N270 Test 3

-Define disordered eating

Disordered Eating is a term used for unhealthy eating behaviors

Sensing but sometimes ignoring

Sometimes skipping meals but eating about the right amount each day

Swinging in body weight a few pounds or up to 10 pounds now and then

Removing food groups or "bad" foods OR eating only sweets for a few days at a time

Exercising to lose a little weight, then stopping when the goal is reached

-Define eating disorders

Eating Disorders are a mental health disorder

Often ignoring hunger cues

Going all day without eating, or eating very little, often

Rapidly gaining/losing weight or due to excessive over or under eating that happens often

Strictly avoiding entire food groups all of the time or to the point where deficiency develops

Exercising to feel "allowed" to eat, or exercising in unsafe conditions or long periods

-What role does exercise play in disordered eating & eating disorders?

Exercising in disordered eating is exercising to lose a little weight, then stopping when the goal is reached. However, eating disorders use exercising to feel "allowed" to eat, or exercising in unsafe conditions or long periods

-Define body image. What role does it play in disordered eating and eating disorders?

Body image is a central psychological factor that influences how people relate to food and their bodies. When it becomes negative or distorted, it can drive unhealthy eating patterns and contribute to the development and maintenance of eating disorders.

Anorexia Nervosa Characteristics

Restricted eating patterns and/or self starvation

Weight loss to BMI <19 or rapid drop of >10# in one month

Interview Signs:

Eating habits,

exercise habits,

health history,

Amenorrhea in female (Lack of periods)

Nutrient deficiencies body image

Anorexia Nervosa S/S

Nutrient Deficiency

Intense fear of weight gain

Eliminating food groups

Amenorrhea

Anorexia Nervosa Health Risks

Deficiency in calories & Micronutrients

Depleted fat stores & loss of lean muscle mass

Reduction of non-vital bodily functions

Electrolyte Imbalances

Late stages associated with increased risk for organ failure

10-20% mortality rate

Late Stage = Organ Failure

Anorexia Nervosa Body Impact

Skin/hair/nails:

Hair becomes thin, dry, and brittle; hair loss occurs

Skin is dry, easily bruised, and discolourd

Nails turn brittle

Blood and immune system:

• Anemia

•Compromised immune system Increases risk or intecion

Kidneys:

Dehydration

• Electrolyte abnormalities that can be life threatening

• Chronic renal failure

Reproductive function:

• Disruption of sex hormone production, resulting in menstrual dysfunction and amenorrhea in females

• Infertility

Muscle:

• Loss of muscle tissue as the body uses the muscles as an energy source

Brain:

• Altered levels of serotonin and other neurotransmitters

• Alteration in glucose metabolism

Mood changes

Thyroid gland:

• Abnormal thyroid levels due to starvation

Heart:

• Low blood pressure and abnormal heart rate contribute to dizziness and fainting

• Abnormal electrocardiogram (ECG)

• Sudden death due to ventricular arrhythmias

Gastrointestinal system:

• Abdominal pain and bloating caused by slowed gastric emptying and intestinal motility

• Acute pancreatitis

• Constipation

Bone:

• Decreased bone mineral density (osteopenia)

• Decreased ability to absorb calcium due to low estrogen levels

• Decreased intake of bone-building nutrients due to starvation

• Increased loss of bone due to elevated cortisol levels

Nutrition Therapy for Anorexia

1. To prevent further weight loss

2. To gradually reestablish normal eating behaviors

3. To gradually increase weight

Refeeding syndrome risk if too fast

4. To maintain agreed-on weight goal

Bulimia Nervosa Characteristics

Characterized by repeated episodes of binge eating and Purging

Types:

Binge eating: Quantity, Speed, Loss of Control

Purging: Compensatory behavior used to prevent weight gain.

Bulimia Nervosa S/S

Fasting to prevent weight gain

Binge Eating

Over use of laxatives

Over exercising

Recurrent episodes of binge eating

Recurrent inappropriate compensatory behavior in order to prevent weight gain

Chronically inflamed and sore throat

Swollen glands in the neck and jaw (Square shaped face)

Worn tooth enamel, scars on knuckles/hands

Bulimia Nervosa Health risks

Electrolyte imbalance

Dental problems

Kidney problems

Gastrointestinal problems (common among all EDs)

Bulimia Nervosa Nutrition Therapy

Identify/ correct food misinformation and fears.

