Nutrition Lecture Notes QUIZ 3 2 24 14 EATING DISORDERS Eat but stay thin Ideal shapes Eat all the food we want but stay thin Women were beautiful as curvaceous now skinny Avg size 14 Anorexia nervosa Characteristics Fear of weight gain Weight loss Disturbed perception of body size and weight Denial of the problem Amenorrhea in females removed from criteria in DSM 5 Diagnosis Weight 85 for expected age and height Adults 20 yrs a BMI or equal to 17 5 Children and adults 20 perfect of avg weight for height calculated using CDC growth charts BMI 5th percentile at risk for AN DSM 5 includes severity rating Psychological characteristics Depression irritability withdrawal Peculiar behaviors Compulsive rituals Strange eating habits Division of foods into good safe and bad dangerous categories Obsession with weight frequent talk of food Vegetarian Talk endlessly about supplements and powders Whole body affected Stop menstruating Hair thins brittle Weak muscles swollen joints bone loss Anemia blood problems Low potassium magnesium sodium Kidney stones failure Bruise easily dry skin growth of fine hair all over body weakened immune system brittle nails Swollen joints bone loss fractures osteoporosis very serious Hair loss Bulimia nervosa binge purge syndrome Characteristics Recurrent episodes of binge eating Feeling lack of control during binge Episodes of purging which may include compensatory behavior self induced vomiting fasting incessant exercise diuretics laxatives persistant over concern with body shape and weight DSM 5 includes severity rating Whole body affected Esophagus damaged due to stomach acid exposure Dental decay carries due to stomach acid Muscle fatigue Diuretics cause kidney problems Problems in kidneys from diuretics abuse Constipation IBS bloating diarrhea abdominal cramping Irregular absent period Abrasion of knuckles from gagging dry skin Cardiac arrest often due to lack of stomach acid chemicals affecting whole body Psychological characteristics Feel controlled by food Obsessive thoughts High expectations of self Must later undo binge purge Feeling of being alone Loss of control once binge begins Prognosis Less focus on family issues Develops in later teens 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 Binge eating disorder BED Compulsive overeating Definition Frequent and sustained regular intake of an objectively large amount of food with an associated sense of loss of control over eating May present with a mixture of symptoms from more than one category Physiological symptoms Anxiety Lonliness Depression stress Binge Eating Disorder BED episodic binge eating vs BED sub threshold BED Occurs frequently with other psychiatric disorders More men than women in episodic overeating category Often neurochemical basis to BED that don t respond to dietary counseling and BED more prevalent in women than men therapy 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 ancious worried or guilty while eating Craving carbohydrate rich foods May be disordered stress response Eating disorder not otherwise specified EDNOS Disorders of eating that do not meet the clinical diagnosis criteria for any specific eatind disorder ADA Prevalence largely unknown due to varying nature of disease Co existing issues Women with ED are 5x more likely to abuse alcohol and drugs Those are 11 x more likely to have ED 20 50 of women with ED have history fo trauma Depression anxiety personality disorders co exist Negative emotion translated into feeling fat Female athlete triad 3 conditions Amenorrhea no period Osteoporosis bone loss Disordered eating Behaviors inclue caloric restriction fasting vomiting diet pills laxatives diuretics nutritional supplements that claim to burn fat s Prevalence and etiology Etiology may stem from believe that leanness will improve athletic performance Can be result of pressure from coaches parents self imposed Prevalence more common in adolescent girls and young adult atheletes in individual sports At risk participants in gymnastics figure skating ballet long distance running cross country skiing swimming wrestling The adolescent patient ED 3rd most common chronic illness in adolescent females Dramatic increase in prevalence Hospitalizations due to eating disorders in children under 12 119 btw 99 06 DSM criteria may not be applicable Irreversible health effects Special skills required in treatment of teens Highly influenced by media peers families Eating disorders among males Markers of male eating disorders include Being fat or overweight during childhood Dieting to most Competing in a sport that req s thin participant runners jockeys wrestelers swimmers body builders Having a job that demands thinness male models actors entertainers Placing emphasis on physical appearance Having a sensitivity to cultureal pressures to fit standards that are unattainable Compultive weightlifting consumption of expensive bulking up substances use of anabolis steroids increased Some research on predictors of success in treatment Little investigation into natural recovery self cure or remission o fEDs w o treatment Going to the gym 1 hr a day Causes of ED Interaction among Genetic Social Psychological ED treatment Nutrition therapist key member of treatment team Treatment team Medicine Psychiatry Psychotherapy Nutrition dental family component for adolescent patient psychological aspects functions history reduce splitting coordinate care effectively language of eating disorders what are patients trying to say learning to say what she means cognitive behavioral therapy gold standard best researched frequently successful approach model fxnl communication child did not receive in developmental best therapy for those with ED as the primary disorder semi structured problem oriented present focus exclusion criteria acute sucidiality major affective disorder medical instability inadequate motivation psychoeducation effects of binge eating adverse effects of dieting food choices normal eating patterns hunger signals teach self monitoring techniques gathering info behavior food identification of precipitants underlying thoughts and feelings more adaptive coping mechanisms discourage calorie counting generate list of alternative