KNES 337 - Unit 11 Disordered Eating

PICA

a recognized eating disorder, eating of non-food substances

comes from the Latin word for magpie - a bird known for its unusual eating habits

recent addition to DSM

types: geophagia, pagophagia - can also be charcoal, ash, paper, chalk, cloth, baby powder, coffee grounds, eggshells 

• largely found in children and pregnant women

geophagia

eating clay or dirt

pagophagia

eating ice cubes, compulsive ice chewing and eating, one case found an individual consumed 10 kg of ice a day

link with iron deficiency anemia is a medical mystery, but treating the deficiency reduces the eating disorder 

ARFID

also a recognized eating disorder, not driven by body image, avoid certain types or textures of food

orthorexia

clean eating, most accurately described as ARFID, though not an official diagnosis yet

healthy body image

body acceptance, normal eating habits, healthy weight, height, body type

disordered eating

restricting, purging, weight and shape preoccupation, steroid use, striving for perfection, laxative abuse, compulsive overeating, excessive exercising, fasting, yo-yo dieting

causes of EDs

• multi factorial 

  • genetic, psychological, social factors (family, individual, triggers)

family causes

history of dieting/eating disorders, depression/anxiety/alcohol dependence, history of obesity

individual causes

female gender, genetics, premature birth, low self esteem, perfectionism, previous depression/anxiety, previous obesity, early puberty, diabetes, Crohn’s disease

possible triggers and maintaining factors

puberty, socio-cultural pressures (social media), family factors, pressure to achieve, behaviour of peers, comments about weight

biological risk factors

• close relative with eating disorder or mental health condition

• history of dieting - early in life, diets as a child

• low energy availability

• type I diabetes

psychological risk factors

• perfectionism 

• cognitive inflexibility - thinking can be tested, can be very set on something, the more inflexible, the higher the risk 

• impulsivity

• body image dissatisfaction

• personal history of mental health condition or substance use disorder

social risk factors

• weight stigma - being shown an ideal body image

• teasing/bullying

• limited social networks

• personal experience of trauma

• acculturation (those from another culture undergoing rapid Westernization)

  • coming into the Western culture can trigger it due to the Western body standards

diagnosing EDs

use of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

anorexia nervosa

• restriction of energy intake leading to significantly low body weight

  • criteria is the low body weight

• intense fear of gaining weight

• disturbance in body image

• 2 types (restricting and binge-eating/purging)

anorexia restricting type 

less calories by not eating

anorexia binge-eating/purging type

less calories by eating a large amount in a sitting, and vomiting it out

features of anorexia

• individuals typically severely restrict their food intake and may exercise intensely

• may self-induce vomiting after eating or misuse laxatives or diuretics

• family members and friends often report high levels of anxiety

• often model students or ideal children (perfectionism, high expectations), but in their personal lives may experience low self-esteem, social isolation, and unhappiness 

physical consequences of anorexia

• anemia - low iron in the blood, lead to fatigue

• low bone density - not getting calcium, vitamin D, low body weight, less weight bearing

• depression

  • many females drop below 12% body fat requirement for the nervous system —> related to depression

• amenorrhea - absence of menstruation 

• impaired immune response 

  • due to lack of nutrients 

• sensitivity to cold - no insulation

• soft, thick facial hair, thinning scalp hair

• low blood pressure 

• irregular slow heart rate, loss of muscle tissue - can lead to death 

  • lose a lot of body fat, using up protein stores from critical organs (heart, liver)

anorexia in men and women

• 1% of women, <0.1% of men

anorexia and age

• reported in girls ages 5-40s

  • encourage lifestyle improvements over dieting 

• usually begins during adolescence

• people at risk tend to be overly concerned about weight and food, and many attempted weight loss/dieted early 

anorexia treatment

• can take a lot of time, ongoing therapy important for continued recovery

• challenging because few with anorexia believe their weight needs to be increased

  • self-image, psychological aspect - they don’t see that they are underweight 

• Programs focus on…

  • normalize eating and exercise behaviours 

    • they feel guilty for eating normally

  • nutritional health and body weight

  • psychological counseling for self-esteem

  • attitudes about body weight and shape

  • antidepressant or other medications

  • family therapy 

• programs show complete success in 25-50% (depending on the study), and are partially successful in others 

bulimia nervosa

• recurrent episodes of binge eating

  • an episode of binge eating = eating within any 2 hour period, an amount of food that is definitively larger than what most people would eat in a similar period of time under similar circumstances

  • a feeling that one cannot stop eating or control what or how much one is eating

• recurrent inappropriate compensatory behaviour

  • prevent weight gain - self-induced vomiting, use of laxatives, diuretics, fasting, excessive exercise 

• occurs at least once a week for 3 months

• self-evaluation is unduly influenced by body shape and weight

bulimia vs. binge-eating/purging anorexia

• bulimia does not have the requirement of a very low body weight

• anorexia is characterized by the very low body weight

onset of bulimia

• often starts with voluntary dieting to lose weight, then control is lost 

  • feeling compelled to engage in binge eating and vomiting

• behaviours become cyclic, food binges are followed by guilt and/or depression, purging, and dieting

• once a food binge starts, it is hard to stop 

bulimia in men and women

occurs in 1-3% of young women and 0.5% of young men

features of bulimia

• people with bulimia usually are not underweight or emaciated 

• tend to be normal weight or overweight

• common among athletes

treatment of bulimia

• nutrition and counseling to break feast/famine cycles

• eating regular meals

• psychological counseling to improve self-esteem and attitudes toward body weight and shape 

• antidepressants may be useful 

• Recovery

  • full recovery of women is higher than for anorexia

  • most women with bulimia achieve partial recovery

  • ⅓ relapse to binging and purging within seven years 

binge-eating disorder

• episodes associated with 3 or more of the following

  • eating much more rapidly than normal

  • eating until feeling uncomfortably full

  • eating large amounts when not physically hungry

  • eating alone because of feeling embarrassed by how much one is eating

  • feeling disgusted with self, depressed or very guilty after overeating 

• binge eating occurs at least once a week for 3 months (on average)

features of binge-eating disorder

• likely to have overweight or obesity, ⅓ are male

• individuals eat several thousands calories during a solitary binge (2 hour period), feel a lack of control over the binges, experience distress or depression after the binge

people do not vomit, use laxative, fast, or exercise excessively in an attempt to control weight gain - no compensatory behaviours

binge-eating disorder stats

• 9-30% of people in weight-control programs and 30-90% of individuals with obesity have binge-eating disorder (different countries, more common in Western countries perhaps)

• condition is far less common (2-5%) in the general population 

treatment of binge-eating disorder

• focuses on disordered eating and underlying psychological issues

• need to identify what starts the binge - triggers

  • people asked to record food intake and note feelings, circumstances, and thoughts related to each eating event

  • information identifies circumstances that prompt binge eating and alternative behaviours to prevent it

  • could be based on the people that are around, the setting

• stress, depression, anger, anxiety, and other negative emotions prompt episodes 

eating disorder resources

• information and services for eating disorders are available

• services delivered by health care teams specializing and experienced

• primary care physician, dietitian, or nurse practitioner 

• reliable sources include Alberta Health Services, UofC Wellness Centre, Eating Disorder Support Network of Alberta