Interrupting the binge/purge cycle

Ensure adequate calories for weight maintenance

Binge Eating Disorder Characterstics

-Recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstance

-Episodes marked by feelings of lack of control

Binge Eating treatment

normalizing eating behaviors and focusing on satiety cues

-Define body dysmorphic disorder and describe it role in eating disorders

Body dysmorphic disorder is when you perceive your body to look different than how others see it

ARFID (Avoidant/Restrictive Food Intake Disorder)

Eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional needs.

ARFID Characteristics

NOT body image issue

Not explained by lack of available food or attributable to a medical disorders

Requires Medical and family TEAM

ARFID S/S

Sensory issues around food

Malnutrition

Irrational fears around food

ARFID Population Impact

Impacts children, boys more, neurodivergence

Often related to fears around food: choking, vomiting, GI pain, sensory issues

Leads to: deficiencies, GI problems, malnutrition, weight loss & apathy towards food

-What is OFSED and what types of disorders are associated with it?

They are Subacute cases of AN or BN and are food disorders that don't fall into the typical diagnostic categories for standard eating disorders

These disorder are

Atypical Anorexia Nervosa

Atypical Bulimia Nervosa

Purging Disorder

Night Eating Syndrome

Orthorexia

Orthorexia Description

-obsessive behavior in pursuit of a healthy diet.

Orthorexia Co-Manifestations

Often display signs and symptoms of anxiety disorders that co-occur with anorexia nervosa or other eating disorders

Orthorexia S/S

-Intense fear & anxiety of veering off diet

-Fear of "unhealthy foods"

-Highly restrictive diet

-Little flexibility in eating

-Can mirror symptoms of anorexia

-Weight loss may or may not be present

Orthorexia Important Considerations

We need to be careful how we talk to our patients about food & relation to health

We want to promote balance as opposed to restriction

How does oral and gastrointestinal change with age that affect nutrition status

Decrease in hydrochroic acid which assists with the absorption of B12, iron, and calcium

Mouth changes make it harder to eat

Slow persistalis due to a decrease in muscle tone

Increased constipation

How does metabolism change with age that affect nutrition status

(Metabolism slows)

Decreased calorie needs

How does the Central nervous system change with age that affect nutrition status

Cognitive decline

Medications change appetite and absorption

Taste changes

Micronutrient deficiencies (More susceptible to food-borne illness)

How does the Renal System change with age that affect nutrition status

Declines with age

Vitamin D metabolism is affected and affects bone mineral density(Decrease)

Other Age related changes in nutrition

• Composition and energy expenditure changes

• Sensory losses

• Other changes - social / LTC

How does fluid change with aging?

older adults at higher risk for dehydration bc they are eating less, which equals less fluid

How do calories change with aging?

Calorie needs decrease with age, but MOST micronutrient requirements stay the same

How does protein change with aging?

The RDA for protein is 0.8 g/kg for both men and women from the age of 19 years and older.

• Older adults have a higher protein need: 1.0-1.2 gm/kg for a healthy person

How does vitamins and minerals change with aging?

• Most recommended levels of intake for vitamins and minerals do not change with aging.

• Significant exceptions

• Calcium (need INCREASES)

Women increase over age 51 due to menopause and decrease estrogen levels

Men age 70

• Vitamin D (need INCREASES)

• Iron (goes down, actually)

Women iron needs go down after menopause

Men stays same however, deficiency goes up posisbloy to do poor absoprtion

• Vitamin B12 (risk of deficiency goes up) due to Low HcL production

• DRI for sodium decreases.

-Why does nutrient density become more important for older people?

Older people eat less calories so those calories need to be more dense to make up for less intake

-Which vitamins and minerals are of concern for older people?

Vitamin D, Calcium, Iron, and B12

-What is frailty and how can it impact nutrition and health status in older adults?

Diminished strength, endurance, and physiologic function that increase an individual's vulnerability for developing dependency

-What is sarcopenia and how does it impact older adults? What is the nutrition approach to managing this disease state?

