Healthy Eating and Eating Disorders Overview

Healthy Eating

• Definition: According to the National Eating Disorders Association (NEDA), "normalized, non-disordered eating" refers to a diet that includes a variety of foods, allowing individuals to mindfully respond to hunger cues while also being able to stop eating when they feel full.
• Characteristics of Healthy Eating:
  • Individuals can choose foods they enjoy and consume what they need and desire.
  • Eating is free from anxiety or guilt.
  • There is a thoughtful consideration of nutritious choices without obsession over caloric content or extreme restrictions.

Eating Disorder Facts

• Mortality Rates:
  • Eating disorders have one of the highest mortality rates among mental health disorders (Anorexia Nervosa and Associated Disorders, 2020).
  • They claim 10% of lives affected by these syndromes (Magnolia Creek, 2019).
  • At least one person dies every 52 minutes due to an eating disorder (ANAD, 2020).
  • Approximately 30 million people in the U.S. have struggled with an eating disorder at some point in their lives (NEDA, 2021b).

Eating Disorder Indicators

• Behavioral Changes:
  • Secrecy and rituals surrounding food/eating.
• Obsessive Behaviors:
  • Focus on calorie counting and fixation on food, weight, body shape, and size.
• Functional Changes:
  • Impacts on social, work, and school life.
  • Lowered self-esteem and potential physical illnesses.

Eating Disorder Warning Signs

• Physical Changes:
  • Unexplained weight fluctuations (loss/gain).
• Behavioral Signs:
  • Lying about food consumption.
  • Engaging in secret eating or bingeing.
  • Excessive exercise routines.
  • Preoccupation with weight and body image.
  • Intense fear of fat.

Eating Disorders: Major Classifications

• Anorexia Nervosa (AN):
  • Characterized by self-induced starvation.
• Bulimia Nervosa (BN):
  • Involves binge eating followed by purging behaviors.
• Binge-Eating Disorder (BED):
  • Involves repeated rapid consumption of large amounts of food unrelated to hunger (APA, 2013).

Other Eating Disorders

• Avoidant Restrictive Food Intake Disorder:
  • Inflexible eating habits, strong sensory aversions or fears of certain foods.
• Orthorexia:
  • An obsession with eating "clean" foods.
• Diabulimia:
  • Diabetics who stop taking insulin to lose weight.
• Pica:
  • Consumption of non-edible items (dirt, paper); commonly seen in children.
• Rumination Disorder:
  • Chewing, reswallowing, or spitting out regurgitated food (APA, 2013).

Risk Factors

• Mental Health Conditions:
  • Anxiety, depression, and substance misuse can increase risk.
• Personality Disorders:
  • Includes obsessive-compulsive, avoidant, and borderline personality disorders.

Continued Risk Factors

• Biological/Genetic Influences:
  • Family history of eating disorders, although no specific gene has been isolated yet.
• Socioeconomic Stresses:
  • Influenced by culture, occupation, family dynamics, and potential abuse (ANAD, 2021).

Serotonin Dysregulation

• Research Findings:
  • Clinical studies suggest that alterations in the serotonin system can impact feeding behaviors.
  • Family history of mood or anxiety disorders may relate to this.

Contributing Biological and Genetic Factors

• Familial Patterns:
  • Eating disorders are more common among family members than in the general population.
• Hypothalamic Dysfunction:
  • Disruption in hypothalamus may contribute to eating disorders.

Trends in Eating Disorders

• Gender Ratio:
  • Historically, there is a 10:1 female to male ratio in eating disorders (NEDA, 2021b).
• Transgender Population:
  • An increase in eating disorders reported among transgender individuals (ANAD, 2021).

Complications Arising from Eating Disorders

• Potential Health Issues:
  • Diabetes (e.g., ketoacidosis), electrolyte disruptions, osteoporosis (leading to fractures and dental issues).
  • Risk of kidney failure, cardiac dysfunction, neuroendocrine problems (thyroid function, menstrual cessation, brain atrophy), as well as skin complications.

Anorexia Nervosa – DSM-5 Criteria

• Energy Intake Restriction:
  • Significant reduction of energy intake relative to requirements, resulting in significantly low body weight based on age, sex, developmental stage, and physical health.
• Fear of Weight Gain:
  • Intense fear of gaining weight or behaviors that inhibit weight gain even underweight.
• Body Image Disturbance:
  • Distorted perception of one's weight, undue influence of weight on self-evaluation, or lack of recognition regarding low weight seriousness.

