eating dis. ch 23 ppt edited-1

7/26/2019 Eating Dis. Ch 23 PPT Edited-1

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Nutrition inNutrition inEating DisordersEating Disorders

Chapter 23Chapter 23

Elsevier items and derived items 2012, 2008, 2007 by Saunders, an imprint of Elsevier Inc.


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Eating DisordersEating Disorders

Debilitatin psyc!iatric illnessesDebilitatin psyc!iatric illnessesc!aracteri"ed by a persistent disturbance ofc!aracteri"ed by a persistent disturbance ofeatin !abits or #ei!t control be!aviorseatin !abits or #ei!t control be!aviors

$nore%ia nervosa$nore%ia nervosa &ulimia nervosa&ulimia nervosa

Eatin disorder not ot!er#ise specifiedEatin disorder not ot!er#ise specified

'ED()S*'ED()S* &ine+eatin disorder '&ED*&ine+eatin disorder '&ED*

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Diagnostic CriteriaDiagnostic Criteria

$merican syc!iatric $ssociation '$$*$merican syc!iatric $ssociation '$$*criteria are t!e standardcriteria are t!e standard

Dianostic and Statistical -anual 'DS-Dianostic and Statistical -anual 'DS-

/+I*/+I*



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Anorexia NervosaAnorexia Nervosa

$ disease c!aracteri"ed by$ disease c!aracteri"ed by

3 /efusal to maintain a minimally normal body/efusal to maintain a minimally normal body#ei!t#ei!t

3 &ody imae distortion&ody imae distortion

3 $menorr!ea in postmenarc!al females$menorr!ea in postmenarc!al females

-ay be one of t#o subtypes-ay be one of t#o subtypes

3 /estrictin/estrictin

3 &ine eatin and purin&ine eatin and purin



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Prevalence of Anorexia NervosaPrevalence of Anorexia Nervosa

0.5 to .75 of #omen6 rate is about one+0.5 to .75 of #omen6 rate is about one+tent! in mentent! in men

Initial presentation is usually durinInitial presentation is usually durin

adolescence or youn adult!oodadolescence or youn adult!ood

enetic, environmental, and psyc!osocialenetic, environmental, and psyc!osocialfactorsfactors

5 to 25 of patients die5 to 25 of patients die



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Psychological Features ofPsychological Features ofAnorexia NervosaAnorexia Nervosa

erfectionism and compulsivityerfectionism and compulsivity

9arm avoidance9arm avoidance

:eelins of ineffectiveness:eelins of ineffectiveness

Infle%ible t!in;inInfle%ible t!in;in

)verly restrained emotional e%pression)verly restrained emotional e%pression

or depression, dyst!ymia,an%iety disorders, obsessive+compulsivean%iety disorders, obsessive+compulsivedisorder, personality disorders, anddisorder, personality disorders, andsubstance abusesubstance abuse

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Bulimia NervosaBulimia Nervosa

=!aracteri"ed by repeated episodes of=!aracteri"ed by repeated episodes ofbine eatin follo#ed by inappropriatebine eatin follo#ed by inappropriatecompensatory be!aviors to prevent #ei!tcompensatory be!aviors to prevent #ei!tainain

3 Self+induced vomitin, la%atives misuse,Self+induced vomitin, la%atives misuse,diuretic misuse, compulsive e%ercise, or fastindiuretic misuse, compulsive e%ercise, or fastin

15 to 5 of adult #omen15 to 5 of adult #omen

&ine @ consumption of an unusually lare&ine @ consumption of an unusually lareamount of food in a discrete periodamount of food in a discrete period

syc!iatric comorbiditiessyc!iatric comorbidities



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Eating Disorder Not OtherwiseEating Disorder Not OtherwiseSecifiedSecified

$ dianostic cateory for eatin disorders$ dianostic cateory for eatin disorderst!at meet most, but not all, criteria for eit!ert!at meet most, but not all, criteria for eit!eranore%ia nervosa or bulimia nervosaanore%ia nervosa or bulimia nervosa



