snacks).

The number of meals is increased gradually, depending on the initial number of meals the patient used to make. At times, the patient may be slightly frightened if, immediately, it is determined to perform five meals a day. We can say that this is our ultimate goal, but this must be done slowly; increase the variety of foods consumed, decreasing the beliefs and food taboos of each patient; correcting nutritional deficiencies in order to establish adequate dietary patterns of macro and micronutrients; and minimize eating restrictions and establish healthy eating practices.

The use of a diary contributes to the development of a meal plan and standardization of meals for patients with bulimia nervosa. It is requested that all food consumed be recorded, followed by data such as: place of meal, people with whom it was made, duration, if the patient considered the meal compulsive and if there was compensatory behavior, and a very important item important for understanding the triggers that lead to inappropriate behavior what the feeling / feel during the time of the meal or throughout the day. Thus, it is possible to better elucidate the established eating pattern.

The focus of treatment is to understand when patients eat and not necessarily what. It is important to point out to the patient that, despite his concern about weight gain, that dieting is incompatible with the treatment of eating disorders at the same time. Therefore, the nutritionist should not offer restrictive diet plans. Mainly because, among the initial causes associated with the initiation of BN, is the use of inadequate diets for weight loss and arbitrary patterns of ideal weight.

Knowledge of the diets already used by the patient, as well as their beliefs, taboos and / or dietary restrictions helps with treatment. Patients should understand that the first intervention is standardization of the food standard. Any change in weight should occur as a result of normalizing meals and eliminating compulsions.

Weight monitoring is necessary, but resistance may occur. Therefore, it should be clarified as to the possible oscillations of weight. The patients with bulimia nervosa have dysfunctions in their perception abilities and mechanisms involved in the regulation of food intake behavior. Thus, they present greater urgency to eat, difficulty in stopping eating and inability to recognize feelings of satiety, as well as disorders in taste receptors. The first stage begins with the normalization of the food standard.

The strategies used for changes in behavior and eating attitudes include: self-monitoring through the use of food diary, food education, use of behavioral alternatives to binge eating, such as eating in quiet places and accompanied by people who help decrease anxiety, and relapse prevention, showing the patient that relapses are common and not necessarily harmful.

The next step is the introduction of banned foods into the diet. This measure is important to prove that your consumption does not generate automatic weight gain. Nutrition education is necessary because although these patients are widely understood about food, their knowledge is limited to the diets for weight loss and nutritional value of some foods. In nutritional treatment, calorie counting or weighing of foods is discouraged, since these patients show extreme attention to the composition of the foods and their caloric values. The nutritionist is the most appropriate professional to help patients in the clarification of food myths. Their performance is important in providing information on diet and nutrition to members of the therapy team so that everyone is consciously involved in the treatment offered to the bulimic patient. Andréa Romero Latterza

is a nutritionist with a specialization in Hotel Administration by Senac and a Masters in Public Health. She has been a volunteer nutritionist at the Ambulatory of Bulimia and Eating Disorders (Ambulin) at the Institute of Psychiatry at the Hospital das Clínicas at the University of São Paulo School of Medicine and is currently a professor and responsible for the Clinical School of Nutrition of the Universidade Metodista de São Paulo Paulo (Umesp), attends a private practice and is a collaborator of the Regional Council of Nutritionists 3rd Region (CRN-3).

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