Anorexia Nervosa – Clinical Presentation

• Physical Appearance:
  • Typically emaciated, exhibiting hypotension, bradycardia, and dysrhythmias.
  • Other symptoms may include hypothermia, dehydration, peripheral edema, and acrocyanosis.
• Onset Age:
  • Usually occurs between 14 and 18 years old.

Anorexia Nervosa – Additional Clinical Presentation

• Skin and Hair:
  • Dry skin, mottled/orangey-yellow skin cast, brittle hair and nails.
• Dental and Bone Health:
  • Reduced bone density, potential issues with decayed or missing teeth.
• Other Symptoms:
  • Muscle weakness, gastrointestinal problems (loss of appetite, constipation), and menstrual irregularities (amenorrhea or infertility).

Anorexia Nervosa – Lab Abnormalities

• Common Findings:
  • Reduced levels of sodium, potassium, magnesium, calcium.
  • Possible anemia and neutropenia.
  • Risk of hypoglycemia.

Anorexia Nervosa – Psychological and Cognitive Manifestations

• Thinking Patterns:
  • Negative and self-defeating thinking.
  • Examples of cognitive distortions include:
  • Polarized thinking
  • Emotional reasoning
  • Catastrophizing
  • Control fallacies
  • Mind reading
  • Often report trouble concentrating.

Types of Anorexia Nervosa

• Restrictive Type:
  • Characterized by control over food intake, including dieting and fasting.
• Binge/Purging Type:
  • Involves binge eating followed by purging methods (e.g., self-induced vomiting, misuse of laxatives, diuretics, or enemas).
• Compulsive Exercise:
  • Compulsive exercise can be used to avoid weight gain in either type.

BMI Reference for Anorexia

• Classification:
  • Anorexia is classified at a BMI of 17.5 or lower.
• General Weight Classifications:
  • Normal Weight: 20 to 24.9
  • Overweight: 25 to 29.9
  • Obesity: 30 or greater.
  • Average American Woman: BMI of 26.
  • Fashion Models: Generally BMI of 18.

Bulimia Nervosa – DSM-5 Criteria

• Binge-Eating Episodes:
  • Characterized by consuming large amounts of food in a discrete time period.
  • Characterized by a feeling of lack of control over eating during these episodes.
• Compensatory Behaviors:
  • Engaging in inappropriate behaviors to prevent weight gain (e.g., self-induced vomiting, laxative misuse).
• Frequency:
  • Behavior occurs at least once a week for three months.
• Body Image Influence:
  • Self-evaluation unduly influenced by body shape and weight (APA, 2013).

Bulimia Nervosa – Manifestations

• Physical Health:
  • Patients may have normal weight, gastrointestinal disturbances, and lab abnormalities.
• Signs:
  • Parotid gland enlargement ("chipmunk cheeks"), dental caries, Russell’s sign (calluses/scars on knuckles).
• Onset Age:
  • Typically onset occurs late adolescence or early adulthood (18-19 years old).
  • Binge eating often begins during or after dieting.

Binge-Eating Disorder (BED) – DSM-5 Criteria (1 of 2)

• Binge-Eating Episodes:
  • Similarly characterized by consuming large amounts of food in a discrete period of time.
  • Feelings of a lack of control similar to bulimia.
• Frequency:
  • Occurs at least once a week for three months.
• Lack of Compensatory Behaviors:
  • Different from bulimia, BED does not include recurrent use of compensatory behaviors.

Binge-Eating Disorder (BED) – DSM-5 Criteria (2 of 2)

• Associated Features:
  • Binge-eating episodes meet three or more of the following:
  • Eating rapidly.
  • Eating until uncomfortable full.
  • Eating large amounts when not physically hungry.
  • Eating alone due to embarrassment.
  • Feelings of disgust with oneself, depression, or guilt after episodes.
  • Marked distress regarding binge-eating (APA, 2013).

Binge-Eating Disorder (BED) – Presentation

• Nutritional Deficiencies:
  • Dental caries often present.
• Gastrointestinal Disturbances:
  • Includes abdominal pain, cramping, bloating, nausea, and gastric acid reflux.
• Health Risks:
  • Increased risk of hypertension and heart disease, potential for obesity and diabetes.

