Quiz Study Guide 3 10 EATING DISORDERS Types of Eating Disorders o Anorexia Nervosa Highest mortality rate Die of malnutrition Characteristics Fear of weight gain Weight loss Disturbed perception of body size and weight Amenorrhea in females Denial of the problem Diagnosis Weight 85 of expected for age and height Range of severity BMI of 17 5 Psychological Characteristics Depression irritability withdrawal o Signs of malnutrition 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 Affects on Body Brain can t think right fear of gaining weight sad moody irritable bad memory fainting changes in brain chemistry Hair gets thin and brittle Heart low blood pressure slow heart rate heart palpitations heart failure Blood anemia other blood problems Muscles Joints Bones weak muscles swollen joints bone loss fractures osteoporosis Kidneys kidney stones kidney failure Body Fluids low potassium magnesium sodium Hormones amenorrhea problems growing trouble getting Intestines constipation bloating pregnant o If pregnant higher risk for miscarriage C section baby with low birth weight and post partum depression Skin bruise easily dry skin growth of fine hair all over body cold easily yellow skin nails get brittle o Bulimia Nervosa binge purge syndrome Characteristics Recurrent episodes of binge eating Feeling lack of control during the binge Episodes of purging which includes self induced vomiting fasting exercise diuretics and laxatives Persistent over concern with body shape and weight Range of severity Affects on Body Brain depression fear of gaining weight anxiety dizziness shame low self esteem Cheeks swelling soreness Mouth cavities tooth enamel erosion gum disease teeth sensitive to temperature Throat Esophagus sore irritated can tear and rupture blood in vomit Muscles fatigue Blood anemia Heart irregular heart beat heart muscle weakened heart Stomach ulcers pain can rupture delayed emptying failure low pulse and blood pressure Body fluids dehydration low potassium magnesium and sodium o Heart doesn t have enough sodium and potassium die of cardiac arrest Kidneys problems from diuretic abuse Intestines constipation irregular bowel movements bloating diarrhea abdominal cramping Hormones irregular or absent period Psychological Characteristics Feel controlled by food Feeling of being alone in a crowd Obsessive thoughts Loss of control once binge begins Very high expectations of self people pleaser Must later undo via binge purge o Binge Eating Disorder BED Compulsive Overeating Characteristics Frequent and sustained regular intake of an objectively large amount of food with an associated sense of loss of control over eating o Night Eating Syndrome NES Increased appetite at night Insomnia Lack of or decreased appetite during the day Evening hyperphagia excessive appetite Nocturnal eating Tense anxious worried or guilty while eating Craving carbohydrate rich foods May be disordered stress response o Eating Disorder Not Otherwise Specified EDNOS Disorders of eating that do not meet the clinical diagnosis criteria for any specific eating disorder Too many conflicting symptoms to call it one or the other Example anorexia but purging Individuals may present with a mixture of symptoms from more than one category Eating disorders often go along with substance abuse history of child abuse and PTSD Female Athlete Triad o Three conditions seen in female athletes 1 Amenorrhea 2 Osteoporosis 3 Disordered eating o Behaviors may include caloric restriction fasting vomiting diet pills laxatives diuretics and nutritional supplements that claim to burn fat o Prevalence Etiology Etiology may stem from belief that leanness will improve athletic Can be a result from pressure from coaches parents and or self performance imposed Prevalence more common in adolescent girls and young adult athletes in individual sports At risk participants in gymnastics ballet dancing figure skating long distance running cross country skiing swimming and wrestling The Adolescent Patient o Eating disorders are the 3rd most common chronic illness in adolescent females o Drastic increase in prevalence o Irreversible health effects o Special skills required in treatment of teens o Highly influenced by peers media and family Eating Disorders Among Males o Markers of male eating disorders include Being fat overweight during childhood Dieting Competing in a sport that requires a thin participant runners jockeys wrestlers swimmers body builders Having a job that demands thinness model actor entertainer Placing emphasis on physical appearance Having a sensitivity to cultural pressures to fit standards that are unattainable for most Treatment approaches for ED The Treatment Team o Nutrition Therapist as a member of the Treatment Team Medicine Psychiatry Psychotherapy Nutrition Dental o Family component for adolescent patient Cognitive Behavioral Therapy o Gold Standard Best researched Frequently successful approach o Best therapy for those with ED as the primary disorder o Semi structured problem oriented present focus o Psycho education Effects of binge eating adverse effects of dieting food choices normal eating patterns hunger signals not a threat o Teach self monitoring techniques Gathering information behavior food More adaptive coping mechanisms o Discourage calorie counting unethical o Generate list of alternative behaviors Identification of precipitants underlying thoughts and feelings Food as a way to modulate emotions a self soothing mechanism Build repertoire of things the patient really likes to do that are self find alternatives pleasing without food o Normalize eating patterns Prescription of 3 4 planned regular meals eating occasions 11 ENERGY BALANCE BODY COMPOSITION AND OBESITY Energy Balance o Positive Energy Balance weight gain o Negative Energy Balance weight loss o Energy Equilibrium stable weight Bomb calorimeter substances as fuel and food Regulation of Energy Intake EI external cues which may be overridden used to determine the heat of combustion kcal of such complex interaction between internal and physiological response to a need for food o Internal Cues Hunger Satiation Satiety Appetite Influence on Internal Cues Diet composition feeling of fullness satisfaction determines interval between meals psychological desire to eat o Satiation high fiber slow down gastric emptying water Fat provides