Nutrition Lecture 14: Some Disorders Which Affect Nutrition

Lecture Objectives

  • Differentiate between disordered eating and eating disorders with specific examples and detailed criteria.

  • Elaborate on the potential causes of disordered eating, including genetic, biological, psychological, and social factors with supporting evidence.

  • Clearly distinguish between anorexia nervosa, bulimia nervosa, and binge-eating disorder, detailing diagnostic criteria, physical and psychological symptoms, and comprehensive treatment approaches.

  • Describe issues related to eating disorders, such as comorbid mental health conditions, medical complications, and the roles of various professionals involved in treatment, including dietitians, psychologists, psychiatrists, and medical doctors.

Eating Disorders in Australia

  • Provide updated statistics on the prevalence of eating disorders among Australians, citing credible sources.

  • Prevalence:

    • Bulimia nervosa: 1-2%

    • Anorexia nervosa: 0.3%

    • Binge-eating disorder: 47%

    • Other eating disorders: 38%

  • Include demographic data, such as age, gender, and socioeconomic status.

  • Highlight the increasing prevalence of eating disorders among males and transgender individuals.

  • Emphasize that eating disorders are complex mental illnesses with biological, psychological, and social underpinnings, not lifestyle choices.

Eating Disorder Continuum

  • Healthy Intuitive Eating: Describe characteristics, such as eating in response to hunger and satiety cues, flexible eating patterns, and a positive relationship with food.

  • Disordered/Restrictive Eating: Detail examples, such as chronic dieting, rigid food rules, and anxiety around food choices. Explain potential health consequences and risk factors for developing an eating disorder.

  • Eating Disorders: Provide clear definitions and diagnostic criteria for anorexia nervosa, bulimia nervosa, and binge-eating disorder, referencing DSM-5 criteria.

Causes of Eating Disorders

  • Emphasize that eating disorders have no single cause but result from a complex interplay of genetic, biological, psychological, and social factors.

  • Genetic factors:

    • Discuss specific genes and neurotransmitter pathways implicated in the development of eating disorders, such as genes related to appetite regulation, metabolism, and reward processing.

  • Biological factors:

    • Explain the role of neurotransmitters like serotonin, norepinephrine, and dopamine in appetite regulation, mood, and impulse control. Discuss how imbalances in these neurotransmitters may contribute to the development of eating disorders.

  • Psychological factors:

    • Elaborate on the role of peer relationships, family expectations, emotional trauma, and personality traits (e.g., perfectionism, obsessive-compulsiveness) in the development of eating disorders. Provide examples of how these factors may interact to increase risk.

  • Social factors:

    • Discuss the impact of media portrayals of ideal body sizes and shapes, cultural norms around dieting and exercise, and weight-based discrimination on body image dissatisfaction and disordered eating behaviors.

Case Study 1: Chloe

  • Provide additional details about Chloe's background, personality, and family dynamics.

  • Explore the psychological impact of the coach's behavior on Chloe's self-esteem and body image.

  • Discuss the potential long-term consequences of Chloe's restrictive eating and excessive exercise on her physical and mental health.

Eating Disorders in New Zealand

  • Update statistics on the prevalence of eating disorders in New Zealand, citing recent research and surveys.

  • Provide additional information on the specific types of eating disorders most commonly diagnosed in New Zealand.

  • Discuss cultural factors that may contribute to the development of eating disorders in New Zealand, such as cultural norms around body size and shape.

  • 1. 7% of the population (68,000 people) will develop an eating disorder in their lifetime.

  • Bulimia is twice as common as anorexia.

  • Gender Distribution : Women represent about 90% and men 10% of all eating disorders (but this may be changing)

  • Transgender people have a higher risk (Men 10.5%, Women 8%)

  • Approximately 20% never recover from an eating disorder.

  • Average age of onset: 17 years old.- Bulimia typically affects females in their late teens and 20s.

Anorexia Nervosa: Diagnostic Criteria

  • Bodyweight less than 85% of expected. Body Mass Index (BMI) Formula: BMI=weight(kg)height(m)2BMI = \frac{weight (kg)}{height (m)^2}. BMI less than 17.5.

  • Elaborate on the use of BMI as a diagnostic tool and its limitations. Discuss alternative measures of body composition and nutritional status.

