Eating Disorders

Eating Habits

Food consumption is an instinctive behavior with number of psychological, social, and cultural purposes
Eating disorders occur as a result of insuficient or excessive consumption of foods or the consumption of non-nutritive material - both conditions leading to deleterious health conditions
Food consumption may be influenced by biological and psychological factors
Anorexia nervosa and Bulimia nervosa are the two primary eating disorders classified by the American Psychological Association: http://www.apa.org/topics/topiceating.html

Anorexia Nervosa

Stems form psychological conflict between consuming food and body image
7% people with anorexia die (from sucide) within 10 years of diagnosis
25% recover within 6 years
The rest diagnosed have a continual battle the rest of their life
Early roots of the disease:
- Simple attempt to loose weight
- Stress from changes in body image
- transition into adulthood
- Physical changes associated with puberty
- Stress from sexual and social tensions
- Stress from loss of a loved one
Progression
- Extreme dieting
- Self enforced starvation
Profile
- Refusal to eat enough to maintain acceptable weight
- Typically white female, middle to upper socioeconomic class
- Often described as responsible, meticulous, obedient
- Competitive and obsessive
- Complains of delayed puberty, fatigue, and depression
- May have conflicts with family structure
- Early warning signs:

Physical Affects
- Weight less than 85% expected
- BMI less than 17.5
- Growth charts used to assess children under 18
- Physical/physiological effects:
- Lowered body temperature
- Slower metabolic rate
- Decreased heart rate
- Iron deficiency anemia
- Rough, dry, scaly, and cold skin
- Low white blood cell count
- Loss of hair
- Lanugo (downy hairs)
- Constipation
- Low blood potassium
- Loss of menstrual period
- Change in neurotransmitter function
- Loss of teeth
- Muscle tears and stress fractures

Treatment: INTERVENTION (nutritional and psychological therapy)
- Nutrition Therapy
  - Hospitalization when person falls below 75% of expected weight
  - Severe cases use tube feeding
  - Goal of gaining 2-3 pounds per week
  - Energy needs begin at 1000-1600 kcals per day, increasing 100-200 kcal increments every few days
  - Achieve ideal caloric distribution of about 50-55% carbohydrate, 15-20% protein, and 25-30% fat
  - Multivitamin and mineral supplements prescribed
  - Provide accurate nutritional information
  - Learn to eat based on natural hunger and satiety
- Psychological Therapy - cognitive therapy

Bulimia Nervosa

First described in 1979 and classified as a clinical psychological disorder in 1980
Profile:
- Common in young adults
- Individuals predisposed with genetic and lifestyle patterns conducive to weight gain
- More commonly female
- Individuals usually slightly overweight
- Half of bulimic patients suffer from major depression
- Turn towards food in critical situations
- Recognize their behavior as abnormal
- Tend to be impulsive
Typical behavior:
- Person binges at least twice a week for 3 months
- Recognizing behavior and patterns nearly impossible because individuals hide their habits
- Alternation between food intake and food restriction is common
- Binging occurs usually at night and may last ½ hour to 2 hours
- Up to 12,000 kcals may be consumed in on session
- Food is purged after session BUT a percentage of food is absorbed
  - 33-75% of food absorbed though vomiting occurred
  - 90% of food absorbed though laxatives or enemas used
- Some patients undergo excessive exercise (hypergymnasia) to expend a large amount of energy due to high absorption of foods
- Binging produces amplified feeling of depression

Health Effects
- Demineralization of teeth
- Blood potassium levels drop – may cause irregular heart rhythms
- Salivary glands swell
- Stomach ulcers and esophageal tearing
- Constipation
- Ipecac poisoning
Treatment
- 16 weeks of treatment – hospitalization in cases of severe laxative abuse, regular vomiting, and substance abuse
- Psychotherapy
- Antidepressant, Fluoxetine (Prozac), has been approved for administration
- Nutritional counseling

Eating Disorders Not Otherwise Specified (EDNOS)

Individuals have partial syndromes that do not meet the strict criteria for the other specific eating disorders (anorexia and bulimia)
50% of people with eating disorders fall into this category
Other disorders requiring professional development:
- Female athlete triad – condition characterized by disordered eating, lack of menstrual periods, and osteoporosis
- Binge-eating disorder – “ compulsive overeating” an eating disorder characterized by recurrent binge eating and feelings of loss of control over eating
- Purge disorder - recurrent purging without binge-eating in order to control weight
- Diabulimia - deliberate manipulation of insulin levels by diabetics in order to control their weight
- Orthorexia nervosa - fixation on or an obsessive avoidence of "unhealthy" or "impure" foods and may lead to instances of malnutrition
- Pregorexia - extreme dieting or over-exercising in order to control pregnancy weight gain
- Baryophobia – disorder of young children and young adults characterized by stunted growth resulting from parental underfeeding in attempt to prevent development of obesity and heart disease
- Pica - compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition
- Prader-Willi Syndrome - child/adult has an insatiable appetite
- Night Eating Syndrome - consists of morning anorexia, evening hyperphagia (abnormally increased appetite for consumption of food frequently associated with injury to the hypothalamus) and insomnia
- Sleep Eating Disorder - sufferers tend to be overweight and have episodes of recurrent sleep walking, during which time they binge on usually large quantities of food, often high in sugar or fat.

Biologocal Involved in Eating Disorders

Genetic - example is Prader Willi; higher than normal ghrelin levels causing hyperphagia
Neurotransmitter imbalances - serotonin and dopamine involved in inhibiting or stimulating feeding behaviors
Endocrine imbalances - leptin and ghrelin imbalance affects the feeling of hunger and food consumption
Cerebrum development - scientist hypothesize that impaired development of somatosensory area of brain may lead to body image distortion
Immune issues - patients who suffer from anorexia and bulimia have higher than normal levels of autoantiodies that may affect biochemicals involved in regulating appetite

Psychological Factors?