Eating Disorders

The Ideal Body Image

Media promotion

Social acceptance

Influence and stress on young individuals

The Paradox of Food Addiction

Eating is a necessity

Dieting to become thin may lead to a disorder

Food: More Than Just Nutrients

Linked to personal emotions

Comfort

Release of natural opioids

Reward

Genetic Link?

Identical twins have a higher chance of eating disorders

Fraternal twins are less likely

Anorexia NervosaExtreme weight lossPerceived body imageDesire for acceptancePsychological conflict and depressionLack of appropriate coping mechanismIntense fear of obesity and weight gainBegins with a simple diet and leads to semistarvationDenial of hunger

Profile of AnorexiaUsually occurs between the ages of 12-18

Typically white female

5%-10% are male

Middle-upper socioeconomic class

Perfectionist, competitive, obsessiveParental standards highCritical of self and others

Anorexia Nervosa

Believes food avoidance is achievement

Control in life

Refuses to accept problem exists

Resists treatment

Equates “goodness” with low food intake

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

Anorexia Nervosa

Food ritualsCuts food in small piecesRearranges food on plate

Eliminates foods gradually300-600 calories a dayDiet pop, sugarless gum

Prolonged exercise

Risk Periods for Anorexia Nervosa

Age 14 – puberty, high school

Age 18 – college, full time jobs

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

AN Diagnostic Criteria

Weight <85% standard

Intense fear weight gain/fat

Distorted body image

Women: miss 3 consecutive periods

AN: Physical Consequences

Low body temperature/cold intolerance

Lanugo: fine body hairs

Lower metabolism: low thyroid hormone

Decreased heart rateFatigue, fainting

AN: Physical Consequences

Dry skin, hair

Hair loss

Iron deficiency anemia

Increased infections

AN: Physical Consequences

GI problemsBloating, abnormal fullness after

eatingConstipationDigestive enzymes low

Refeeding → difficulties

AN: Physical Consequences

Electrolyte imbalance → heart failure, deathLow intake potassiumLoss in vomiting, diuretics

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

AN: Treatment

NutritionIncrease food intake so to raise the BMRPrevent further weight lossRestore appropriate food habitsUltimately weight gain

AN: Treatment

PsychologicalCognitive behavior therapy

Determine underlying emotional problems

Reject the sense of accomplishment associated with weight loss

Family therapy, support group

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

Bulimia Nervosa5% 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

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

Profile of BulimiaHypergymnasia (excessive exercise)

Guilt, depression, low self-esteem

High food bills

Bulimia Nervosa

Characterized by binge/purge cycle

≥ 2 binges/purge cycles in one weekUncontrollable eating during bingePurge regularly: vomiting, laxatives,

diuretics, strict dieting, fasting, vigorous exercise

Continues for ≥ 3 months

Binge

Relieves stress

3000 or more calories within ½-2 hours

Common binge foods:High carbohydrate, high fatConvenience foodsCakes, cookies, ice creamSoft, easier to purge

Purge

Laxatives, enemasAct on large intestine90% of calories are absorbed in small

intestineDamages large intestine → constipation

Vomiting

33-75% of calories still absorbed

Fingers down throat Damaged knuckles

Syrup of IpecacToxic to heart, liver, kidneysPoison if taken repeatedly

VomitingTeethStomach acid erodes enamelPain, decay

Vomiting

Salivary gland infections

Stomach ulcers

Esophageal/stomach rupturesBleed to death

Electrolyte imbalanceLost in vomitingPotassium loss→heart failureDeath follows

Diuretics

Water loss

Electrolyte loss

NO fat loss!

Vicious Cycle of Bulimia

Treatment of Anorexia and Bulimia

Individual counseling

Family therapy

Medical supervision

Nutritional intervention

Treatment of Bulimia Nervosa

Decrease episodes of binge & purgePsychotherapy to improve self-acceptanceChange the “all-or-none” attitude and misconceptions about foodCorrect misconceptions about foodEstablish good, normal eating habitsGroup therapy Possible anti-depressant drugs

Female Athlete Triad

Three Components

Eating disorder

Lack of menstrual periods

OsteoporosisBones like 60-year-oldCaused by low estrogenOften irreversibleEarly warning: stress fractures

Female Athlete TriadFemale athletes participating in appearance-based and endurance sports

Seen in 15% swimmers, 62% gymnasts, and 32% of all other sport

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

Binge-Eating Disorder (Compulsive Overeating)Binge-eating episodes not accompanied by purging at least 2x/wk for 6 monthsCannot control bingesEat more rapidly than usualEat until uncomfortableEat when not hungryEmbarrassed, guilty after binge

Binge-Eating Disorder (Compulsive Overeating)Complex and serious eating disorderOccurs 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 depressionNot preoccupied with body shape

Characteristics of a Binge-Eater

Consider self as hungrier than normalIsolate self to eat large quantitiesTriggered by stress, depression, anxiety, loneliness, anger, frustrationUsually binge on “junk” foodsEat without regards to biological needFood is used to reduce stress, provide feeling of power and well-being

Treatment for Binge-Eating

Learn to eat in response to hunger

Learn to eat in moderation

Avoid restrictive diets which can intensify problems

Treatment for Binge-Eating

Address hidden emotions

Overeaters Anonymous

Antidepressants

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

Treatment for Baryophobia

Nutrition education

Nutrition required for proper growth

Appropriateness of sweets and fats in the diet

Dying To Be Thin

Normal to be concerned about diet, health, and body weightWeight normally fluctuates Treat physical and emotional problems earlyDiscourage restrictive dietsCorrect misconception about foodsThin is not necessary better

PrognosisMortality 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.