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Clemente-Suárez VJ, Ramírez-Goerke MI, Redondo-Flórez L, Beltrán-Velasco AI, Martín-Rodríguez A, Ramos-Campo DJ, Navarro-Jiménez E, Yáñez-Sepúlveda R, Tornero-Aguilera JF. The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions. Nutrients 2023; 15:2594. [PMID: 37299557 PMCID: PMC10255390 DOI: 10.3390/nu15112594] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Maria Isabel Ramírez-Goerke
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, C/Tajo s/n, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Ana Isabel Beltrán-Velasco
- Psychology Department, Facultad de Ciencias de la Vida y la Naturaleza, Universidad Antonio de Nebrija, 28240 Madrid, Spain;
| | - Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Rodrigo Yáñez-Sepúlveda
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile;
| | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
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Patterson-Norrie T, Ramjan L, Sousa MS, George A. Dietitians' Experiences of Providing Oral Health Promotion to Clients with an Eating Disorder: A Qualitative Study. Int J Environ Res Public Health 2022; 19:14193. [PMID: 36361071 PMCID: PMC9654250 DOI: 10.3390/ijerph192114193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/17/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Eating disorders (EDs) can seriously impact oral health, leading to irreversible dental damage. Dietitians play a key role in the care of people with an ED and are well-placed to promote oral health. However, there is currently little understanding of how dietitians perceive their role in this space. This study aimed to explore the perceptions and role of dietitians in providing oral health promotion to their clients in an ED clinical setting. (2) Methods: This descriptive qualitative study used semi-structured interviews to explore the perceptions of 14 registered dietitians practicing across seven states in Australia. Participants were recruited using a combination of purposive and snowball sampling. A hybrid thematic analysis approach was undertaken to identify and describe the key themes generated from the data. (3) Results: Generally, dietitians were insightful and knowledgeable of the oral health issues that clients with an ED may be experiencing. However, dietitians' practices across education, screening, and referrals were inconsistent. Challenges such as inadequate training, unknown referral pathways, and clear guidelines were cited as significant barriers to practice. (4) Conclusions: The results reinforce the need for education and the development of targeted strategies that address challenges to oral health promotion in dietetic practice.
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Affiliation(s)
- Tiffany Patterson-Norrie
- Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Lucie Ramjan
- Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 1871, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Mariana S. Sousa
- Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- IMPACCT—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Ajesh George
- Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, NSW 2010, Australia
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Villa M, Opawsky N, Manriquez S, Ananías N, Vergara-Barra P, Leonario-Rodriguez M. Orthorexia nervosa risk and associated factors among Chilean nutrition students: a pilot study. J Eat Disord 2022; 10:6. [PMID: 35016711 PMCID: PMC8753887 DOI: 10.1186/s40337-022-00529-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/02/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Orthorexia nervosa (ON) is characterized by an excessive, obsessive concern with healthy eating generating psychological complications and even malnutrition at a caloric and protein level. Current evidence suggests that people with greater food knowledge are the most likely to be affected, placing nutrition students as a populational risk group. Since there are no nationwide studies dealing with orthorexia nervosa in this risk group, the present pilot study intends to identify risk factors for orthorexia nervosa in a sample of Nutrition and Dietetics students in Chile. METHOD A descriptive cross-sectional pilot study was done on 90 Nutrition and Dietetics students from a Chilean university, representing 70% of its population. The ORTHO-11-ES instrument was applied to determine ON risk, along with consulting about attitudinal, physical-clinical and social variables. Statistical tests were performed in GraphPad PRISM 8.0®, applying probability ratios and personal correlation, between