Binge-Eating Disorder (BED) – Psychological and Cognitive Manifestations

• Mental Health:
  • Includes symptoms of depression and anxiety.
• Self-Image:
  • Feelings of guilt, shame, and embarrassment.
  • Low self-esteem and cognitive impairments (global).
  • Decreased inhibitory control and an addictive style of thinking.

Comparison of Major Conditions (1 of 3)

Comparison of Major Conditions (2 of 3)

Comparison of Major Conditions (3 of 3)

Interprofessional Team Approach

• Roles:
  • Provider: Prescribes medication and treatments; manages medical complications.
  • Nurse: Provides direct care to client, monitors eating patterns, weight, and health status.
  • Dietitian: Recommends nutritional intake; collaborates on diet plans.
  • Therapist: Conducts counseling sessions addressing emotional and psychological issues.
  • Social Worker: Facilitates discharge planning and coordinates case management.

Nurse’s Role

• Primary Responsibilities:
  • Assess personal values and attitudes towards eating disorders.
  • Establish trust and rapport with patients.
  • Utilize a therapeutic relationship as a cornerstone of mental health nursing.
  • Engage in therapeutic use of self.
  • Follow nursing processes to ensure effective patient care.

Nursing Process

• Assessment:
  • Recognizing cues from manifestations and lab values (e.g., glucose, electrolytes, CBC, liver panel, BUN, pancreatic enzymes, EKG, bone density).
  • Collect collateral data from family and friends.
  • Use the SCOFF tool for assessments:
  • S: Sick - vomit after meals due to feeling full?
  • C: Control - worried about losing control over eating?
  • O: One stone - lost more than one stone (14 pounds/6.4 kg) recently?
  • F: Fat - feel too fat even when others say you are too thin?
  • F: Food - does food dominate your life?

Analyzing Cues/Prioritizing

• Criteria for Analysis:
  • Medical Stability: Evaluate physiological functioning.
  • Psychosocial Aspect: Assess mood and affect.
  • Safety Considerations: Ensure a safe environment for care.
  • Educational Needs: Discuss treatment/therapy, medications, nutrition, and resources.

Generating Solutions

• Decisions:
  • Determine inpatient or outpatient care based on acuity of condition.
  • Address physiological stability needs.
  • Engage in nutritional engineering for weight restoration/maintenance.
  • Address psychosocial needs related to body image and self-esteem.

Take Action – Nutritional Re-engineering

• Care Strategies:
  • Placement in specialized units may occur; dietitian involvement is essential.
  • Daily caloric intake may start low (approximately 1800 calories).
  • Close monitoring to prevent refeeding syndrome, a condition characterized by fluid/electrolyte shifts and cardiovascular decompensation.
  • Regular monitoring of vital signs, weight, and relevant lab tests.

Take Action – Pharmacotherapy

• Medications:
  • Vitamins and minerals for deficiencies.
  • GI medications such as bulk laxatives and simethicone for discomfort.
  • Psychedelic medications (e.g., antidepressants, mood stabilizers, anxiolytics).
  • FDA Approved Medications:
  • Fluoxetine for bulimia.
  • Olanzapine for anorexia.
  • Lisdexamfetamine dimesylate for BED.

Take Action – Meal Monitoring

• Procedures:
  • Meals must occur within a designated timeframe.
  • All food on tray should be consumed ( "Food is medicine").
  • Supplements may be included in dietary plans.
  • Strict calorie counting to ensure nutritional needs are met.
  • Vigilance for any food hiding or smearing behaviors.

Take Action – Bathroom Monitoring & Weighing Protocols

• Post-meal Procedures:
  • Implement protocols to wait one hour after meals before bathroom breaks to deter purging.
  • Daily weights should occur under controlled conditions (morning after voiding, before breakfast).
  • Quality control with the use of hospital gowns during weighing.

Take Action – Psychosocial Interventions

• Therapeutic Approaches:
  • Acceptance Commitment Therapy: Assists clients in aligning behavior with personal values.
  • Behavioral Therapy: Rewards and motivations for reinforcing treatment behaviors.
  • Cognitive Behavioral Therapy: Focuses on reframing negative or dysfunctional thoughts.
  • Dialectical Behavioral Therapy: Enhances skills for mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.

Evaluating Outcomes

• Overall Goals:
  • Achieve weight stabilization and restoration.
  • Address nutritional reengineering.
  • Develop improved coping skills.
• Assessment of Interventions:
  • Determine which interventions were successful in aiding recovery.