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Post on 22-Dec-2015
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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
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
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
Vomiting
Salivary gland infections
Stomach ulcers
Esophageal/stomach rupturesBleed to death
Electrolyte imbalanceLost in vomitingPotassium loss→heart failureDeath follows
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
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
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