Overview of Eating Disorders and Nutrition Across Life Stages

Binge Eating Disorder

Not accompanied by compensatory behaviors.

isolates self to eat large quantities

uses food to reduce stress, provide feeling of power

Seen mostly in adults 40-50 years old (much older than the other eating disorders)

patients often have other mental health disorders such as depression

About 4 million people in US (more causes than anorexia and bulimia)

about 40% are male

about 70% with the disorder are obese

Physical effects of binge eating disorder are the same as

obesity.

Binge Eating Disorder has a genetic predisposition

true

Binge Eating Disorder arises when person is stressed by

environmental trigger (emotional stress).

3 characteristics of Anorexia Nervosa

• extreme weight loss

• irrational fear of weight gain

• distorted body image.

Personality traits of Anorexia Nervosa

• perfectionism

• OCD

• body dysmorphic disorder (BDD).

To be diagnosed with Anorexia Nervosa an individual has to display

characteristics 75% of the days in the last 3 months.

2 subcategories of Anorexia Nervosa

restricting type, restricting energy intake.

binge eating/ purging (similar to bulimia but have a BMI under 17

Bulimia Nervosa

Bulimia means ravenous (ox-like) hunger.

recurrent episodes of binge eating followed by compensatory behavior.

Compensatory Behaviors

Actions taken to rid body of excess calories and/or alleviate guilt, anxiety associated with a binge.

Compensatory Behaviors for bulimia nervosa

Include vomiting, misuse of laxatives, or excessive exercise.

• debiting

Many people with bulimic behavior are

never diagnosed

Risk of Osteoporosis

Not Having a Period is NOT Normal.

Factors Affecting Menstruation

Nutrition, exercise, stress, and sleep.

When menstruation stops

Body can't focus on reproductive system when not enough energy to maintain vital functions.

lack of Menstruation

May cause premature osteoporosis.

Normal Menstrual Function

Requires an energy intake of 30 kcal per kg of body weight (or 13 to 14 kcal per pound).

Inducing a Period

Slowly increasing caloric intake should help induce a period.

Amenorrhea

Do NOT simply accept birth control from a medical provider as a 'fix' for amenorrhea!

Pica

Persistently eating nonfood substances (e.g. clay, dirt, ice, chalk, or wood); tends to co-occur with other mental disorders such as OCD & Autism.

Lanugo

Fine, downy hair that grows over the body and signals low body fat (it is the body's attempt to regulate body temp).

Anorexia Treatment Steps

1) Intervention by friends/family

2) Outpatient treatment with multidisciplinary team

3) Inpatient treatment if weight is 75% of what is normal for an individual's height.

Anorexia Dietary Treatment

1) Consume Vit D/Calcium for bone health

2) Increase weight 2-3 lb per week during the 'refeeding' process

3) Emphasize pre/probiotics.

Average Recovery Time for Anorexia

7 years.

Average Cost of Anorexia Treatment

$180K.

Bulimia Treatment Goals

Correct misconceptions about food, decrease amount of food consumed in a binge

decrease frequency of purging

develop normal eating pattern

psychotherapy to improve self-acceptance

change 'all-or-none' attitude about food

group therapy for social support.

Fluoxetine (Prozac®)

Only antidepressant approved by FDA for treatment of bulimia nervosa.

Psychological Binge Eating Disorder Treatment

CBT, group therapy, educating patient about physiological hunger signals, encouraging positive coping mechanisms.

Vyvanse®

First drug approved by the FDA (2015) to treat Binge Eating Disorder; stimulant also used to treat attention-deficit hyperactivity disorder.

Purging Disorder

Purging but not binging.

Night Eating Syndrome

Eating more than 25% of calories after dinner; needing to eat to sleep; feeling depressed at night.

Orthorexia

Obsession with healthy, 'perfect' eating (e.g. organic, vegan, gluten-free); NOT considered an eating disorder.

Drunkorexia/Alcoholimia

Using compensatory behaviors after an alcohol binge; NOT considered an eating disorder.

Muscle Dysmorphia

Men and some women perceive themselves as too thin; preoccupied with weight-lifting and diet regimens to gain muscle; increased anabolic steroid use; not considered a clinical eating disorder yet.

• reversed anorexia

Key Minerals for Fertility

Two most important: Iron and zinc; needed for normal ovulation in women.

Folate

MOST important vitamin for female/male fertility; role in DNA synthesis for the egg/sperm.

Breastfeeding Recommendation

Exclusively breastfeed for 6 months, then a combo of breastmilk/solids.

Prolactin

Hormone that stimulates milk production.

Breastfeeding Caloric Needs

Breastfeeding mothers need 380-400 extra calories daily.

Advantages of Breastfeeding for Baby

Antibodies and 'good' bacteria support immune system; decreases risk of diarrhea, respiratory disease, and ear infections; reduces risk of food allergies, asthma, & eczema; may enhance nervous system development and learning.

Advantages of Breastfeeding for Mom

No prep/convenient; far cheaper than formula.

Burns 600-800 calories per day

Decreases the risk of ovarian and premenopausal breast cancer

Lower risk in later life for moms who breastfeed

Hypertension, cardiovascular disease, and diabetes.

Autism spectrum disorder

1 in every 59 kids (higher in boys).

Gluten-free & Casein-free diet

A popular nutrition intervention based on the idea that dairy protein may impair brain functioning.

for kids with autism

Pre/postbiotics

Giving children these can be helpful for autism (see Nature 2020 study on TCU Online).

