Assessment: Food/Nutrition-RelatedHistory


Box 3.5 Selected Medications Relevant to Nutrition Assessment of Eating Disordersa


(continued)


In response, patients may inappropriately restrict intake and exercise excessively, behavior that can trigger an eating disorder in susceptible individuals. Such patients should instead be advised to use their prescribed medicine while they appropriately change behaviors to the point the medica- tions are no longer needed.


• Medications associated with increased appetite, impaired fluid excretion, or decreased metabolism: Medication with the potential to increase appetite and/or weight can be scary for anyone who fears weight gain. This fear can lead a patient to underuse or disregard prescribed medications, or drastically restrict eating in an effort to counteract the medi- cation’s weight-related effects.


• Medications that deplete nutrients or have known food- medication interactions: Prescription of such medications should be accompanied by nutrition education.


• Laxatives, enemas, diuretics, stimulants, and metabolic enhancers: Not only dangerous on their own, these substances can also have potentially dangerous interactions with pre- scribed medications. Reduction of these substances should be medically supervised because they may have addictive effects in the gastrointestinal tract. Nonstimulant stool-softeners may be recommended as patients are weaned from laxatives. (See Chapter 9 for more detailed information about laxative abuse.)


• Insulin: Insulin is so often restricted to promote weight loss that it has spawned the name “diabulimia” (7). Eating disorders are twice as common among girls and women with diabetes who use insulin compared with females without diabetes. Women and girls who abuse insulin for weight loss have three times the risk of death from diabetes and its complications compared with females with diabetes who do not misuse insulin (8). Adolescents newly diagnosed with diabetes are considered to be a particularly at-risk group and should be monitored for abnormal weight loss, ketones, and high blood glucose levels. These findings may indicate dan- gerous manipulation/underuse of medication.


a See Chapter 8 for more information on medications.


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