Académique Documents
Professionnel Documents
Culture Documents
Eating
Disorder
s
Media
promotion
Social
acceptance
Influence and
stress on
young
individuals
Anorexia nervosa
Bulimia nervosa
Eating disorder not otherwise
specified (EDNOS)
Binge eating disorder (BED)
Genetic Link?
Profile of Anorexia
Anorexia Nervosa:
Psychological Features
Perfectionism
Harm avoidance
Feelings of ineffectiveness
Inflexible thinking
Overly restrained emotional
expression
Limited social spontaneity
Schebendach in Krause, 12th Ed., p. 564
Anorexia Nervosa
Food rituals
Cuts food in small pieces
Rearranges food on plate
Prolonged exercise
Preoccupation with food
Cooks for others
Hungry, but refuses to eat
Diagnostic Criteria
American Psychiatric
Association Diagnostic
and Statistical Manual
of Mental Disorders
(DSM) criteria are the
standard
AN APA Diagnostic
Criteria
AN Diagnostic Criteria
Related Psych
Disorders in AN
Prevalence of AN
Age 14
puberty, high
school
Age 18 college,
full time jobs
Pathophysiology of AN
Physical and
psychological
consequences
of malnutrition
Pathophysiology of AN
Amenorrhea
Cheilosis
Bradycardia; hypothermia
Sleep disturbances
Pathophysiology of
AN: Osteopenia
Pathophysiology of AN
Pathophysiology of
AN: Cardiovascular
Pathophysiology of AN
Pathophysiology of
AN: GI
Bloating, abnormal fullness
after eating
Constipation
Digestive enzymes low
Pathophysiology of AN
Bulimia Nervosa
An illness characterized by repeated
episodes of binge eating followed
by inappropriate compensatory
methods
Purging, including self-induced
vomiting or misuse of laxatives,
diuretics,
or enemas
Non-purging including fasting or
engaging in excessive exercise
Bulimia Nervosa
Prevalence
Bulimia Nervosa
Prevalence
5% of college women
20% of college women exhibit
symptoms (Sx)
50% of those with anorexia
nervosa develop bulimia nervosa
Gorging and purging/vomiting
Susceptible populationsathletes,
actors, dancers, wrestlers, runners
Profile of Bulimia
Profile of Bulimia
Nervosa
Binge Definition
Binge
Relieves stress
Common binge foods:
Purge
Laxatives, enemas
Act on large intestine
90% of calories are absorbed in
small intestine
Damages large intestine
constipation
Vomiting
Syrup of Ipecac
Vomiting
Teeth
Stomach acid erodes
enamel
Pain, decay
Diuretics
Water loss
Electrolyte loss
NO fat loss!
Hypergymnasia:
Excessive Exercise
Symptoms of BN
Pathophysiology of
BN: Vomiting
Dehydration
Alkalosis
Hypokalemia
Sore throat, esophagitis, mild
hematemesis
Abdominal pain
Pathophysiology of
BN: Vomiting
Subconjunctival hemorrhage
Mallory-Weiss esophageal tears
Esophageal ruptures (rare)
Acute gastric dilatation or rupture
Salivary gland infections
Pathophysiology of
BN: Laxative Abuse
Dehydration
Elevation of serum aldosterone
and vasopressin levels
Rectal bleeding
Intestinal atony
Abdominal cramps
Pathophysiology of
BN: Diuretic Abuse
Dehydration
Hypokalemia
Pathophysiology of BN
Vicious Cycle of
Bulimia
Physical
Manifestations of
Eating Disorders
Treatment of Eating
Disorders
AN: Treatment
Nutrition
AN: Treatment
Psychological
Nutrition Assessment
in Eating Disorders
Assessment of Intake
in Eating Disorders
Dietary Intake in AN
Dietary Intake in BN
Eating Behavior in
AN/BN
Food aversions
Safe foods
Magical thinking
Binge trigger foods
Ideas on appropriate amounts of food
Misconception that purging
eliminates all calories from a binge
episode
Lab Assessment
Lab Assessment
Vitamin-Mineral
Abnormalities
Hypercarotenemia: in AN restrictors;
mobilization of lipid stores, catabolic
changes, metabolic stress; normalizes
with rehab
Deficiency diseases rare in AN, possibly
due to use of supplements, catabolic
state, use of nutrient-dense foods
Osteopenia and osteoporosis are
common
Metabolic Changes
Anthropometric
Assessment
Body Weight
Assessment
Management of Eating
Disorders
Treatment Goals
Factors Affecting
Weight Gain in AN
Fluid balance
Metabolic rate
Resting energy expenditure
Postprandial energy expenditure
Factors Affecting
Weight Gain in AN
Previous obesity
Physical activity
Nutritional Care in AN
Nutritional Care in AN
Refeeding Syndrome
Energy Needs in AN
Energy Needs in AN
Macronutrient Mix
Micronutrients
MNT in AN
MNT in BN
Energy Needs in BN
Energy Needs in BN
Monitoring of BN
Patients
Macronutrients in BN
Cognitive Behavioral
Therapy
Structured psychotherapeutic
method alters attitudes and problem
behaviors
Identifies and replaces negative,
inaccurate thoughts
Typically a 20-week intervention that
Establishes a regular eating pattern
Evaluates and changes beliefs about
shape and weight
Prevents relapse
Three Components
Eating disorder
Lack of menstrual periods
Osteoporosis
Female athletes
participating in
appearance-based
and endurance
sports
Seen in 15%
swimmers, 62%
gymnasts, and 32%
of all other sport
Binge-Eating Disorder
(Compulsive
Overeating)
Complex and serious eating disorder
Binge-Eating Disorder
(Compulsive
Overeating)
Eat more rapidly than usual
Precondition
Trigger phase
Maintenance phase
Ending phase
Post-binge phase
(consequences)
Characteristics of a
Binge-Eater
Learn to eat in
response to
hunger
Learn to eat in
moderation
Avoid restrictive
diets which can
intensify
problems
Increase activity
Baryophobia
Treatment for
Baryophobia
Nutrition education
Nutrition required for proper
growth
Appropriateness of sweets and
fats in the diet
Childhood Eating
Disorders
Eating Disorders in
Dietetics Students
Eating Disorders in UG
College Students
Eating Disorders in UG
College Students
Eating Disorders in
College Students
Eating Disorders in
College Students
Fredenberg et al surveyed 5
groups of students in DPD
dietetics, CP dietetics, non-food
home economics curricula,
college basketball or volleyball
programs, and sororities
Fredenberg JP, Berglund PT, Dieken HA. Incidence of eating disorders among
selected female university students. J Am Diet Assoc 1996;96:64-65.
Eating Disorders in
College Students
Prognosis
Set-point theory
Modified from Schebendach J, Nussbaum MP: Nutrition management in Adolescents with eating disorders. Adoles Med:
State Art Rev 3 (3): 556, 1992.
Modified from Schebendach J, Nussbaum MP: Nutrition management in Adolescents with eating disorders. Adoles Med:
State Art Rev 3 (3): 556, 1992.
Dying To Be Thin
Summary