Eating Disorders: Not Just for Skinny People Anymore Mary Ellen Olbrisch, Ph.D., ABPP Departments of Psychiatry and Surgery

I hope you enjoyed your lunch! A note about the slide design With apologies to Steve Auerbach, who (hopefully) was overruled on the broccoli and turnips option

Anorexia Nervosa Highly publicized problem Alarming to observers Well-known body image distortion, with disorder often precipitated by a belief that one is “fat”

Incidence .5-1% of Caucasian adolescent females Incidence among males thought to be rising to as much as 10% Highest mortality rate of any psychiatric disorder (6%) Serious long-term health consequences

Eating disorder usually includes severe food restriction, with food intake excluding most calories from protein and fat Extreme exercise as a means of compensation for the few calories that are consumed Efforts to deceive others in order to maintain the pathology and perceived benefits

Bulimia Also highly publicized but less visible because those with the disorder are often of normal weight Behavior is usually carried out in secret Alarming when observed, particularly purging behaviors, but often techniques are passed along through social networks

Thought to affect at a minimum 10% of adolescent girls and young women Number of cases among boys and men thought to be low and may be less visible due to many fewer with purging and views as to acceptable food consumption for “growing boys” Can result in death and other serious long term health consequences

Dynamics may be similar to those found in anorexia nervosa, especially the desire to maintain a socially acceptable body size Purging behaviors usually involve vomiting or laxative abuse but may also involve extreme compensatory exercise

There is HOPE!

OBESITY Increasing in the U.S. and throughout the world, including third world countries About 12 million Americans are thought to be morbidly obese (BMI > 40) Physicians now consider it the country’s leading health problem

Affects 1/3 of adults in the U.S. Nearly half of adults in the U.S. have a BMI > 25 Disproportionately affects minorities from the African-American, Native American and Hispanic populations

Also highly publicized Not included in the psychiatric diagnostic nomenclature Considered not especially alarming, evoking more a sense of disgust directed to some degree at the behavior but to a larger extent at the resultant body

Very few instances where it is possible to overcome negative stereotyping and social stigma

Increase in Obesity among children and associated increase in serious health problems including diabetes and NAFLD is considered alarming from a public health perspective

Increase in obesity at all ages and life stages is associated with morbidity and disability Enormous cost to society in lost work productivity, disability and medical costs

Also affecting our furry friends

Eating Behavior- What is Healthy?

Eating Behavior- What is Normal?

Eating Disorders: If normal isn’t healthy, aren’t eating disorders for practically EVERYONE?! Should BMI define who has an eating disorder?

BMI and Eating Disorder Imbalance between energy consumption (calories) and energy expenditure Resultant abnormal body weight (BMI < 19 or BMI > 25 Persons in these categories may be otherwise healthy Persons in these categories may be genetically programmed to maintain weights in these ranges without abnormal food consumption or energy expenditure Body weight tends to reach and fluctuate around a “set point” or “settling point” Persons in the normal weight range may eat in a manner that increases disease and mortality risk or that has resulted in morbidity

Candidate Eating Disorders among Persons of Normal Weight and Persons with Obesity Disorders of food preference and nutrient balance Disorders of Control Binge Eating/Unrestrained Eating/Grazing/Mindless Eating Time of Eating Problems (Night Eating Syndrome) Emotional Eating Food-related Obsessions Compulsive Eating