Defined as loss of muscle mass, strength & function that occurs with age

-Increasing protein intake can be helpful to maintain muscle mass, 1.0-1.2 g/kg for OA

-Older Adults CAN gain muscle mass and weight

Screen tool FRAIL

F - Fatigue

R - Resistance

Can they walk up 1 flight of stairs

A- Aerboic

Can they walk one block

I - Illness

5 or more illnesses

L - Loss of weight

Loss of 5% or more of weight in last 6 months

Osteopenia and Osteoporosis

• Osteopenia: low bone mass

• Osteoporosis: BMD is so low that the skeleton cannot sustain ordinary strains

Osteopenia and Osteoporosis Risk Factors

Low body weight, petite frame, low muscle mass, Female, Caucasian and Asian higher

Osteopenia and Osteoporosis Nutrition Therapy

- Calcium, vitamin D & K2 supplementation

- Other bone minerals (phos, zinc, mag, K2)

- Adequate protein, 1.0- 1.2 g/kg for OA

Osteopenia and Osteoporosis Important Notes

Weight bearing excerise helps bone mineral density

Prevention is key

Older adults at greatest risk of consuming an inadequate diet are those who are:

Less educated/ low health literacy

Live alone/socially isolated

Have low incomes

Are in LTC (long term care)

Screening criteria for malnutrition in older adults.

Needs assistance in self-care

Disease

Eating poorly

Tooth loss/mouth pain

Economic hardship

Reduced social contact

Involuntary weight loss/gain

Medications

How to screen for Needs assistance in self-care

Are you able to not shop or feed yourself

How to screen for Disease related to malnutrition

Do you have illness that changes food or amount you eat

How to screen for Eating poorly related to malnutrition

Do you eat fewer than 2 meals a day

How to screen for Reduced social contact related to malnutrition

Do you eat alone most of the time

How to screen for Involuntary weight loss/gain related to malnutrition

Gained or loss 10 lbs without trying

What weight do you feel best at

How to screen for Medications related to malnutrition

Do you take three or more prescribed or over-the-counter drugs a day?

Medications effects on nutrition

-Dry mouth, changes in taste & smell, GI Upset

-PPIs- Affects B12, iron, calcium absorption

-Statin- Affects CoQ10., D, calcium, potassium

-BP meds- Affects Magnesium, calcium, potassium

Know the three main components that contribute to total energy expenditure

Basal Metabolic Rate, Thermic Effect of Food and physical activity

Basal metabolic rate (BMR)

Basal metabolic rate (BMR) Represents the rate at which the body expends energy to sustain basic life processes, respiration, heartbeat, blood circulation, etc.

Basal metabolic rate percentage of TDEE

(60-75% TDEE)

Factors That Increase BMR

Higher lean body mass

Greater height (more surface area)

Younger age

Elevated levels of thyroid hormone

Stress, fever, illness

Male gender

Pregnancy and lactation

Certain drugs, such as stimulants, caffeine, and tobacco

Working Out

Factors That Decrease BMR

Lower lean body mass

Lower height

Older age

- BMR decreases with age, 3-5% per decade after age 30

Depressed levels of thyroid hormone

Starvation, fasting or very-low Calorie diets

Female gender due to decreased lean tissue

The thermic effect of food (TEF) percentage of TDEE

10%

The thermic effect of food (TEF)

The Thermic Effect of Food represents the increase in energy expenditure associated with the body's processing of food

- Digestion,

- Absorption,

- Transport,

- Metabolism,

- Storage of energy from ingested food.

TEF Interpretation

Higher TEF --> Less efficient the process is --> More energy to metabolize food --> More heat generated or calories burned

The energy expenditure of physical activity or exercise Categories

#1 Exercise Activity Thermogenesis (EAT)- Physical Exercise

#2 Non Exercise Activity Thermogenesis (NEAT)-Simple moving

-Understand the difference between Exercise Activity Thermogenesis (EAT) and Non Exercise Activity Thermogenesis (NEAT). Which one burns more calories?

