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L20_Eating Disorders, Disordered Eating_M

Learning Objectives

  • Eating disorder types

  • Etiology of eating disorders

  • Metabolic and performance consequences associated with eating disorders/disordered eating

Disordered Eating and Eating Disorders

Definition

  • Eating Disorders: A psychiatric disorder characterized by severe disturbances in body image and eating behaviors. Here, emotional aspects of food overshadow the role of nourishment.

  • Disordered Eating: A broad spectrum of eating behaviors aimed at losing weight or maintaining an abnormally low body weight.

Disordered Eating Spectrum

  • Involves unhealthy patterns of eating that can lead to clinical eating disorders.

Types of Eating Disorders

Common Eating Disorders

  • Anorexia Nervosa: Extreme restriction of food intake and an intense fear of gaining weight.

  • Bulimia Nervosa: Binge eating followed by compensatory behaviors to prevent weight gain.

  • Binge Eating Disorder: Recurrent episodes of eating large quantities of food, often to the point of discomfort, without compensatory behaviors.

  • Other Specified Feeding or Eating Disorders (OSFED): Unspecified eating disorder that does not meet criteria for other specific disorders.

Disordered Eating Patterns in Athletes

  • Anorexia Athletica: Focus on excessive weight control and eating behaviors.

  • Muscle Dysmorphia: Preoccupation with increasing muscle size.

  • Orthorexia: Obsession with eating healthy food.

Prevalence Statistics

  • Females:

    • Anorexia Nervosa: 0.9%

    • Bulimia Nervosa: 1.5%

    • Binge Eating Disorder: 3.5%

  • Males:

    • Anorexia Nervosa: 0.3%

    • Bulimia Nervosa: 0.5%

    • Binge Eating Disorder: 2.0%(Hudson et al., 2007)

Causes of Eating Disorders

Factors Influencing Development

  • Biological Component: Genetic predisposition may play a role.

  • Social/Cultural Factors: Cultural ideals regarding body image, familial influences, and peer pressure contribute significantly.

  • Psychological Factors: Low self-esteem, experiences of teasing, desire for control, and perfectionism are common antecedents.

Historical and Cultural Influences

  • 1900: Lillian Russell exemplifies an accepted beauty at ~90 kg (200 lbs).

  • 1920s: The rise of the thinner flapper look; Twiggy represents a shift to very slim ideals.

  • 1950s: Marilyn Monroe sets a new standard of curvy beauty.

  • 1980s: Fitness culture, as seen in Jane Fonda's workout popularity, influences body image perceptions.

  • Today's ideal combines slimness with muscularity.

Disordered Eating in Athletes

At-Risk Groups

  • Athletes in aesthetically demanding sports (e.g., gymnastics, diving).

  • Sports focused on weight classes (e.g., boxing, wrestling).

Prevalence Rates

  • Elite athletes possess a threefold higher risk for eating disorders compared to non-athletes.

  • Up to 70% of elite athletes in weight class sports exhibit disordered eating patterns.

Anorexia Nervosa

Diagnostic Criteria

  • Very Low Body Weight: Less than 85% of expected weight for height and age.

  • Fear of Weight Gain: Intense anxiety about gaining weight.

  • Distorted Body Image: Misperception of body weight or shape.

  • Amenorrhea: Cessation of menstrual periods in females.

Subtypes

  • Restriction Type: Significant energy reduction.

  • Bingeing/Purging Type: Binge eating followed by purging, exercising, or fasting.

Physical Consequences of Anorexia Nervosa

  • Hematological: Anemia and other blood abnormalities.

  • Skeletal: Low bone density, higher risk for fractures.

  • Nervous System: Heightened incidence of depression, anxiety, and mental fogginess.

  • Endocrine: Risks of infertility.

  • Dermatological: Poor skin quality and low body temperature.

  • Dermatological: Thinning hair and lanugo.

  • Cardiovascular: Risk of hypotension, irregular heart rate, and tissue loss.

  • Gastrointestinal: Common manifestations include constipation.

Bulimia Nervosa

Diagnostic Criteria

  • Binge Eating: Characaterized by recurring episodes, typically occurring within a 2-hour window.

  • Compensatory Behaviors: Could include self-induced vomiting, use of laxatives, excessive exercise, or fasting.

  • Frequency: Occurrences at least twice a week over three months.

Other Symptoms

  • Physical signs include Russell’s sign (indicative of self-induced vomiting), tooth enamel erosion, and parotid gland swelling.

Binge-Eating Disorder

Diagnostic Criteria

  • Binge Eating: Consuming larger quantities of food than typical within a 2-hour time frame.

  • Overeating Awareness: Recognized sense of loss of control during episodes.

  • Associated Features: Rapid eating, eating until discomfort, eating when not hungry, isolation during eating, and post-eating disgust leading to depressive feelings.

  • Frequency: At least once a week for three months.

Anorexia Athletica

Definition and Characteristics

  • A condition driven by inappropriate eating behaviors and controlling weight to thwart fat increases.

  • Common features include excessive exercise, dietary restriction, and considerable fear surrounding weight gain.

Female Athlete Triad

Concept Overview

  • A medical condition illustrating the interdependent relationship between energy availability, menstrual function, and bone mineral density.

  • Consists of Disordered Eating, Amenorrhea, and Osteoporosis.

Energy Availability

  • Defined as dietary energy consumption minus exercise energy expenditure. It indicates energy available for bodily functions post-exercise.

Relative-Energy Deficiency in Sport (RED-S)

Definition

  • A syndrome reflecting physiological complications arising from insufficient energy availability to meet bodily requirements.

  • Affects both female and male athletes in various sports.

Systems Affected

  • Impacts endocrine, gastrointestinal, cardiovascular, reproductive, renal, and central nervous systems.

Performance Implications

  • Results in decreased endurance and strength, diminished training response, poor CNS functioning, and increased injury risk.

Muscle Dysmorphia (Bigorexia)

Definition

  • An obsession with body size, muscularity, and concern over perceived inadequacies in muscle development.

Signs

  • Symptoms include excessive muscular preoccupation affecting personal life, high levels of exercise fixation, strict dietary adherence, and potential for substance abuse (e.g., steroids).

Orthorexia Nervosa

Definition

  • Unhealthy focus on eating only foods perceived as healthy or beneficial for well-being.

Motivations and Signs

  • Motivations often stem from health-consciousness, identity issues, or control. Symptoms include devoting excessive time to meal planning and experiencing guilt when deviating from strict eating habits.

Prevention of Eating Disorders/Disordered Eating

Multidisciplinary Approach

  • Primary Prevention: Focused on protection against predisposed factors; prioritizes skill development over weight management; discouragement of dieting.

  • Secondary Prevention: Involves early detection and medical referrals.

  • Tertiary Prevention: Aims to prevent disorder chronicity.

Resources

  • Local Health Services: FRAILUXA and similar medical facilities.

  • National Eating Disorder Information: Source for advice and resources.

  • Mental Health Teams: Support options available at various institutions.

  • TED Talk: "Eating Disorders from the Inside Out" by Laura Hill available at https://youtu.be/UEysOExcwrE.