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Anorexia nervosa e exercícios: questões éticas envolvendo profissionais de educação física

Anorexia nerviosa y ejercicios físicos: cuestiones éticas involucrando profesionales de educación física

Anorexia nervosa and exercise: ethical issues involving physical education professionals

Resumos

A anorexia nervosa acomete cerca de 0,3% a 1% de mulheres jovens. A prática de exercícios em excesso é um comportamento problemático que ocorre em 40% a 80% dos indivíduos diagnosticados com esse transtorno alimentar. Para que suspeitem da doença os profissionais de educação física devem conhecer os vários comportamentos que essas pessoas adotam quando praticam atividade física, estar atentos tanto quanto aos riscos/benefícios da prática como às questões éticas decorrentes de aceitar treinar indivíduos nesta situação, pois, apesar de existirem poucos estudos sobre essas questões, há argumentos contrários e favoráveis quanto à indicação de exercícios. Em todo caso, o princípio básico deve ser o mesmo que se aplica a qualquer indivíduo que esteja praticando exercícios sob supervisão: promover a saúde.

Educação física e treinamento; Exercício; Esportes; Anorexia nervosa; Transtornos dismórficos corporais


La anorexia nerviosa afecta alrededor del 0,3% a 1 % de mujeres jóvenes. La práctica de ejercicios en exceso es un comportamiento problemático que ocurre en 40% a 80 % de los individuos diagnosticados con ese trastorno alimentario. Para que sospechen de la enfermedad los profesionales de educación física deben conocer los distintos comportamientos que esas personas adoptan cuando practican actividad física, estar atentos en cuanto a los riesgos/beneficios de la práctica así como a las cuestiones éticas derivadas por aceptar entrenar individuos en esta situación, puesto que, aunque existan pocos estudios a respecto de esas cuestiones, hay argumentos en contra y a favor de la indicación de ejercicios. De todos modos, el principio básico es el mismo que se aplica a cualquier individuo que practique ejercicios bajo supervisión: promover la salud.

Educación y entrenamiento físico; Ejercicio; Deportes; Anorexia nerviosa; Transtornos dismórficos corporales


Anorexia nervosa affects from 0.3% to 1% of young women. Excessive exercise is a problematic behavior that occurs in 40% to 80% of individuals with this eating disorder. Physical education professionals must observe multiple behaviors to make the suspicious of this disorder, be aware about the risks/benefits as well as the ethical issues of accepting to train people with anorexia nervosa because, even with few studies on this issue, there are favorable and contrary arguments regarding the indication of exercises. In any case, the basic principle is the same of what is applicable in any training practice under supervision: to promote health.

Physical education and training; Exercise; Sports; Anorexia nervosa; Body dysmorphic disorders


  • 1
    Keski-Rahkonen A, Hoek HW, Linna MS, Raevuori A, Shivola E, Bilik CM et al Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry. 2007;164(8):1.259-65.
  • 2
    Zunker C, Mitchell JE, Wonderlich SA. Exercise interventions for women with anorexia nervosa: a review of the literature. Int J Eat Disord. 2011;44(7):579-84.
  • 3
    Giordano S. Exercise and eating disorders an ethical and legal analysis. New York: Routhledge; 2010.
  • 4
    Giordano S. Understandig eating disorders: conceptual and ethical issues in the treatment of anorexia and bulimia nervosa. New York: Oxford University Press; 2005.
  • 5
    Hechler T, Beumont P, Marks T, Touyz S. How do clinical specialists understand the role of physical activity in eating disorders? Eur Eat Disord Rev. 2005;13(2):125-32.
  • 6
    American Psychiatry Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: APA; 1994.
  • 7
    World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: WHO; 1993.
  • 8
    Ackard DM, Fulkerson JA, Neumark-Sztainer D. Prevalence and utility of DSM-IV eating disorder criteria among youth. Int J Eat Disord. 2007;40(5):409-17.
  • 9
    Boyd C, Abraham S, Luscumbe G. Exercise behaviors and feelings in eating disorder and non-eating disorder groups. Eur Eat Disord Rev. 2007;15(2):112-8.
  • 10
    Cook BJ, Hausemblas HA. The role of exercise dependence for the relationship between exercise behavior and eating pathology: mediator or moderator? J Health Psychol. 2008;13(4):495-502.
  • 11
    Scroff H, Reba L, Thornton LM, Tozzi F, Klump KL, Barrettini WH et al Features associated with excessive exercise in women with eating disorders. Int J Eat Disord. 2006;39(6):454-61.
  • 12
    Klein DA, Bennett A, Schebendach J, Foltin RW, Devlin MJ, Walsh T. Exercise "addiction" in anorexia nervosa: model, development and pilot data. CNS Spectrum. 2004;9(7):531-7.
  • 13
    Palla B, Litt IF. Medical complications of eating disorders in adolescents. Pediatrics. 1988;81(5):613-23.
  • 14
    Swenne I, Larsson PT. Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion. Acta Pediatr. 1999;88(3):304-9.
  • 15
    Golden NH. Osteopenia and osteoporosis in anorexia nervosa. Adolesc Med. 2003;14(1):97-108.
  • 16
    US Department of Health and Human Services. Physical Activity Guidelines for Americans. [Internet]. Washington: HHS; 2008 (acesso 28 abr. 2012). Disponível: http://www.health.gov/paguidelines/pdf/paguide.pdf
  • 17
    Daves S, Parech K, Etelepaa K, Wood D, Jaffa T. The impatient management of physical activity in young people with anorexia nervosa. Eur Eat Disord Rev. 2008;16(5):334-40.
  • 18
    Calogero R, Pedrotty K. The practice and process of health exercise: an investigation on the treatment of exercise abuse in women with eating disorders. Eat Disord. 2004;112(4):273-91.
  • 19
    Hausemblas HA, Cook BJ, Chittester NI. Can exercise treat eating disorders? Exerc Sport Sci Rev. 2008;36(1):43-7.
  • 20
    Beumont PJV, Arthur B, Russell JD, Touyz SW. Excessive physical activity in dieting disorder patients: proposal for a supervisioned exercise program. Int J Eat Disord. 1994;15(1):21-36.
  • 21
    Fossati M, Amati F, Painor D, Reiner M, Haemi C, Golay A. Cognitive-behavioral therapy with simultaneous nutritional and physical activity education in obese patients with binge eating disorder. Eat Weight Disord. 2004;9(2):134-8.
  • 22
    Giordano S. Risk and supervisioned exercise: the example of anorexia to illustrate a new ethical issue in the traditional debates of medical ethics. J Med Ethics. 2005;31:15-20.
  • 23
    Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Kimbamki A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med. 2005;165(5):561-6.
  • 24
    Sylvester CJ, Forman SF. Clinical practice guidelines for treating restrictive eating disorder patients during medical hospitalization. Curr Opin Pediatr. 2008;2008(4):390-9.
  • 25
    Golden NH, Katzman DK, Kreipi RE, Stevens SL, Sawyer SM, Rees J et al Eating disorders in adolescents: position paper of The Society for Adolescent Medicine. J Adolesc Health. 2003;33(6):496- 503.
  • 26
    American Academy of Pediatrics. Committee on Adolescence Identifying and Treatment Eating Policy Statement. Pediatrics. 2003;111(1):204-11.

Datas de Publicação

  • Publicação nesta coleção
    22 Maio 2014
  • Data do Fascículo
    Abr 2014

Histórico

  • Recebido
    11 Jun 2013
  • Aceito
    05 Fev 2014
  • Revisado
    30 Nov 2013
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