ObesityEpidemiology of ObesityKey Prevalence FactsPowerPoint PresentationSlide 5Slide 6Slide 7Energy Balance Model of ObesityEnergy Balance Conceptualization of ObesityAssessment of ObesityMedical Treatments for ObesityPsychological Treatments for ObesityEvolution of Behavioral Treatments for ObesityCognitive-Behavioral Treatments for ObesityLimitations of Behavioral Treatment ResearchImproving Long-term Weight LossBulimia NervosaDiagnostic FeaturesEssential Features of Binge EatingEpidemiology of Bulimia NervosaSlide 21Stice Dual Pathway ModelRisk Factors for BulimiaSlide 24Slide 25Slide 26Slide 27Slide 28Slide 29Slide 30Pharmacotherapy for Bulimia NervosaSlide 32Slide 33Cognitive Model of BulimiaRestraint Theory (Herman & Polivy, 1985)Types of DisinhibitorsCognitive-Behavioral Treatments for BulimiaControlled Outcome Studies for BulimiaAgras et al (2000)Agras et al (2000) Study OverviewAgras et al (20000 Intent-to-Treat FindingsModerators of Treatment OutcomeBinge Eating DisorderDiagnostic Features of Binge Eating DisorderEpidemiology of Binge Eating DisorderAssociated Features of Binge Eating DisorderCBT for Binge Eating DisorderProcedural Components of CBT for Binge Eating DisorderControlled Outcome Studies for Binge Eating DisorderC.Telch et al (1990)Wifley et al (1993)Agras et al (1993)Slide 53DBT Treatment of Binge Eating Disorder01/14/19 Eating Disorders 1Obesity01/14/19 Eating Disorders 2Epidemiology of Obesity•Definition/Prevalence•Medical Complications•Social and Psychological Consequences01/14/19 Eating Disorders 3Key Prevalence Facts•Overall rate of obesity is 34.8%•Rates have risen significantly (25.4 vs 34.8)•Overall men and women do not differ much (men 33.7-women 35.9)•Rates increase with age up to age 64 and then decline•Rates significantly higher among black and Hispanic females (see table)01/14/19 Eating Disorders 4Acrobat Document01/14/19 Eating Disorders 5Epidemiology of Obesity•Medical complications:–Increases risk for•Heart disease and stroke•Certain forms of cancer•Diabetes–Contributes to other known risk factors•Elevated serum cholesterol•Hypertension•Physical inactivity01/14/19 Eating Disorders 6Epidemiology of Obesity•Social and psychological consequences–Social prejudice (more pronounced for women)–Job discrimination–Low self-esteem, depression, anxiety*01/14/19 Eating Disorders 7Epidemiology of Obesity•Genetics of obesity–Adoption studies–Twin studies01/14/19 Eating Disorders 8Energy Balance Model of ObesityCaloric Intake – Caloric Expenditure+ (Weight Gain)- (Weight Loss)01/14/19 Eating Disorders 9Energy Balance Conceptualization of Obesity•Calorie input–Intake of liquid and solid foods•Calories out–Basal metabolic rate (BMR)–Exercise–Food-related thermogenesis–Exercise-related thermogenesis01/14/19 Eating Disorders 10Assessment of Obesity•Body weight based on gender and height•Percent body fat–Skin-fold thickness–Underwater weighing–Electrical impedance•Body mass index (BMI)01/14/19 Eating Disorders 11Medical Treatments for Obesity•Pharmacotherapy–Appetite suppressants (Fenfluramine)–Stimulants (Ephedrine)*–Opiate antagonists (Naltrexone)•Other medical procedures–Stomach stapling–Medically-supervised low calorie–Liposuction01/14/19 Eating Disorders 12Psychological Treatments for Obesity01/14/19 Eating Disorders 13Evolution of Behavioral Treatments for Obesity•First Generation•Second Generation•Third Generation01/14/19 Eating Disorders 14Cognitive-Behavioral Treatments for Obesity•Self-monitoring•Stimulus control•Goal setting•Reinforcement•Education•Cognitive restructuring•Nutritional education•Exercise prescriptions•Relapse prevention training01/14/19 Eating Disorders 15Limitations of Behavioral Treatment Research•Studies do not last long enough to get patients to goal weight•Inadequate comparison groups•Inadequate follow-up01/14/19 Eating Disorders 16Improving Long-term Weight Loss•Better screening•Longer programs•Incentive systems for increasing adherence•Social support•Treatment matching•Relapse prevention strategies•Integration of “non-behavioral” treatments01/14/19 Eating Disorders 17Bulimia Nervosa01/14/19 Eating Disorders 18Diagnostic Features•A. Recurrent binge eating•B. Recurrent inappropriate compensatory behavior in order to prevent weight gain•C. Binge eating and compensatory behavior occur at least 2/wk for 3 months•D. Self-evaluation is unduly influenced by body shape and weight•E. Exclude the diagnosis if the symptoms occur exclusively during episodes of anorexia nervosa01/14/19 Eating Disorders 19Essential Features of Binge Eating•Large amount of food consumed in a small amount of time (< 2 hours)•During the eating episode there is the distinct feeling of being out of control over one’s eating01/14/19 Eating Disorders 20Epidemiology of Bulimia Nervosa•Prevalence–2.8 to 5.5% (Kendler et al, 1991)–4 % (Rand & Kuldau, 1992;Whitaker et al, 1990)01/14/19 Eating Disorders 21Epidemiology of Bulimia Nervosa•Etiology–Genetic factors01/14/19 Eating Disorders 22Stice Dual Pathway ModelBodydissatisfactionDietingNegativeaffectBulimicsymptomsThin-idealinternalizationPressure tobe thin.25*.17***.38***.14^.20**01/14/19 Eating Disorders 23Risk Factors for Bulimia•Social pressures to be thin–Perceived pressure fro thinness is correlated with bulimic pathology (Stice et al., 1996)–Perceived pressure fro thinness predicts future bulimic symptoms (Stice et al., 2000)–Experimental exposure to thin-ideal images increases negative affect and body dissatisfaction (Stice & Shaw, 1994)01/14/19 Eating Disorders 24Risk Factors for Bulimia•Internalization of the thin ideal–Bulimics are more likely to endorse the thin ideal than non-bulimics (Williamson et al, 1993)–Internalization of the thin ideal is associated with bulimic symptoms (Stice et al., 1994)–Internalization of the thin ideal predicts future bulimic symptoms (Kendler et al, 1991; Joiner et al., 1997; Stice et al, 2000)01/14/19 Eating Disorders 25Risk Factors for Bulimia•Elevated body fat (adiposity)–Body Mass Index correlated with bulimic symptoms (Stice et al., 1996)–Body Mass Index predicts future body dissatisfaction (Stice et al., 2000)–Body Mass Index predicts onset of subclinical eating pathology (Killen et al., 1994)01/14/19 Eating Disorders 26Risk Factors for Bulimia•Body Dissatisfaction–High body
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