Gut microbiota transfer

Promising improvements seen when kids with ASD are given this via enema from kids without ASD.

There is a possible connection between pregnant womens diets and ASD

true

Pregnant women who consumed higher amount of processed foods

may be linked with autism due to PPA (preservative) changing the fetal neural system

Infertility

Inability to conceive after 1 year of trying occurs in 19% of those planning pregnancy.

Nutritional status and fertility

Link between nutritional status and fertility;

both under- and overweight status in women and men can impact fertility.

Underweight women

Ovaries & adipose tissue (fat) synthesize fertility hormones (e.g. estrogen), so low body fat can impact hormone production.

Underweight men

Lower sperm count.

Overweight women

Endocrine changes.

Overweight men

Higher estrogen & lower testosterone; extra fat also increases heat around testes.

Obesity

Raises oxidative stress which can damage DNA.

Fertility Diet

Avoid trans fats;

use more unsaturated fats;

eat more vegetable protein;

choose 'low and slow' carbohydrates;

incorporate moderate exercise.

Dairy products in fertility diet

Temporarily trade in low-fat and fat-free dairy products for full-fat versions.

Multivitamin and mineral supplement (Fertility Diet)

Use a daily multivitamin and mineral supplement containing folic acid.

Iron intake (Fertility Diet)

Ensure adequate iron intake from sources other than red meats.

Hydration (Fertility Diet)

Choose water for hydration.

Weight loss for fertility (Fertility Diet)

Lose 5% to 10% of body weight (if overweight).

Polycystic Ovarian Syndrome (PCOS)

Tiny cysts that surround the ovaries; leading cause of female infertility.

Symptoms of PCOS

Women with PCOS have: unusually high levels of testosterone, irregular or absent periods, excess body hair, infertility, higher chance of miscarriage, difficulty losing weight.

Weight loss and PCOS

Losing 5% body weight improves conception chances.

Childhood obesity

Since 1970s, childhood and adolescent overweight & obesity more than tripled.

About ___ of obese children and about ___ of obese adolescents become obese adults.

40%; 80%

Type 2 Diabetes Among Youth

Alarming increase of type 2 diabetes in children; 85% overweight at diagnosis.

Risk factors for type 2 diabetes

Close relative with the disease;

belonging to nonwhite population.

AAP Guidelines for type 2 diabetes

Monitoring of blood glucose, use of medications, weight management, and physical activity.

Hygiene hypothesis

'Germophobic' society, with protection of antibiotics, hand sanitizers, and antimicrobial soaps and cleaners; immune systems not vigorously challenged by antigens.

food allergy

reaction to food that involves an immune response

Food Intolerance

reaction to food that does NOT involve an immune response.

Anaphylaxis

Severe allergic response (low blood pressure, trouble breathing).

2006 Food Allergen Labeling & Consumer Protection Act

Act mandated that manufacturers clearly identify presence of major food allergens.

#1 Food allergy

Peanuts

Recommendations for babies and allergies (Prior to 2008)

the recommendation was to AVOID giving babies egg whites, chocolate, peanuts, tree nuts, seafood or fish until after 1 year

Newer allergy recommendation

give kids at risk for allergies a small amount of peanut butter beginning around 4 months.

Placenta

Organ that forms in uterus to accommodate growth and development of the fetus.

• exchanges nutrients, oxygen and other gases

1st trimester calorie needs

Mother needs NO extra calories.

2nd trimester calorie needs

+340 kcals.

3rd trimester calorie needs

+452 kcals.

Micronutrient needs during pregnancy

Increase up to 50%.

Protein requirement during pregnancy

+25 daily grams.

Water requirement during pregnancy

12.5 cups per day(during pregnancy);

16 cups when nursing.

Linoleic acid (omega-6) requirement

13 daily grams.

Alpha-linolenic acid (omega-3) requirement

1.4 grams.

Folate requirement

Need 600 mcg daily; important for DNA synthesis.

MOST CRITICAL

Folate benefits during pregnancy

• Key for preventing neural tube defects such as spina bifida (may also lower incidence of Down syndrome & heart defects)

Neural tube closure

Closes 28 days after conception.

Vitamin D requirement

Need 15 mcg daily; controls blood sugar/blood pressure.

Iodine

Supports thyroid hormone synthesis in mother & baby; key for normal brain development.

• consume iodine salt

Iron

Supports hemoglobin synthesis; almost all prenatal vitamins have iron.

Zinc

Key for protein synthesis & enzyme function.

Gestational Diabetes

Hormones made by placenta decrease action of insulin; 28 week screening happens in 1 in 10 pregnancies.

Gestational hypertension

Appears after 20 weeks gestation; usually resolves after delivery.

½ of women with gestational hypertension develop

• preeclampsia (mild form), protein in urine

• eclampsia (severe form), protein in urine, seizures

Impact of aging on the digestive system

Decline of digestive enzymes results in lower gallbladder & pancreas function.

Osteoarthritis

Common leading cause of disability in older adults.

Chronic diseases in older adults

Obesity, heart disease, osteoporosis, cancers, hypertension, & diabetes;

• 4 of 10 older adults have at least two chronic diseases.

Impact of Aging on Endocrine system

•  decrease in insulin sensitivity, but diet & exercise may halt this decline