the sociodemographic variables and the risk of orthorexia nervosa. This study was approved by the university Ethics Committee based on the Helsinki Declaration. RESULTS 23.3% of the studied population was at risk of suffering ON. Associated variables were being in the second year of their major (OR 2.22), coming from a charter school (OR 3.00) and cohabitation being limited to ≤ 1 person (OR 2.47). Particularly, declared physical activity limits are associated to the risk of suffering ON (Sedentary OR 2.42, Heavy OR 3.53), as well as time spent on the social network Instagram (< 1 h OR 2.77, > 3 h OR 1.80). CONCLUSIONS There is an ON risk prevalence of 23.3% in the present pilot sample under study, indicating that years of study, cohabitation, secondary educational establishment, physical activity and Instagram use constitute associated factors for the studied condition. Some results vary from international evidence, describing a dual nature in the variables for Instagram time and declared physical activity for ON risk. This study needs replication in more representative samples and longitudinal character with control groups which can confirm the studied elements as ON risk factors. Orthorexia nervosa (ON) is an expression created to indicate a possible new eating disorder characterized by excessive and obsessive preoccupation with healthy eating. Some of its most distinctive traits include marked anxiety over food, exaggerated fear over the appearance of some diseases and shame about physical appearance. This ultimately impacts food choice, planning, acquisition, preparation and consumption, creating psychological complications along with some associated with malnutrition. Considering that Nutrition students are an at-risk group, the present pilot study evaluated its prevalence and associated factors in a specific sample in Chile. Conditions associated with the risk of orthorexia nervosa identified in the present study include: number of hours spent using Instagram, limited cohabitation, extreme physical activity, and number of years in the major. These results should be taken cautiously, with their association confirmed in follow-up studies.
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Affiliation(s)
- Manuel Villa
- Nutrition and Dietetics School, Faculty of Sciences, Universidad Mayor, Temuco, Chile
| | - Nicole Opawsky
- Nutrition and Dietetics School, Faculty of Sciences, Universidad Mayor, Temuco, Chile
| | - Sara Manriquez
- Nutrition and Dietetics School, Faculty of Sciences, Universidad Mayor, Temuco, Chile
| | - Nicole Ananías
- Nutrition and Dietetics School, Faculty of Sciences, Universidad Mayor, Temuco, Chile
| | - Pablo Vergara-Barra
- Departament of Psychiatry and Mental Health, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Marcell Leonario-Rodriguez
- Nutrition and Dietetics School, Faculty of Sciences, Universidad Mayor, Temuco, Chile. .,Department of Basic Sciences, Center for Molecular Biology and Pharmacogenetics, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile.
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Affiliation(s)
- Hélène Rangé
- Department of Periodontology, Université de Paris, U.F.R. d'Odontologie-Garancière, Paris, France.,Service d'Odontologie, Hôpital Rothschild, AP-HP.Sorbonne Université, Paris, France.,UR 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Université de Paris, Paris, France
| | - Pierre Colon
- Service d'Odontologie, Hôpital Rothschild, AP-HP.Sorbonne Université, Paris, France.,Department of Restorative Dentistry and Endodontics, U.F.R. d'Odontologie-Garancière, Université de Paris, Paris, France.,Laboratoire Multimatériaux et Interfaces, Université Claude Bernard Lyon 1, UMR CNRS, Villeurbanne, France
| | - Nathalie Godart
- Service Hospitalo-Universitaire de Santé Mentale pour les Adolescents et Jeunes Adultes, Fondation Santé des Etudiants de France, Paris, France.,U.F.R. Simone Veil, Université Versailles Saint Quentin en Yvelynes (UVERSUSQ), Montigny-Le-Bretonneux, France.,Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Hôpital Paul Brousse, Villejuif, France
| | - Yvonne Kapila
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, California, USA
| | - Philippe Bouchard
- Department of Periodontology, Université de Paris, U.F.R. d'Odontologie-Garancière, Paris, France.,Service d'Odontologie, Hôpital Rothschild, AP-HP.Sorbonne Université, Paris, France.,UR 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Université de Paris, Paris, France
