NUTR 400 3.4 Disordered Eating and Eating Disorders

The college transition

• new dining environment

• demanding schedule

• increased independence

eating behavior spectrum

normal eating: choices made based on hunger/preference, flexibility, eating a variety

disordered: choices made on how they will affect the body

eating disorders: restricting, coping, isolation 

disordered eating 

• eating behaviors that do not fit within the DSM-5 criteria (that would make it an ED)

• unhealthy eating behaviors 

• hard to detect, can become an ED

• physiologically and physically harmful 

eating disorders 

• very serious but treatable 

• extreme disturbance in eating behaviors 

• physiologically and physically harmful 

EDs facts and statistics

• among the deadliest phycological illnesses

• ages 18-21 most common

• 9% of the US pop will have an ED

• Rates in males are inc at a faster rate than in females

• 10-15% of peeps w/ anorexia/bulimia are male

• over 70% with ED’s don’t seek treatment

ED’s in college

• “freshman 15” = not real

• 10-20% of college woman have one

• 4-10% of college men have one

• pre pandemic, 15%

• post pandemic, 28%

• trans students 4x more likely

• 91% of girls have tried to control their weight via diets

• 35% of “normal” dieters progress to pathological dieting. 20-25% of these turn to at least partial ED’s

Risk factors 

Biological- 

• genetic

• fam history 

• co-existing metal health issues

• dieting history 

• alch/drug use

• negative energy balance 

• type 1 diabetes 

phycological-

• perfectionism, body image dissatisfaction, personal history if mental health condition, trauma 

environment-

• bullys

• weight stigma

• fam dynamic

• media

• idolize thin 

INC likely hood of development in…

• females

• adolescence

• pre-existing conditions,

• family history

• “type A”

• unhealthy environment

• body focused career/dieting

• chronic dieting

Types of eating disorders

• Anorexia Nervosa (AN)

• Bulimia Nervosa (BN)

• Binge Eating Disorder (BED)

• Avoidant/Restrictive Food Intake Disorder (ARFID)

• Other Specified Feeding or Eating Disorder (OSFED)

• Unspecified Feeding or Eating Disorder (UFED)

• Pica (eating rocks and shit)

• Rumination Disorder (RD) (bringing food up from the stomach the second it enters)

Anorexia Nervosa (AN)

• distorted body image

• excessive dietary restrictions 

• low weight 

• fear of weight gain

• restriction of energy intake relative to body weight 

There are two types of AN- what is the difference?

one does not have a purge/binge, one does

risks of AN

brain- fatigue/dizzy, bad mental health

heart- low BP, low heart rate, cardiac arrest

endocrine- impact hormonal function (no period w/ woman)

skin- dry, thin hair/hair loss, lanago (small hairs trying to keep your body warm

GI- stomach pain, bloating constipation dehydration

THE SOONER CAUGHT, THE MORE WE CAN REVERSE

Bulimia Nervosa 

Eating a lot in a short amount of time

• recurrent episodes of binging and then a purge 

• the binge/purge must occur at least once a week for 3 months

• self evaluation is influenced by body shape/weight, fear of weight gain  

• purging methods- vomit, fasting, excessive exercise, meds, laxatives 

The binge/purge cycle

1. strict diet

2. diet “slips”

3. binge triggered

4. purge to avoid gain

5. guilt shame

Bulimia Nervosa health risks

mouth- tooth decay, erosion of dental enamel (from puke)

heart- low BPm cardiac arrhythmias

brain- dizzy/faint, bad mental health

throat- sore, heart burnm damaged esophagus swollen salivary glands

skin- callus/scars/dry hands/knuckles

kidneys- dehydration

GI- stomach ulcers

Warning Signs of Bulimia Nervosa

Evidence of binge eating:

• Consuming large amounts of food in short periods of time, lots of empty food wrappers of packages..

Evidence of purging behaviors:Frequent trips to the bathroom after meals

1. Creation of complex lifestyle schedules 

2. Swelling of the cheeks or jaw area 

3. Discoloration or staining of the teeth 

4. Calluses on the back of hands and knuckle

5. Frequent dieting 

6. May see fluctuations in weight - up or down

Binge eating disorder (BED)

• not associated with recurrent use of inappropriate coping behaviors (unlike AN/BN)

• occurs at least one a week for three months

• Associated with 3 or more of the following: Eating more rapidly than normal 

  • Eating until uncomfortably full 

  • Eating large amounts when not hungry 

  • Eating alone out of embarrassment 

• in peeps of al sizes

• eating till uncomfortably full

• feelings of shame and guilt

The binge/restrict cycle

Restrict → Struggle → Binge → Struggle  

• when you are not eating enough, you are more likely to binge

Health risks of Binge eating

Brain- bad mental health

heart- high BP, stroke, high cholesterol

• weight gain

• type 2 diabetes

• osteoarthritis 

• gallbladder disease

Other specified feeding or eating disorder (OSFED)

Recognize and categorize ED’s that don’t meet criteria for AN, BN, or BED

• examples:

  • Atypical Anorexia Nervosa (meets all the criteria besides low weight)

  • Bulimia Nervosa of low frequency/limited duration

  • Binge Eating Disorder of low frequency/limited duration

  • purging disorder (no binge)

  • Night Eating Syndrome (all/most energy intake is at late hours)

Orthorexia

• not formally recognized in the DSM-5

• fixation on healthy eating

• ridget eating styles/exercise patterns

• cutting out all of some food groups 

• checking nutrition labels

• obsessed with food health 

• anxiety when there is no “healthy” option

• think of food for hours 

Treatment

Appropriate, multidisciplinary, compassionate intervention

• Team approach: RD, physician, and counselor 

• Individual/group/family therapy

Typical treatment goals:Restore adequate nutrition

1. Restore and maintain body weight

2. Reduce excessive exercising

3. Improve food-related behavior

Nutrition counseling is important

Barriers to Care

• Denial – unwilling to seek care

• Fear of weight gain

• Stigma

• Cost/Insurance coverage

• Lack of awareness/knowledge

• Weight bias

• Access to care