Exercise Activity Thermogenesis (EAT) 10-15%

Increased with longer exercise duration or higher intensity

Decreased with shorter exercise duration or lower intensity

Non-Exercise Activity Thermogenesis (NEAT) 30%

Increased by being more active in your day through standing, walking, fidgeting, etc.

Decreased by being more sedentary

The energy expenditure of physical activity or exercise percentage of TDEE

(15-30% TDEE)

-What is BMI?

Body mass index (BMI)- Expresses the ratio of a person's weight to the square of his or her height

BMI Flaws

-Muscle Mass

-Older People

-Certain Ethnic Groups

BMI Categories

• UNDERWEIGHT: 18.5 or below

• Overweight: ≥25.

• Obesity: BMI ≥30.

Morbidly obese >40

• Outside 18.6-24.9 = associated with risks of health problems

BMI Foundational Model Sizes

Men and women in same category for BMI

• Ideal weight for women

Height 5' = 100 pounds

Every inch over 5' add 5 pounds

• Ideal weight for men

Height 5' = 106#

Every inch over 5' add 6 pounds

Example woman: 5'5", 100 + 25 = 125 pounds

Then add the range: 125# +/- 10% = 112.5-137.5

Adjusted IBW Use Vs BMI

Someone who is obese

This is because they automatically have more muscle than someone of equivalent height

Add 25% of total excess weight to their ideal body weight

More realistic ideal body weight for someone obese

-What tools are used to measure body composition?

-Underwater weighing

-Skinfold measurements

-Bioelectrical impedance analysis (BIA)

-Dual-energy x-ray absorptiometry (DEXA) (gold standard)

-Bod Pod (gold standard)

Fat distribution pattern measurment

-Measured by waist-to-hip ratio and waist circumference

-Disease risk is associated with a waist-to-hip ratio of higher than 0.90 in men, and 0.80 in women

-Apple-shaped fat patterning: mid-body Health Associations

-Apple-shaped fat patterning: mid-body

-Increased risk of chronic diseases (type 2 diabetes, heart disease, hypertension)

-Pear-shaped fat patterning: lower body Health Associations

-Pear-shaped fat patterning: lower body

-Some studies show less risk of chronic diseases

-Identify factors that contribute to maintenance of body weight, gaining weight, or losing weight

- Energy intake versus energy expenditure

- Genetic factors

- Composition of the diet

- Metabolic factors

- Physiologic factors

- Cultural and economic factors

- Social factors

- Emotional Factors

- Hormonal

FTO gene

- Fat mass and obesity associated gene

• Thrifty gene theory

- Proposes that a gene (or genes) causes people to be energetically thrifty

• Set-point theory

- Proposes that each person's weight stays within a small range

- Cultural and economic factors on weight

Cultural customs and beliefs

Changes in work and leisure activity levels

Cultural norms related to body size

Lack of health literacy

Food Environment

Lack of access to affordable, healthful foods

- Social factors on weight

Expectations of others, holidays

• Buffets, fast foods, serving sizes

• Work responsibilities, devices, other distractions

• Pressures to achieve unrealistic weight goals

• Feelings/emotions, trauma, body image

Hormones that play a role in weight:

TSH, Insulin, Sex Hormones, Cortisol, Leptin, Ghrelin

Hormonal influences: Ghrelin

Ghrelin- "hunger hormone"

• Produced by the stomach and duodenum

• Ghrelin secretions increases between meals when the stomach is empty.

-High levels of ghrelin make us feel hungry.

-Returns to normal after eating

Hormonal influences: Leptin

• Leptin is the Satiety (Fullness) Hormone. When leptin is high you experience fullness and stop eating

• Leptin is produced in our fat cells

• As body fat decreases -->

Leptin is reduced --> =Appetite increases

• As the body fat level increases --> Leptin levels increase --> Appetite is reduced(Calorie intake should be reduced!)

Leptin Resistance

Leptin Resistance- the body's inability to properly respond to leptin, plays a role in overeating and obesity.

What causes Leptin Resistance?

-High stress

-Poor Sleep

-Overeating

-High insulin & triglycerides-Processed foods, sugar & HFCS

-Yo-yo dieting

-Too little or too much exercise

-Excessive snacking

Insulin Impact on hunger

• Insulin regulates hunger when working properly

-Insulin resistance can lead to increased feelings of hunger.