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Kuipers S, Boonstra N, Kronenberg L, Keuning-Plantinga A, Castelein S. Oral Health Interventions in Patients with a Mental Health Disorder: A Scoping Review with Critical Appraisal of the Literature. Int J Environ Res Public Health 2021; 18:ijerph18158113. [PMID: 34360406 PMCID: PMC8346069 DOI: 10.3390/ijerph18158113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022]
Abstract
Poor oral health affects quality of life and daily functioning in the general population and especially in patients with mental health disorders. Due to the high burden of oral health-related quality of life in patients with a mental health disorder, it is important for nurses to know how they can intervene in an early phase. The aim of this systematic scoping review was to identify and appraise oral health interventions in patients with a mental health disorder. A systematic scoping review with a critical appraisal of the literature was conducted using the Joanna Briggs Institute (JBI) methodology for scoping reviews and their checklists. MEDLINE, CINAHL, PsycINFO and reference lists were searched from their inception until December 2020. Results: Eleven quantitative studies were included in the review: four randomized controlled trials, six quasi-experimental studies and one cohort study. Studies focused on interventions for patients (n = 8) or focused on patients together with their professionals (n = 3). Four types of oral health interventions in mental health were found: (I) educational interventions; (II) physical interventions; (III) interventions combining behavioural and educational elements and (IV) interventions combining educational and physical elements. All studies (n = 11) had an evaluation period ≤12 months. Nine studies showed an effect on the short term (≤12 months) with regard to oral health knowledge, oral health behaviour, or physical oral health outcomes (e.g., plaque index). Two studies showed no effects on any outcome. Overall, the methodological insufficient to good. Conclusion: Four types of interventions with positive effects (≤12 months) on oral health knowledge, oral health behaviour, and physical oral health outcomes in different diagnostic patient groups were found. Due to the heterogeneity in both interventions, diagnostic groups and outcomes, one golden standard oral health intervention cannot be advised yet, although the methodological quality of studies seems sufficient. Developing an integrated oral health toolkit might be of great importance in mental health considering its potential effect on oral health-related quality of life.
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Affiliation(s)
- Sonja Kuipers
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands; (N.B.); (A.K.-P.)
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands;
- Correspondence: ; Tel.: +31-652-690-627
| | - Nynke Boonstra
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands; (N.B.); (A.K.-P.)
- KieN VIP, Oosterkade 72, 8911 KJ Leeuwarden, The Netherlands
| | - Linda Kronenberg
- Dimence Mental Health Care, Burgemeester Roelenweg 9, 8021 EV Zwolle, The Netherlands;
| | - Annette Keuning-Plantinga
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands; (N.B.); (A.K.-P.)
- Health Sciences-Nursing Science & Education, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Stynke Castelein
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands;
- Lentis Research, Lentis Psychiatric Institute, Hereweg 80, 9725 AG Groningen, The Netherlands
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Lin JA, Woods ER, Bern EM. Common and Emergent Oral and Gastrointestinal Manifestations of Eating Disorders. Gastroenterol Hepatol (N Y) 2021; 17:157-167. [PMID: 34035776 PMCID: PMC8132634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Eating disorders (EDs) such as anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder are associated with restricted diets and abnormal compensatory behaviors, frequently leading to malnutrition and oral and gastrointestinal manifestations. Dental and oral complications are generally caused by malnutrition, micro-nutrient deficiency, and chronic acid exposure; hence, treatment of the ED and frequent dental examinations are essential to reduce morbidity. Gastrointestinal manifestations are multifactorial in origin, and may be caused by disordered behaviors, malnutrition, anxiety, and/or may be a function of the ED itself. This article reviews the most common oral and gastrointestinal manifestations of EDs and describes emergent complications such as acute gastric dilation and superior mesenteric artery syndrome. It is important for providers to recognize complications associated with EDs to provide the best treatment possible.
