1. Judith E. Brown Prof. Albia Dugger Miami-Dade College www.cengage.com/nutrition/brown Disordered Eating: Anorexia Nervosa, Bulimia, and Pica Unit 11

2. The Eating Disorders Symptoms of disordered eating: Self-imposed starvation Feast and famine cycles Binge eating Purging Regular consumption of nonfood substances

3. Key Terms Purging The use of self-induced vomiting, laxatives, or diuretics (water pills) to prevent weight gain

4. The Eating Disorders Four types of disordered eating: 1. Anorexia nervosa 2. Bulimia nervosa 3. Binge-eating disorder 4. Pica

5. Anorexia Nervosa Individuals with anorexia nervosa starve themselves – no matter how emaciated they are, they never feel thin enough Anorexia nervosa An eating disorder characterized by extreme weight loss, poor body image, and irrational fears of weight gain and obesity

6. Anorexia Nervosa People with anorexia nervosa eat less than 1200 calories a day (below: 562 calories)

7. Anorexia Nervosa Health effects of anorexia nervosa Dry skin Low or irregular heartbeat Low blood pressure Osteoporosis Infertility Women: irregular menstrual cycles

8. Anorexia Nervosa 90% of people with anorexia nervosa are women

9. Female Athlete Triad Three problems occur together in young female athletes with low caloric intakes: Eating disorders that lower estrogen levels Menstrual cycle dysfunction Decreased bone mineral density

10. Motivation Behind Anorexia Nervosa Overwhelming desire to be thin drives people with anorexia nervosa to refuse to eat, and to exercise intensely Preoccupation with food Low self esteem Social isolation Unhappiness

11. Motivation Behind Anorexia Nervosa Half of the people with anorexia nervosa turn to binge-eating and purging to lose weight Binge-eating Consumption of a large amount of food in a short period of time

12. What Causes Anorexia Nervosa? Many different psychological and biological causes may predispose an individual to become anorexic Western society’s expectations of acceptable body weight and shape contribute to low self esteem

13. Conforming to Expectations

14. How Common is Anorexia Nervosa? In Western societies: 1% of adolescent and young women 0.1% of young males Certain groups are at higher risk

15. Treatment for Anorexia Nervosa Few people with anorexia believe they are underweight or need help Generally takes 5 to 7 years of professional help to correct, or partially correct Nutrition and psychological counseling 50% success 3% die within 8 years

16. Features of Anorexia Nervosa

17. Bulimia Nervosa Bulimia nervosa Characterized by cycles of dieting and episodes of rapid, uncontrolled eating of large amounts of food in a short time (bingeing) Episodes of binge eating are often followed by purging (vomiting, laxatives, diuretics, enemas) and sometimes exercise

18. Bulimia Nervosa: Binge Eating

19. Bulimia Nervosa Characteristics: Preoccupied with eating and weight Tend to be normal weight or overweight Is more common in young athletes, along with anorexia nervosa Major changes in metabolism Teeth may be eroded by stomach acid

20. Bulimia Nervosa Associated with depression, abnormal food- intake mechanisms, feast-and-famine cycles Restrained eating Purposeful restriction of food intake below desired amounts to control body weight Deprivation and hunger may trigger binge eating

21. Treating Bulimia Nervosa Break feast-and-famine cycles via nutrition and psychological counseling Regular eating reduces urge to binge Improve self esteem and body image May include antidepressant medication 1/3 relapse within 7 years

22. Features of Bulimia Nervosa

23. Binge-Eating Disorder Binge-eating disorder Characterized by periodic binge eating, not followed by purging or excess exercise Average two binges per week for 6 months Tend to be overweight or obese Affects males and females equally

24. Binge-Eating Disorder Associated with: Stress, depression, anxiety 30-90% of obese people 9-30% of people in weight-control programs Aggregates in families Genetic and environmental origins

25. Treating Binge-Eating Disorder Nutrition and therapy sessions focus on disordered eating and psychological issues Record food intake, feelings, circumstances Identify triggers and behaviors to avoid them Counseling on normal eating, hunger cues, and meal planning

26. Binge-Eating Disorder Food Diary

27. Features of Binge-Eating Disorder Treatment is successful in 85% of women treated for binge-eating disorder

28. Resources for Eating Disorders Primary care physicians, dieticians, or nurse practitioners can help find a health care team that specializes in treatments of eating disorders Support groups Treatment centers Hotlines

29. Undieting: Clash Between Culture and Biology Unhealthfully thin body shapes portrayed by models and other popular ideals can lead normal adults to weight dissatisfaction Acceptance of healthy body weight and shape is important to prevent anorexia nervosa, bulimia nervosa, and binge-eating

30. Movement Toward Size Acceptance

31. Pica Pica has been observed in many cultures since ancient times Pica Regular consumption of nonfood substances such as clay or laundry starch Mostly in young children and pregnant women

32. Forms of Pica Geophagia (clay or dirt eating) Craving for taste or smell May relieve nausea Associated with iron deficiency and sickle-cell anemia Problems: Blockage of intestinal tract Parasitic and bacterial infections

33. Forms of Pica Pagophagia (ice eating) Associated with iron deficiency Common during pregnancy

34. Forms of Pica Amylophagia (laundry starch or cornstarch eating) Carbohydrate, sweet taste, provides calories Associated with pregnancy Problems: May reduce intake of nutrient-dense foods May contain contaminants

35. Forms of Pica Plumbism (lead eating) Primarily from paint flakes in old houses Major cause of lead poisoning in young children Lead poisoning Causes mental retardation, death 1.4% of young US children have elevated lead levels

36. Plumbism

37. Some Nonfoods Eaten

38. Other Abnormal Patterns Proposed eating disorders: Nighttime eating syndrome Compulsive overeating Purging disorder Restrained eating Orthorexia nervosa