Energy Balance and Eating Disorders Regulation of food intake Body attempts to closely regulate intake to maintain energy balance Hunger physiological need for food Appetite psychological desire to eat Satiation feeling full Satiety long term fullness Dietary Composition Protein Fat Carbohydrate protein gives stronger satiety Fiber content Energy Density high fat low fiber Liquid vs solid liquids have lower satiety GI and Neurological Factors Response to food in mouth and stomach Gherlin hunger hormone Leptin satiety hormone Energy Out Total Energy Expenditure Resting Energy Expenditure REE Basal Metabolism Energy for basic body functions Affected by body size composition age gender activity level emotions Physical Activity PA Affected by Thermic Effect of Food TEF Energy for body size fitness and activity level Digestion absorption metabolism Highest for protein Lowest for fat Physical activity and energy balance Estimated Energy Expenditure Predicts total energy expenditure TEE Used to determined DRI for energy intake Equation estimates for men and women include Age PA Weight Height Measures of Energy Expenditure Calorimetry Direct Indirect Measure body s heat production to calculate energy expenditure Calculates energy expenditure from the respiratory exchange ratio of CO2 and O2 Body Mass Index BMI A composite number used to define overall obesity Weight kg height2 m Fatness vs Weight Height weight tables Body mass index BMI Assessing body fatness Densitometry DEXA Body fat distribution Waist circumference Android central obesity worse Gynoid fat around hip thighs Weight Gain and Obesity Weight reduction decreases fat cell size but not cell number Prevention is key once fat is gained it is more difficult to lose A pound of fat is 3 500 calories Obesity is a chronic illness requiring long term prevention and management Underweight Definition BMI 18 5 kg m2 Weight gain strategies Small frequent meals Fluids between meals High calorie foods and beverages Weight Cycling A pattern of losing and regaining weight repeatedly This behavior can be harmful low HDL impaired immune system hypertension even harder on the body than overweight itself For obese people the potential benefits of weight loss may outweigh the potential risks of weight cycling Prescription and OTC drugs Prescribed short term need diet change many side effects Cognitive Behavioral Therapy CBT Helps cope with stress and emotions Impact on eating behavior A Antecedents triggers B Behavior overeating C Consequences desirable or not Examples for therapy A change cues that trigger overeating B positive self talk avoid excuses and rationalizations C create positive consequences Surgery Banding Bypass Band to reduce stomach size Staples to bypass stomach and duodenum Alternate route carries food directly into jejunum Take Home Messages Energy balance Relationship between energy input and output Food intake regulators Hunger satiety and appetite Influenced by complex factors GI CNS etc Major components of energy expenditure Resting basal energy expenditure largest component Factors that increase or decrease REE or BMR Thermic effect of food Energy from physical activity Factors that influence resting metabolism Body composition age gender and hormones BMI overall body fatness Ratio of body weight and height Correlates with total body fatness Risk of chronic disease BMI classification normal BMI 18 25 kg m2 Central obesity waist circumference Android high health risk Gynoid Weight gain and obesity factors Increased food intake portion size Excess calories consumed Types of Eating Disorders Anorexia Nervosa Characteristics Weight loss Fear of weight gain Disturbed perception of body size and weight Amenorrhea in females Denial of the problem Anorexia Diagnosis Weight less than 85 of expected for age and height Children and young adults 20 percent of average weight for height calculated using CDC growth charts BMI less than the 5th percentile are at risk for AN Anorexia Nervosa Psychological Characteristics Depression irritability withdrawal Peculiar behaviors such as Compulsive rituals Strange eating habits Division of foods into good safe and bad dangerous categories Obsession with weight frequent talk of food Bulimia Nervosa binge purge syndrome Recurrent episodes of binge eating Feeling of lack of control during the binge Episodes of purging which may includes any compensatory behavior self induced vomiting fasting exercise diuretics laxatives Persistent over concern with body shape and weight Bulimia Psychological Characteristics Feel controlled by food Obsessive thoughts Feeling of being alone in a crowd Loss of control once binge begins Very high expectations of self people pleaser Must later undo via binge purge Prognosis Bulimia Tends to develop in later teens Less focus on family issues May take 1 years to become a set behavior pattern choice may be gone In some studies 20 25 recover may be chronic when under stress Shame based illness many unable to seek treatment Prevalence of Anorexia and Bulimia In general population 1 of girls age 10 20 years have anorexia Recent survey indicated that 20 of college age students have or have had an ED bulimia 50 of women with a history of anorexia will develop symptoms of Binge Eating Disorder BED or Compulsive Overeating Frequent and sustained regular intake of an objectively large amount of food with an associated sense of loss of control over eating Individuals may present with a mixture of symptoms from more than one category Binge Eating Disorder BED Episodic binge eating vs BED Distinction is psychological state Occurs frequently with other psychiatric disorders BED more prevalent in women than men Night Eating Syndrome NES Lack of or decreased appetite during the day Increased appetite at night Insomnia Evening hyperphagia nocturnal eating eat after having gone to bed Tense anxious worried or guilty while eating Craving carbohydrate rich foods May be disordered stress response 1 Female Athlete Triad Amenorrhea Osteoporosis Disordered eating Behaviors may include caloric restriction fasting vomiting diet pills laxatives diuretics and nutritional supplements that claim to burn fats Prevalence More common in adolescent girls and young adult athletes I n individual sports At risk participants in gymnastics ballet dancing figure skating long distance running cross country skiing swimming and wrestling ED Treatment Team Psychological Aspects Functions of the team Model