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Binge!Eating DisorderBinge!Eating Disorder

=!aracteri"ed by bine+eatin episodes at=!aracteri"ed by bine+eatin episodes atleast t#ice a #ee; for a ?+mont! periodleast t#ice a #ee; for a ?+mont! period

(o inappropriate compensatory be!aviors(o inappropriate compensatory be!aviors

after a bineafter a bine )ccurs in late adolescence)ccurs in late adolescence

Emotional distress and feelin ofEmotional distress and feelin of

po#erlessnesspo#erlessness

-ost are over#ei!t-ost are over#ei!t

(i!t eatin syndrome and sleep disorders(i!t eatin syndrome and sleep disorders

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Eating Disorders in ChildhoodEating Disorders in Childhood

Symptoms of c!ild!ood eatin disordersSymptoms of c!ild!ood eatin disordersun!ealt!y #ei!t control practices orun!ealt!y #ei!t control practices orobsessin over food and body #ei!tobsessin over food and body #ei!t

Barnin sins of a c!ild!ood or earlyBarnin sins of a c!ild!ood or earlyadolescent eatin disorder p!ysicaladolescent eatin disorder p!ysicalcomplaints 'e.., nausea* as #ell as foodcomplaints 'e.., nausea* as #ell as foodavoidance, self+induced vomitin, andavoidance, self+induced vomitin, and

e%cessive e%ercisine%cessive e%ercisin



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"reatment Aroach"reatment Aroach

-ultidisciplinary psyc!iatric or psyc!oloical,-ultidisciplinary psyc!iatric or psyc!oloical,medical, nutritionalmedical, nutritional

reatment includes inpatient !ospitali"ation,reatment includes inpatient !ospitali"ation,

residential treatment, day !ospitali"ation,residential treatment, day !ospitali"ation,intensive outpatient treatment, and outpatientintensive outpatient treatment, and outpatienttreatmenttreatment

Practice Guideline for the Treatment ofPractice Guideline for the Treatment ofPatients with Eating DisordersPatients with Eating Disorders



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Clinical Characteristics andClinical Characteristics and#edical Comlications#edical Comlications

$nore%ia nervosa$nore%ia nervosa3 =ac!ectic and prepubescent body !abitus=ac!ectic and prepubescent body !abitus

3


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Physical Signs and SymtomsPhysical Signs and Symtomsof Anorexia Nervosa and Bulimia Nervosaof Anorexia Nervosa and Bulimia Nervosa



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Clinical Characteristics and #edicalClinical Characteristics and #edicalComlications of Bulimia NervosaComlications of Bulimia Nervosa

Csually normal #ei!t and secretiveCsually normal #ei!t and secretivebe!aviorbe!avior

Sins of self+induced vomitin '/ussellsSins of self+induced vomitin '/ussells

sin*sin*

/esults of c!ronic vomitin can include/esults of c!ronic vomitin can includeesop!aus and stomac! damaeesop!aus and stomac! damae

Effects of la%ative and diuretic abuseEffects of la%ative and diuretic abuseinclude electrolyte imbalance and cardiacinclude electrolyte imbalance and cardiacarr!yt!miaarr!yt!mia



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Psychotheraeutic "reatmentPsychotheraeutic "reatment

oalsoals3 9elp patients understand and cooperate #it!9elp patients understand and cooperate #it!

nutritional and p!ysical re!abilitationnutritional and p!ysical re!abilitation

3 9elp patients understand and c!ane be!aviors9elp patients understand and c!ane be!aviorsand dysfunctional attitudesand dysfunctional attitudes

3 Improve interpersonal and social functioninImprove interpersonal and social functionin

3 $ddress psyc!opat!oloy and psyc!oloical$ddress psyc!opat!oloy and psyc!oloicalconflictsconflicts

&e!avioral reinforcers&e!avioral reinforcers syc!ot!erapy, conitive+be!avioralsyc!ot!erapy, conitive+be!avioral

t!erapy, family or marital t!erapyt!erapy, family or marital t!erapy

$ssessment instruments$ssessment instruments1Elsevier items and derived items 2012, 2008, 2007 by Saunders, an imprint of Elsevier Inc.