  • Intense fear of weight gain.

  • Discuss the cognitive distortions and irrational beliefs that contribute to the intense fear of weight gain in individuals with anorexia nervosa.

  • Distorted body image.

  • Explain the concept of body image disturbance and how it manifests in individuals with anorexia nervosa. Discuss the use of body image assessment tools and therapeutic interventions.

  • Amenorrhea: absence of three or more menstrual cycles.

  • Explain the physiological mechanisms underlying amenorrhea in individuals with anorexia nervosa. Discuss the potential long-term health consequences of amenorrhea, such as bone loss and infertility.

Causes

  • Detail the psychological and emotional issues often underlying anorexia, such as low self-esteem, perfectionism, anxiety, and depression.

Warning Signs

  • Significant weight loss.

  • Prolonged dieting.

  • Feeling fat, even after losing weight.

  • Preoccupation with food, calories, nutrition, and/or cooking.

  • Eating in isolation and compulsive exercise.

  • Use of diuretics and laxatives to lose weight.

  • Provide specific examples of behaviors and attitudes that may indicate anorexia nervosa, such as:

    • Cutting food into tiny pieces or rearranging food on the plate.

    • Making excuses to avoid eating or lying about food intake.

    • Wearing baggy clothes to hide weight loss.

    • Social withdrawal and isolation.

Case Study 2: Julie

  • Provide additional details about Julie's academic achievements, extracurricular activities, and social relationships.

  • Explore the potential triggers for Julie's eating disorder, such as academic pressure, family expectations, and peer influences.

  • Discuss the medical complications that Julie may experience as a result of her eating disorder, such as electrolyte imbalances, cardiac abnormalities, and bone loss.

  • Highlight the importance of early intervention and multidisciplinary treatment for individuals with anorexia nervosa.

Anorexia Nervosa: Characteristics (contd.)

  • Provide additional examples of Julie's restrictive eating behaviors and compensatory behaviors, such as:

    • Skipping meals or eating only small portions of low-calorie foods.

    • Obsessively tracking calories and macronutrients.

    • Engaging in excessive exercise, even when injured or exhausted.

    • Using laxatives, diuretics, or diet pills to control weight.

  • Discuss the cognitive and emotional symptoms that Julie may experience, such as:

    • Intense fear of weight gain.

    • Distorted body image.

    • Low self-esteem.

    • Anxiety and depression.

    • Social isolation.

Anorexia Nervosa: Physical Effects

  • Loss of fat stores and muscle tissue.

  • Reduced thyroid metabolism.

  • Cold intolerance.

  • Leukopenia: abnormal decrease of white blood cells.

  • Iron-deficiency anemia.

  • Growth of lanugo (fine hairs) over the trunk.

  • Osteopenia and osteoporosis.

  • Loss of cardiac tissue and abnormal heart rhythm.

  • Bloating and constipation.

  • Provide detailed explanations of the physiological mechanisms underlying each of these physical effects. Discuss the potential long-term health consequences of these effects, such as:

    • Organ damage.

    • Infertility.

    • Cognitive impairment.

    • Increased risk of mortality.

Anorexia Nervosa: Treatment
Immediate Goals

  • Stabilize physical condition.

  • Gain patient participation.

  • Emphasize the importance of medical monitoring and management during the initial stages of treatment.

Then

  • Restoring nutritional status.

  • Gradual weight gain with a focus on learning to respond to hunger signals.

  • Address the psychological and emotional issues underlying anorexia, such as:

    • Cognitive distortions.

    • Body image dissatisfaction.

    • Low self-esteem.

    • Anxiety and depression.

  • Psychotherapy:

    • Individual, group, and family therapy.

    • Describe different types of psychotherapy used in the treatment of anorexia nervosa, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and family-based therapy (FBT).

Bulimia Nervosa: Diagnostic Criteria

  • Recurrent binge eating (at least twice a week for 3 months).

  • Recurrent purging, excessive exercise, fasting.

  • Excessive concern about weight and shape.

Causes

  • Genetics, biology, emotional health, societal expectations and other issues.

  • Discuss the etiological factors for Bulimia Nervosa to the same level of detail as Anorexia Nervosa

Warning Signs

  • Frequent bathroom use after meals.

