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PSYCHOLOGY OF NUTRITION

Eating Disorders Introduction Anorexia Nervosa Bulimia Nervosa Obesity Attention deficit hyperactivity disorder Mood Disorders Schizophrenia

-define eating disorder Introduction -define eating disorder -a situation where a person eats or overeats non-nutritious amounts of foods and/or deliberately vomits foods   -vomiting may include ridding the body of non-nutritious or nutritious amounts of foods -leads to disease or disability -classified on basis of visible end result (extreme thinness or fatness) or on the basis of variation of eating patterns (fasting, binging, food restriction)

Introduction continued -what causes eating disorders -psychiatric/psychological or biochemical aberration

Anorexia Nervosa -define -characterised by self-imposed weight loss, hormone function, and distorted psychopathological attitude towards eating and weight   -epidemiology -typically occurs in females shortly after puberty or later in adolescence -but can be before puberty or later in life

-family dynamics causing intrapsychic conflicts -social Anorexia Nervosa -causes-   -biological -unexplained physiological (possibly hormonal changes) with possible genetic predisposition   -psychological -family dynamics causing intrapsychic conflicts -social -the belief that the person is too heavy -the view that heavy is ugly and thinness is beautiful -self-esteem may be low -ties in with onset of puberty

-similar to other states of semi-starvation Anorexia Nervosa -consequences -similar to other states of semi-starvation -adaptive responses by the body that allow the person to survive decreased dietary energy intake   -such adaptive measures have their costs -such costs are limitations on mental and physical abilities of person -these limitations come about because sparing of utilisation of glucose and proteins and the shift to the utilisation of fat stores in the body

Anorexia Nervosa Consequences -shift in fluid and electrolyte (mineral) balance in body   -disturbances in hormones leading to lack of a period and infertility, cold intolerance, dry skin and hair, and constipation

-done jointly with physician and dietitian -mild cases Anorexia nervosa Treatments     -done jointly with physician and dietitian -mild cases -counselling about adolescent growth and nutrition education and consequences of starvation   -more severe cases -psychiatrist and dietitian who specialise in eating disorders and provide psychological and dietary counselling, and general support   -very severe-hospitalisation including feeding by other than mouth combined with above

Anorexia Nervosa outcomes -  must follow for at least 4 years - 50-60 % of patients are back to normal weight after 4 years - after 6 years have 50 % recovery from disease (previous point?) - 6- 12 years of illness 75 % recover - after 12 years of illness recovery unlikely - mortality rate- 0 –5 %

Bulimia nervosa   Defined -Characterised by frequent binge eating and purging associated with the loss of control over eating and the persistent overconcern about body shape and weight. Occurs predominately in young adult women -Milder forms of binging and purging (vomit and laxatives) are common in normal weight females.

Multiple determinants -Depression Bulimia Nervosa Multiple determinants -Depression -Impaired hormonal regulation suggesting really full when not -Reduced post-prandial satiety - if person once maintained a higher weight and if they are in the normal range due to binge and purge now it will be sub-optimal for them -therefore in a state of semi-starvation -Binge and purge can also occur in in normal weight persons who have never had anorexia nervosa-some may have been overweight or desire slimmer figure. Meal skipping and calorically restricted meals often starts the process.

Bulimia nervosa Consequences -Clinically changes similar to anorexia nervosa occur -Diversity of eating patterns among bulimics makes it difficult to generalise regarding the physiological consequences   Epidemiology -1-9% among young adult women; rare in males -mean age for diagnosis 23 years -among 15-24 yr females bulima nervosa is 2 x as common as anorexia nervosa

Bulimia nervosa Treatment   As per anorexia nervosa Outcomes Few studies that follow patients for more than one year after treatment In the short term there is 66 % recovery.

Obesity -define -excessive accumulation of fat in the body -body mass index of greater than or equal to 30 -body mass index is kg/m2 -greater than or equal to 94 cm males and 80 cm females  

Obesity -epidemiology During the survey period of 2007 to 2009, the majority of Canadian children and youth (74%) had a BMI that was neither overweight nor obese, based on physical measurement of their height and weight. Slightly more than 17% were overweight and 9% were obese. During the 2007-to-2009 period, just under 38% of adults were at a healthy weight. About 1% were underweight, 37% were overweight and 24% were obese.

Obesity -causes -low income -higher percentage of low income population are obese -higher income -lower percentage of affluent population are obese why?   - different ethnic groups have different percentage of their respective populations that are obese e.g. among U.S. males- Hispanics > whites > blacks

Obesity causes -media impact- eat more -hormonal-rare -genetics- it has been suggested that obese parents produce obese children but this is not absolute

Interesting observation in Belgium- first year university students with larger waist circumferences have a greater chance of failure-Deliens et al (2013) Nutrition Journal 12:162. -yet another reason for young people to be concerned about obesity (aside from type 2 diabetes, heart disease, hypertension, stroke, end stage renal disease, blindness, amputation, liver disease, depression, sleep apnea, osteoarthritis, some types of cancer (e.g. breast, prostate, colon), lack of workplace productivity, job insecurity, poorer income, reduced benefits and pensions, and loss of publically funded healthcare)  

Five food felons Contributing to Obesity are: 1) saturated fats 2) trans fats 3) added sugars 4) syrups 5) any grains that aren’t 100% whole  

Obesity continues to rise in Canada Perspective on Obamacare  BOTTOM LINE Not all Canadians are walking the talk. They know what has to be done but cannot bring consistently themselves to do it. Canadians as a population just do not get it. Obesity continues to rise in Canada Perspective on Obamacare  

Obesity Treatments -caloric restriction and exercise- otherwise yo yo effect -appetite suppressing drugs -psychotherapy -behaviour modification- eg only eating in dining room -surgery-stomach stapling   Outcomes of treatments -highly individual

Attention deficit hyperactivity disorder -define -developmentally inappropriate activity levels -low frustration tolerance -impulsivity -poor organisation of behaviour -inability to sustain attention and concentration  

Attention deficit hyperactivity disorder -consequences -medication can reduce appetite and hence affect growth   -treatments -reduce drug dose

Mood Disorders -define -depression or manic-depression   -causes -brain biochemical disorder -consequences -depression- loss of appetite and anorexia -manic depression- lithium used to treat-gives weight gain

Mood Disorders Treatments -depression- treat via counselling and medication -manic depression-keep dietary sodium up because lithium rises in blood if dietary sodium is restricted

Schizophrenia -define chronic hallucinations, delusions, illogical thinking and bizarre behaviour   -causes -biochemical disorder in brain -consequences -voices telling people not eat- weight loss -treatments -counselling and medication