2. Eating Disorders

3. The Ideal Body Image Media promotion Social acceptance Influence and stress on young individuals

4. The Paradox of Food Addiction Eating is a necessity Dieting to become thin may lead to a disorder

5. Food: More Than Just Nutrients Linked to personal emotions Comfort Release of natural opioids Reward

6. Genetic Link? Identical twins have a higher chance of eating disorders Fraternal twins are less likely

7. Anorexia Nervosa Extreme weight loss Perceived body image Desire for acceptance Psychological conflict and depression Lack of appropriate coping mechanism Intense fear of obesity and weight gain Begins with a simple diet and leads to semistarvation Denial of hunger

8. Profile of Anorexia Usually occurs between the ages of 12-18 Typically white female 5%-10% are male Middle-upper socioeconomic class Perfectionist, competitive, obsessive Parental standards high Critical of self and others

9. Anorexia Nervosa Believes food avoidance is achievement Control in life Refuses to accept problem exists Resists treatment Equates “goodness” with low food intake

10. Anorexia Nervosa Experiencing physical changes associated with puberty False body perception Demonstrates ritual involving food Preoccupation with food Cooks for others Hungry, but refuses to eat

11. Anorexia Nervosa Food rituals Cuts food in small pieces Rearranges food on plate Eliminates foods gradually 300-600 calories a day Diet pop, sugarless gum Prolonged exercise

12. Risk Periods for Anorexia Nervosa Age 14 – puberty, high school Age 18 – college, full time jobs

13. Warning Signs Abnormal eating habits and eating very little food Hiding and storing food Exercise compulsively Prepares large meals for others Withdraws from friends and family Critical of self and others Sleep disturbance and depression Ammenorrhea

14. AN Diagnostic Criteria Weight <85% standard Intense fear weight gain/fat Distorted body image Women: miss 3 consecutive periods

15. AN: Physical Consequences Low body temperature/cold intolerance Lanugo: fine body hairs Lower metabolism: low thyroid hormone Decreased heart rate Fatigue, fainting

16. AN: Physical Consequences Dry skin, hair Hair loss Iron deficiency anemia Increased infections

17. AN: Physical Consequences GI problems Bloating, abnormal fullness after eating Constipation Digestive enzymes low Refeeding → difficulties

18. AN: Physical Consequences Electrolyte imbalance → heart failure, death Low intake potassium Loss in vomiting, diuretics

19. Intervention Necessary if person falls below 75% of expected weight Loved ones confront them Multidisciplinary team Eating disorder clinic Gaining trust and cooperation of the patient

20. AN: Treatment Nutrition Increase food intake so to raise the BMR Prevent further weight loss Restore appropriate food habits Ultimately weight gain

21. AN: Treatment Psychological Cognitive behavior therapy Determine underlying emotional problems Reject the sense of accomplishment associated with weight loss Family therapy, support group

22. Bulimia Nervosa A psychological conflict; depression Low self esteem Preoccupied with food Involves episodes of bingeing followed by attempts to purge Recognize behavior is abnormal May not be diagnosed

23. Bulimia Nervosa 5% of college women 20% of college women exhibit symptoms (Sx) 50% of those with anorexia nervosa develop bulimia nervosa Gorging and purging/vomiting Susceptible populations—athletes, actors, dancers, wrestlers, runners

24. Profile of Bulimia Young (usually female) adults (college students) May be predisposed to becoming overweight Usually at or slightly above normal weight Tried frequent weight-reduction diets as a teen Impulsive Usually from disengaged families

25. Profile of Bulimia Hypergymnasia (excessive exercise) Guilt, depression, low self-esteem High food bills

26. Bulimia Nervosa Characterized by binge/purge cycle ≥ 2 binges/purge cycles in one week Uncontrollable eating during binge Purge regularly: vomiting, laxatives, diuretics, strict dieting, fasting, vigorous exercise Continues for ≥ 3 months

27. Binge Relieves stress 3000 or more calories within ½-2 hours Common binge foods: High carbohydrate, high fat Convenience foods Cakes, cookies, ice cream Soft, easier to purge

28. Purge Laxatives, enemas Act on large intestine 90% of calories are absorbed in small intestine Damages large intestine → constipation

29. Vomiting 33-75% of calories still absorbed Fingers down throat Damaged knuckles Syrup of Ipecac Toxic to heart, liver, kidneys Poison if taken repeatedly

30. Vomiting Teeth Stomach acid erodes enamel Pain, decay

31. Vomiting Salivary gland infections Stomach ulcers Esophageal/stomach ruptures Bleed to death Electrolyte imbalance Lost in vomiting Potassium loss →heart failure Death follows

32. Diuretics Water loss Electrolyte loss NO fat loss!

33. Vicious Cycle of Bulimia

34. Treatment of Anorexia and Bulimia Individual counseling Family therapy Medical supervision Nutritional intervention

35. Treatment of Bulimia Nervosa Decrease episodes of binge & purge Psychotherapy to improve self-acceptance Change the “all-or-none” attitude and misconceptions about food Correct misconceptions about food Establish good, normal eating habits Group therapy Possible anti-depressant drugs

36. Female Athlete Triad

37. Three Components Eating disorder Lack of menstrual periods Osteoporosis Bones like 60-year-old Caused by low estrogen Often irreversible Early warning: stress fractures

38. Female Athlete Triad Female athletes participating in appearance-based and endurance sports Seen in 15% swimmers, 62% gymnasts, and 32% of all other sport

39. Treatment for Female Athlete Triad Reduce preoccupation with food, weight, and body fat Increase meals and snacks gradually Rebuild body to healthy weight Establish regular menses Decrease training

40. Binge-Eating Disorder (Compulsive Overeating) Binge-eating episodes not accompanied by purging at least 2x/wk for 6 months Cannot control binges Eat more rapidly than usual Eat until uncomfortable Eat when not hungry Embarrassed, guilty after binge

41. Binge-Eating Disorder (Compulsive Overeating) Complex and serious eating disorder Occurs in ~30% -50% of subjects in weight control programs (40% are males) More common with obese individuals with history of restrictive dieting ~50% exhibit clinical depression Not preoccupied with body shape

42. Characteristics of a Binge-Eater Consider self as hungrier than normal Isolate self to eat large quantities Triggered by stress, depression, anxiety, loneliness, anger, frustration Usually binge on “junk” foods Eat without regards to biological need Food is used to reduce stress, provide feeling of power and well-being

43. Treatment for Binge- Eating Learn to eat in response to hunger Learn to eat in moderation Avoid restrictive diets which can intensify problems

44. Treatment for Binge- Eating Address hidden emotions Overeaters Anonymous Antidepressants

45. Baryophobia “The fear of becoming heavy” Children are given a low-fat, restricted diet in hopes to ward off obesity or heart disease Detrimental to children; affect growth and development Self-imposed restrictive diets by young adults to avoid obesity Lack of appropriate nutrition information

46. Treatment for Baryophobia Nutrition education Nutrition required for proper growth Appropriateness of sweets and fats in the diet

47. Dying To Be Thin Normal to be concerned about diet, health, and body weight Weight normally fluctuates Treat physical and emotional problems early Discourage restrictive diets Correct misconception about foods Thin is not necessary better

48. Prognosis Mortality has declined for AN from 10% to 2%. 20% to 30% will have a lifelong struggle with food Bulimics may need long-term counseling to correct underlying philosophies and beliefs. Family counseling is useful for both AN and bulimia.