  • Preoccupation with body weight.

  • Depression or mood swings.

  • Irregular menstrual periods.

  • Dental problems, swollen cheeks or glands, heartburn.

Bulimia Nervosa: Binge/Purge Cycle

  • Triggers (e.g., stress, anxiety, depression) lead to bingeing.

  • Bingeing is followed by a morbid fear of weight gain, leading to purging.

  • Purging results in a transient loss of fear but also fear of discovery and guilt.

  • Binge: consuming a large amount of food in a short period.

    • High-calorie, high-fat foods.

    • Describe the characteristics of a binge episode, including:

      • Feeling out of control.

      • Eating rapidly and without pleasure.

      • Consuming large quantities of food in a short period of time.

  • Purge:

    • Affects fluid and electrolyte balance and pH.

    • Esophageal inflammation.

    • Erosion of dental enamel.

    • Fatigue and weakness.

    • Seizures.

    • Can be life-threatening.

    • Provide detailed explanations of the physiological mechanisms underlying each of these physical effects. Discuss the potential long-term health consequences of these effects, such as:

      • Electrolyte imbalances.

      • Cardiac arrhythmias.

      • Esophageal rupture.

      • Tooth decay.

Case Study 3: Kelly

  • Provide additional details about Kelly's personal and professional life.

  • Explore the potential triggers for Kelly's binge-purge cycle, such as:

    • Stress at work.

    • Relationship difficulties.

    • Body image concerns.

  • Discuss the psychological and emotional consequences of Kelly's bulimia nervosa, such as:

    • Low self-esteem.

    • Depression.

    • Anxiety.

    • Guilt and shame.

Bulimia Nervosa: Treatment
Medical

  • Hospitalization if severely depressed or facing imminent physical harm.

  • Emphasize the importance of medical monitoring and management during the initial stages of treatment.

Nutritional

  • Counseling focused on recognizing and responding to hunger signals.

  • Provide specific strategies for nutritional rehabilitation, such as:

    • Meal planning.

    • Regular eating patterns.

    • Mindful eating techniques.

Therapy

  • Antidepressant medications (pharmacotherapy).

  • Psychotherapy.

  • Describe different types of psychotherapy used in the treatment of bulimia nervosa, such as:

    • Cognitive-behavioral therapy (CBT).

    • Interpersonal therapy (IPT).

    • Dialectical behavior therapy (DBT).

Binge Eating Disorder

  • Persistent feelings of hunger.

  • Obsessive thinking about food.

  • Triggering event (e.g., anxiety, stress, depression).

  • Episodes of bingeing or grazing.

  • Feelings of helplessness.

  • Feelings of guilt, embarrassment, or shame.

Diagnostic criteria

  • Recurrent binge eating.

  • Distress over-eating behaviors.

  • No recurrent purging.

  • Absence of anorexia.

  • Detail the distress and psychological impact

Triggers of binge eating

  • Stress

  • Conflict

  • Frequent dieting

Treatment

  • Psychotherapy.
    -Cognitive behavioral therapy

  • Long-term support.
    -Support groups

Case Study 4: Charlie

  • Provide a comprehensive overview of Binge Eating Disorder, including its diagnostic criteria, clinical features, and associated health risks.

Orthorexia Nervosa

  • Term defined as the “fixation on righteous eating,” coined in 1997 by Steven Bratman, MD.

  • Ortho = right, correct.

  • Not merely healthy eating but a "Healthy Eating Disorder."
    -Discuss how this differs from just healthy eating behaviors

Characteristics

  • Preoccupation with healthy eating: Time spent thinking about, planning, and preparing healthy food interferes with other activities.

  • Fear of unhealthy foods: Eating or being near unhealthy food is distressing, creates anxiety and shame; personal happiness depends on the purity of the foods consumed.
    -Explain the long term dangers associated with Orthorexia Nervosa

Relative Energy Deficiency in Sport (REDS)

  • RED-S- Replaced the term “Female Athlete Triad”
    -Describe the components

Preventing Eating Disorders

  • Promote self-esteem.

  • Accept the diversity in all sizes and shapes.

  • Promote an understanding of nutrition for health (rather than body shape).

  • Present accurate information about nutrition, weight management, and health.

  • Encourage eating in response to hunger, not emotions.