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Psychotheraeutic "reatmentPsychotheraeutic "reatment$cont%d&$cont%d&

reatment usually 1 year or morereatment usually 1 year or more

=ompared #it! anore%ia, bulimia patients=ompared #it! anore%ia, bulimia patientsare enerally more open to interventionare enerally more open to intervention

Depression, separation an%iety, andDepression, separation an%iety, andenerali"ed an%iety must also be treatedenerali"ed an%iety must also be treated

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Nutrition AssessmentNutrition Assessment

Diet !istoryDiet !istory3 )ver+ and underreportin)ver+ and underreportin

3 =alories retained from bines=alories retained from bines

3 Specific dietary practices and c!aotic eatinSpecific dietary practices and c!aotic eatin

3 (utritional adeuacy(utritional adeuacy

Eatin be!aviorEatin be!avior

3 :ood aversions:ood aversions

3 Cnusual or ritualistic be!aviorsCnusual or ritualistic be!aviors

3 rier foodsrier foods



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Nutrition Assessment $cont%d&Nutrition Assessment $cont%d&


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Nutrition Counseling in theNutrition Counseling in theContinuum of CareContinuum of Care

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#edical Nutrition "heray and#edical Nutrition "heray andCounseling' Anorexia NervosaCounseling' Anorexia Nervosa

=orrect bioloical and psyc!oloical=orrect bioloical and psyc!oloicalseuelae of malnutritionseuelae of malnutrition

/estore body #ei!t/estore body #ei!t

(ormali"e eatin patterns(ormali"e eatin patterns

(ormali"e !uner or satiety cues(ormali"e !uner or satiety cues



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$cont%d&$cont%d&

9ospitali"e #!en patient is medically unstable,9ospitali"e #!en patient is medically unstable,severely malnouris!ed, or ro#t! retardedseverely malnouris!ed, or ro#t! retarded

Institutional protocols patient participation in menuInstitutional protocols patient participation in menuplannin and meal plannin approac!esplannin and meal plannin approac!es

)utpatient /Ds counselin s;ills are important)utpatient /Ds counselin s;ills are important

-ost patients are precontemplative-ost patients are precontemplative

/easonable #ei!t+ain oals 2 to lbF#ee; for/easonable #ei!t+ain oals 2 to lbF#ee; forinpatient6 0. to 1 lbF#ee; for outpatientinpatient6 0. to 1 lbF#ee; for outpatient



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$cont%d&$cont%d& roressive increase in caloric prescription G100roressive increase in caloric prescription G100

to 200 ;cal every 2 to daysto 200 ;cal every 2 to days

$ressive refeedin of severely malnouris!ed$ressive refeedin of severely malnouris!edanore%ia patients 'H705 standard body #ei!t*6anore%ia patients 'H705 standard body #ei!t*6care to avoid refeedin syndromecare to avoid refeedin syndrome

-ay need 000 to 4000 ;calFday to ac!ieve oal-ay need 000 to 4000 ;calFday to ac!ieve oal#ei!t#ei!t

Inta;e of macronutrients and micronutrientsInta;e of macronutrients and micronutrients

Cse of snac;s and supplementsCse of snac;s and supplements



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#edical Nutrition "heray and#edical Nutrition "heray andCounseling' Bulimia NervosaCounseling' Bulimia Nervosa

/easonable plan of controlled eatin/easonable plan of controlled eatin

)utpatient counselin)utpatient counselin

Interrupt bine+and+pure cycle, restore normalInterrupt bine+and+pure cycle, restore normal

eatin be!avior, and stabili"e body #ei!teatin be!avior, and stabili"e body #ei!t $ssessment of enery needs$ssessment of enery needs

