Lecture 15: Diets and Eating Disorders Will Brown 02/28/2012

What is a Diet? What do you think people mean when they say, I am going on a diet? A diet comprises everything that you eat A Diet usually refers to an attempt to change eat patterns for the purposes of losing weight Why is the underlying reason to lose weight? What are the motivations behind a Diet?

Diet Reality Roughly 45 million Americans will go on diets over the course of the year 85% will fail In 2009 a study was published in Annuls of Internal Medicine said that most commercial diet plans do not have data to back up their claims of helping people lose weight – The one exception was Weight Watchers

Why dont we succeed?

Fad Diet What is a Fad Diet? – Diet that becomes popular very quickly and may fall out of favor very quickly – Important to note that Fad does not mean failure Recommendations that promise a quick fix Dire warnings of dangers from a single product or regimen Claims that sound too good to be true Simplistic conclusions drawn from a complex study Recommendations based on a single study Dramatic statements that are refuted by reputable scientific organizations Lists of "good" and "bad" foods Recommendations made to help sell a product Recommendations based on studies published without review by other researchers Recommendations from studies that ignore differences among individuals or groups Eliminated one or more of the five food groups

Fad Diets: Categories Extreme diets Low Carb diets Low fat/high carb Food combining Liquid diets Diet pills

Extreme Diets HCG Diet – Eat 500 calories while taking a growth hormone – No longer approved by the FDA Cabbage soup diet – Eat cabbage soup every time you feel hungry – Claims of losing 10 pounds a week; a near physiological impossibility – Extreme flatulence is a side effect

Low Carb Grapefruit diet; a.k.a. the Hollywood diet – Eat half a grapefruit with every meal – Grapefruit can interfere with medications Atkins diet Carb addict diet Zone diet

Why dont these work? They are unrealistic – It is not possible to eat in those ways or long term They are to restrictive – They deny to much from what a body needs They do not address underlying causes – They address weight and weight only – Most weight issues are lifestyle related not just food

What happens when diets lead to disorders?

Eating Disorders: Causes Root cause for each person is different Not just physical but psychological as well What kind of images are we subjected to? – To skinny – To fat What kind of messages are sent? – Fad Diets – Fashion and Magazines What does food represent? – Currency – Power – Bribe – Comfort

Eating Disorders Severe changes in eating patterns linked to physiological changes. The main four – Anorexia nervosa – Bulimia nervosa – Binge eating – Female athlete triad Affect about 5 million Americans – Women more than men; 5:1 ratio

Eating Disorders: Anorexia Nervosa and Bulimia Nervosa Affects ~5% of women Nervosa refers to the belief that one is disgusted with themselves Anorexia – Loss of appetite but is a denial of appetite – Affects 1:200 adolescent girls typically blame themselves for age related weight gain – Men account for 10% of cases; mainly athletes that require weight loss Bulimia – binge eating followed by attempts to purge by vomiting and laxatives

Anorexia First described in 1689 Patients suffer from extreme fear of being fat or obese Although it is an eating disorder it is more psychological in nature Only 25% recover, after ~6 years, but most go on to suffer other eating disorders as well Numerous reasons why anorexia begins – Affects primarily Caucasian females from middle to upper socioeconomic backgrounds Conflict within family structure is common Also, power and control issues are common

Anorexia Early patterns – Extreme dieting; diet because single focus – Odd eating behavior Cutting peas in half Making but not eating a large meal Compulsive exercise As disease progresses, safe and unsafe food lists develop Internally, these behaviors are seen as rational

Anorexia Physical effects – Body weight less then 85% of expected weight BMI <17.5 – Low body temp intolerance to cold – Slowed metabolic rate – Decreased heart rate – Anemia – Rough, cold, dry, skin – Low WBC – Loss of hair – Etc. Etc. Etc. All are attempts of the body to hold onto what weight it can

Anorexia: Treatment For success, requires a team of experts and most importantly a strong support structure Nutrition Therapy – Goal is to increase oral food intake – Switches to stopping weight loss then gaining weight Psychological treatment – Once dietary needs are met treatment switches to underlying causes

Bulimia Nervosa Categorized by binge eating and purging by vomiting or laxatives Most common in college ages, some high school students are at risk Usually successful females – different from anorexia in that bulimics are typically above average weight Rather than turning away from food, food is a coping mechanism in critical situations Bulimics acknowledge they have a problem – Many report childhood abuse – Many are impulsive in other areas of life

Bulimia: Typical Behavior Harder to diagnose – patients must binge and purge twice weekly for 3 months Eating large amounts of food in a short time followed by periods of strict food consumption – Most binge eating occurs at night – No set time frame for cycles – Binges typically last ½ - 2 hours Common foods include those high in carbohydrates and convenience foods – Problem is that 33-75% of calories can still be absorbed leading to more weight gain – If laxatives are used because of the fact that they act in the LI after absorption occurs Excessive exercise

Bulimia Health issues – Demineralization of teeth – Low blood potassium resulting in heart problems – Swollen salivary glands – Stomach and esophageal tears and ulcers – Constipation from laxative use – Certain vomit inducing agents are toxic; ipecac Debilitating disease that can lead to death due to suicide, low blood potassium, or infection

Bulimia: Treatment Similar to anorexia requires a team of professionals Most do not start treatment underweight so psychological treatment by begin before food therapy Food therapy starts with reducing amount of food consumed in a binge – Leads to less damage to esophagus Psychotherapy aims to reduce all-or-nothing thinking – Medication can also be used to combat the depression associated with bulimia Nutritional counseling to re-establish proper food habits Overall goal is to not stop binge/purge cycles but to reset good eating habits

Other eating disorders Binge eating – binge cycles not accompanied by purges – Generally not diagnosed – Severe dieting increases likelihood of developing binge eating disorder – 40% are male – Perceive hunger when not hungry – Depression is common Night eating syndrome Female athelete triad

An Ounce of Prevention… The best treatment is prevention Change outlooks and perception as to what is acceptable Learn principles of good nutrition – Begin this earlier in life Supportive environments Etc. Etc. Etc…