[Obesity and Eating Disorders. Indications for the different levels of care. An Italian Expert Consensus Document]. / Documento di Consensus. Obesità e Disturbi dell'Alimentazione Indicazioni per i diversi livelli di trattamento.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Dynamic monitoring of restricted eating disorders by indirect calorimetry: a useful cognitive approach.

OBJECTIVE: Outpatient treatment in restricted eating disorder: indirect calorimetry during dynamic monitoring. DESIGN: A retrospective observational study. SUBJECTS: Twenty seven women affected by restricted eating disorder (essentially anorexia nervosa) with a body mass index [weight (kg)/height (m2)] of 17.29+/-2.47 were studied. The sample was compared as itself control during rehabilitative way. INTERVENTIONS: Fat mass (FM) and fat free mass (FFM) were determined by anthropometry technique. REE/day and respiratory quotient (RQ,VCO2/VO2) were measured by indirect calorimetry using a Calorimeter Vmax 29n-Sensor Medics-California. Skinfold thickness and circumferences were also measured. Arm muscle area (AMA) and fat area were calculated by formulas reported in Frisancho. RESULTS: The data indicated a positive correlation between AMA, VO2/ml/min and resting energy expenditure (REE)/day values examined during follow-up of patients. The increase of these parameters indicated a good monitoring index correlated to a FFM recovery during psychonutritional rehabilitation. CONCLUSION: Indirect calorimetry represents a useful approach for determining REE and prescribing diets in these patients. Moreover, the combined use of anthropometric techniques allows to accurately assess and adjust therapy according to the patient's progress. This study shows that restricted eating disorders are characterized by a recovery of FFM related to improvement of body weight and REE/day. On the contrary, the increase of AFA revealed a recovery of fat-metabolism (corresponding to RQ decrease) and lipid/carbohydrates oxidation improvement, only in the presence, at the same time, of O2 consumption increase.