-acronutrient and micronutrient inta;e-acronutrient and micronutrient inta;e

/estoration of !uner and satiety cues/estoration of !uner and satiety cues =onitive+be!avioral t!erapy=onitive+be!avioral t!erapy

Staes of readiness to c!aneStaes of readiness to c!ane



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#edical Nutrition "heray and#edical Nutrition "heray andCounseling' Binge!EatingCounseling' Binge!Eating

DisorderDisorder (utrition counselin and dietary(utrition counselin and dietary

manaementmanaement

Individual and roup psyc!ot!erapyIndividual and roup psyc!ot!erapy

-edication-edication

oals self+acceptance, improved bodyoals self+acceptance, improved bodyimae, increased p!ysical activity, betterimae, increased p!ysical activity, betteroverall nutritionoverall nutrition



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"oics for Nutrition Education"oics for Nutrition Education

Impact of malnutrition on ro#t! andImpact of malnutrition on ro#t! anddevelopmentdevelopment

Impact of malnutrition on be!aviorImpact of malnutrition on be!avior

Set+point t!eorySet+point t!eory

-etabolic adaptation to dietin-etabolic adaptation to dietin

/estrained eatin and disin!ibition/estrained eatin and disin!ibition

=auses of binin and purin=auses of binin and purin

B!at does #ei!t ainJ meanKB!at does #ei!t ainJ meanK



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"oics for Nutrition Education"oics for Nutrition Education$cont%d&$cont%d&

Impact of e%ercise on caloric e%penditureImpact of e%ercise on caloric e%penditure Ineffectiveness of vomitin, la%atives, andIneffectiveness of vomitin, la%atives, and

diuretics in lon+term #ei!t controldiuretics in lon+term #ei!t control

ortion controlortion control

:ood e%c!ane system:ood e%c!ane system

Social dinin and !oliday dininSocial dinin and !oliday dinin

-yyramid-yyramid

9uner and satiety cues9uner and satiety cues Interpretin food labelsInterpretin food labels

(utrition misinformation(utrition misinformation

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PrognosisPrognosis

/elapse in anore%ia up to 05 of patients/elapse in anore%ia up to 05 of patientsreuire re!ospitali"ationreuire re!ospitali"ation

Endurin morbid food and #ei!tEndurin morbid food and #ei!t

preoccupationpreoccupation )utcomes are better in youner patients)utcomes are better in youner patients

9i! mortality rates associated #it!9i! mortality rates associated #it!

anore%iaanore%ia /elapse in bulimia/elapse in bulimia



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Focal PointsFocal Points

$nore%ia nervosa and bulimia nervosa must be understood$nore%ia nervosa and bulimia nervosa must be understoodand appreciated as potentially c!ronic disordersand appreciated as potentially c!ronic disordersc!aracteri"ed by periods of relapse.c!aracteri"ed by periods of relapse.

/efeedin in eatin disorders reuires t!e collaborative effort/efeedin in eatin disorders reuires t!e collaborative effortof medical and mental !eat! professionals #it! t!e supportof medical and mental !eat! professionals #it! t!e supportof friends and family.of friends and family.

(utrition re!abilitation can correct some 'i.e., !ypometabolic(utrition re!abilitation can correct some 'i.e., !ypometabolicstate, vital sin instability* but not all 'oran mass, bonestate, vital sin instability* but not all 'oran mass, bonemass, and ro#t!* of t!e pat!op!ysioloic conseuences ofmass, and ro#t!* of t!e pat!op!ysioloic conseuences ofmalnutrition in eatin disorders.malnutrition in eatin disorders.

Successful lon+term treatment can ta;e years, and t!eSuccessful lon+term treatment can ta;e years, and t!ee%pectation of a uic; cure s!ould be dispelled.e%pectation of a uic; cure s!ould be dispelled.

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eating dis. ch 23 ppt edited-1

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