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Affiliation(s)
- Jessica A. Lin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth R. Woods
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Elana M. Bern
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
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Smorthit K, Sawbridge D, Fitzgerald R. Eating disorders and the orthodontist: Diagnosis, considerations and referral. J Orthod 2021; 48:313-322. [PMID: 33611972 DOI: 10.1177/1465312521993491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Eating disorders are relatively common mental health disorders in Western European and North American populations. The peak incidence occurs within the adolescent years, which correlates with the largest orthodontic patient population. The morbidity associated with these psychological conditions is significant, and has a direct impact upon patient well-being, orthodontic outcomes and the success of treatment. Therefore, it is of relevance to the orthodontist to be aware of potential presenting features of these conditions, when and where to seek advice, and how such disorders may impact upon orthodontic outcomes. METHODS Articles published on PUBMED and MEDLINE relevant to orthodontics and eating disorders were reviewed. Key information was extracted, and the relevant evidence for the orthodontist summarised. RESULTS Eating disorders may present to the orthodontist in specialist or hospital practice, either undiagnosed or as a co-morbidity. Orthodontists may benefit from an appreciation of these potential diagnoses, the orthodontic implications and to have the confidence to refer their patients to the necessary services. LIMITATIONS There is little existing research in this area. CONCLUSIONS These conditions have a significant impact on patient morbidity and mortality. This cohort of patients is not suitable for orthodontic treatment while their disease is active. The impact of a developing eating disorder can adversely affect orthodontic treatment.
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Affiliation(s)
- Kelly Smorthit
- Orthodontic Department, Lancashire Teaching Hospitals NHS Trust, Preston, Lancashire, UK
| | - David Sawbridge
- Department of Gastroenterology and Hepatology, Cork University Hospital, Cork, Republic of Ireland
| | - Rhian Fitzgerald
- Orthodontic Department, Alder Hey Children's Hospital, Liverpool, UK
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Patterson-Norrie T, Ramjan L, Sousa MS, Sank L, George A. Eating disorders and oral health: a scoping review on the role of dietitians. J Eat Disord 2020; 8:49. [PMID: 33062271 PMCID: PMC7552467 DOI: 10.1186/s40337-020-00325-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compromised nutritional intake due to eating disorder related behaviors, such as binge eating and purging, can lead to multi-system medical complications, including an irreversible impact on oral health. However, dental anxiety, fear or embarrassment may hinder individuals with an eating disorder from seeking assistance for their oral health concerns. As key health professionals in eating disorder treatment, dietitians are well positioned to provide basic dental screening, however, their capacity to perform this role in practice has not been established. The aim of this review was to identify current evidence on the role of dietitians in promoting oral health among individuals with eating disorders. METHODS A comprehensive search of eight electronic databases and the grey literature was conducted to address the following three focus areas: 1) guidelines and recommendations on the role of dietitians in oral health 2) knowledge, attitudes and practices of dietitians regarding oral health promotion and; 3) current models of oral health care and resources for dietitians. RESULTS Twelve articles were included. The review indicated that current national and international position statements encourage dietitians to conduct basic oral health screening and promote oral health in high risk populations, such as those with an eating disorder. However, no evidence was found to indicate dietitians performed oral health screening or education in populations with an eating disorder. In other population settings, dietitians were found to play a role in oral health promotion, however, were noted to have mixed knowledge on oral health risk factors, prevention and treatment and generally were not providing referrals. Some oral health promotion resources existed for dietitians working in pediatric, HIV and geriatric clinical areas however no resources were identified for dietitians working in eating disorder settings. CONCLUSION Despite current evidence showing that dietitians can play a role in oral health care, no models of care exist where dietitians promote oral health among individuals with an eating disorder. There are also no training resources and screening tools for dietitians in this area. Further research is required to develop this model of care and assess its feasibility and acceptability.
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Affiliation(s)
- Tiffany Patterson-Norrie
- Centre for Oral Health Outcomes & Research Translation (COHORT), School of Nursing and Midwifery , Western Sydney University/South Western Sydney Local Health District/ Ingham Institute for Applied Medical Research, Liverpool BC, Locked Bag 7103, Sydney, NSW 1871 Australia
| | - Lucie Ramjan
- School of Nursing and Midwifery, Western Sydney University, Centre for Oral Health Outcomes & Research Translation (COHORT), Sydney, Australia
| | - Mariana S. Sousa
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Lindy Sank
- Sydney Dental Hospital, Oral Health Services, SLHD, Sydney, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University/South Western Sydney Local Health District/University of Sydney/ Ingham Institute for Applied Medical Research, Sydney, Australia
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