-Increased fat storage

Calorie Reduction Approach to weight Loss

Most common approach to weight loss

Often focused on limiting calories and may or may not focus on nutrient quality

Calorie Reduction Approach Diets

Reducing Macro Groups: Keto, Atkins -Low carb, high fat, low fat, etc

Calorie Reduction: Jenny Craig, Weight Watchers, etc-No focus on food quality

Other Diets: Vegan, Low Fat, South Beach, Beach Body, Zone, Intermittent Fasting, Paleo...

Fad Diets Approach to weight loss Characteristics:

• Claims rapid weight loss

• Eliminates or severely restricts entire food groups/categories of food

• Requires the purchase of a product

• Involves restrictive calorie counting and/or counting of macronutrients

• Claims a new discovery, secret or undiagnosed illness

• May be promoted by a celebrity/doctor• Few people stick with fad diets long enough to harm themselves

• Results tend to be short term…

#1 reason for eating disorders

Who is Pharmacotherapy recommended for in weight loss

• People with a BMI ≥30

• People with a BMI ≥27 with comorbid conditions

• People with waist circumference >35 inches (women) and 40 inches (men) are also candidates for pharmacotherapy if comorbidities are present.

FDA approved drugs for pharmacologic weight loss

• Orlistat - fat blocker

• Phentermine-Topiramate -appetite supressant

• Naltrexone-Buproprion - anti depressant, anti-addiction

• Liraglutide (Saxenda) - GLP 1

• Semaglutide (Wegovy) - GLP 1

• Tirzepatide (Zepbound) - GLP 1

Who can get Bariatric Surgery for weight loss

• BMI >40

• BMI 35-39.9 with 1 co-morbidity

• BMI 30-34.9 with 2 co-morbidities

How does Bariatric Surgery work for weight loss

-Restricting the stomach's capacity

-Creating malabsorption of nutrients and calories

-Or a combination of both

Bariatric Surgery Types

Sleeve gastrectomy - Staples stomach in half to create pouch

Gastric bypass - Bypass stomach creating small stomach pouch and connecting pouch to small intestine

Gastric banding - Puts band near the esophageal sphincter to create small pouch and trick brain into thinking thats stomach

Weight Loss surgery results

Weight is lost for typically 3-5 years

Definite metabolic benefits

• Improve/eliminate type 2 diabetes

• Improved blood lipids

• Improved sleep apnea

Quality of life is important

Effect of low calorie diets

Calorie deprivation → Leads to energy reduction→ BMR Decreases→ Metabolism slows

• Metabolism adapts to lower intake, conserves energy stores

• Weight loss stalls/plateaus due to metabolic adaptation

Effect of diet on hormones

Leptin (satiety hormone) decreases because body fat stores decrease. → You don't feel full.

Hunger increases, people grow tired of restriction, continuing to lower calories becomes challenging.

-What is weight cycling?

Weight cycling refers to repeated loss and regain of weight, commonly occurring after attempts to lose weight, and is more common among obese individuals.

Impacts of weight cycling

Increases inflammation

Higher risks of mortality

Hypertension

Diabetes

Hyperlipidemia

Cardiovascular disease (CVD)

Stroke

Gallbladder disease

Osteoporosis

Altered immune function.

What are the principles of the HAES theory?

weight inclusive approach

addresses weight bias and weight stigma

Focuses on increased health and longevity

Reduces stigma against people of size which can contribute to health risks (weight cycling, disordered eating)

lifestyle interventions viewed as independent from weight

-What is weight stigma?

Weight stigma, or internalized negative attitudes about weight, increases the risk of hypertension, diabetes, hyperlipidemia, metabolic syndrome, eating disorders, and depression.

How does weight stigma impact patients in the healthcare setting?

Larger bodied people may not be able to get the healthcare they need because practitioners may be more focused on influencing their patients to lose weight, than addressing their current concerns

• Patients may feel shame and embarrassment about their weight. They may avoid regular medical care due to weight stigma, worsening their health conditions.