The Nutrition Care Process for Binge Eating Disorder Leah

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The Nutrition Care Process for Binge Eating
Disorder

• Leah Bekkerus
• Concordia College
• Moorhead, MN

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Objectives

• Be able to identify Binge Eating Disorder (BED)
• Identify the two types of binge eating disorder
• Identify the factors that contribute to binge
  eating disorder
• Understand the nutrition care process associated
  with binge eating disorder
• Understand motivational interviewing
• Be able to identify ethical issues associated
  with binge eating disorder

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Statistics

• 1 in 142 people in the United States suffer from
  binge eating disorder
• Approximately 1.9 million people
• 2 of United States population
• Has become the most
• common eating disorder

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What is Binge Eating Disorder?

• Binge Defined
• An act of excessive or compulsive consumption
• Binge Eating Disorder Defined
• An eating disorder characterized by recurring
  episodes of binge eating accompanied by a sense
  of lack of control and often negative feelings
  about oneself but without intervening periods of
  compensatory behavior.
• Merriam- Websters Medical Dictionary

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What is Binge Eating Disorder? (cont.)

• Frequent episodes of uncontrollable binge eating
• Feeling extremely distressed or upset during or
  after the binge
• No regular attempts to make up for the binge
• Vomiting
• Fasting
• Overexercising

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Types of Binge Eating

• Objective Binge Eating (OBE)
• Loss of control over eating
• Large amount of food is consumed
• Subjective Binge Eating (SBE)
• Sense of out of control over eating
• Large amount of food not consumed

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Binge Eating Disorder vs.Objective Overeating

• Binge Eating Disorder
• Sense the loss of control
• Feel remorse
• Consume excess amounts of food
• Objective Overeating
• Do not sense the loss of control
• Consume excess amounts of food

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Who is at Risk for Binge Eating Disorder?

• Everyone
• 2 of men
• 3.5 of women
• Usually late onset (40s)
• Can happen in younger years
• People who are over weight or obese
• Over weight BMI 25-29.9
• Obese BMI gt 30
• People of a healthy weight
• BMI 18.5-24.9

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Causes of Binge Eating Disorder

• Negative self image
• Depression
• Negative mood
• Sadness
• Emotional eating
• Boredom
• Worry
• Stress
• Anger
• Failed dieting

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Psychological effects of Binge Eating Disorder

• Can elevate negative self image
• Can enhance depression
• Becomes an addiction
• Begin to obsess over self control

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Risk Factors of Binge Eating Disorder

• Binge eating causes
• Weight gain
• Results ? obesity
• Obesity causes
• Type 2 diabetes
• High cholesterol
• High blood pressure
• Heart disease
• Sleep apnea

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Signs of Binge Eating Disorder

• Eating more rapidly than usual
• Eating until uncomfortably full
• Eating large amounts of food when not hungry
• Eating alone to hide actual food intake
• Feelings of disgust, depression, or guilt after
  eating

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The Cycle of Binge Eating Disorder
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The Nutrition Care Process

• Assessment
• Collect and interpret laboratory values
• Diagnosis
• Determine illness or disorder
• Find contributing factors
• Intervention
• Care plan
• Monitor
• Evaluate the Nutrition Care Process

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Nutrition Care Process Assessment

• Assess the patients caloric intake
• Determine if it is within their acceptable range
• Record patients
• Height (cm)
• Weight (kg)
• Ideal Body weight
• Males 106 lbs./5 ft. 6 lbs./ in.
• Females 100 lbs./5 ft. 5 lbs./in.
• Ideal Caloric intake (Mifflin- St. Jeor)
• Males (9.9 x wt) (6.25 x ht) (4.92 x age)
  (5 x SF)
• Females (9.9 x wt) (6.25 x ht) (4.92 X age)
  (161 x SF)
• SF Stress Factor 1.3-1.5

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Nutrition Care Process Assessment

• Determine why the over eating occurs
• Stress levels
• Emotional eating
• Depression
• Determine if the patient is overweight or obese
• BMI Body Mass Index
• Weight (kg)
• Height (m squared)
• Overweight BMI 25-29.9
• Obese BMI gt 30

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Nutrition Care Process Assessment
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Nutrition Care Process Diagnosis

• Binge eating disorder
• Overweight or obese
• Determine contributing factors to the binge
  eating disorder

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Nutrition Care ProcessIntervention

• Four common practices of treatment
• Psychotherapy
• Cognitive behavioral therapy
• Interpersonal therapy
• Dialectal behavior therapy
• Medication
• Antidepressants
• Anticonvulsants (Topamax)
• Anti-obesity medication (Meridia)
• Behavioral weight-loss programs
• Self help strategies

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Nutrition Care ProcessIntervention (cont.)

• The Goal of the RD
• Help the patient
• Learn self monitoring skills
• Develop regular eating patterns
• Learn alternatives to binge eating
• Develop problem solving skills
• Reduce restrained eating
• Evaluate thoughts on eating and self control

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Motivational Interviewing

• A method of communication with your patient.
• Started as a tool for addiction counseling
• What can the RD do?
• Give them insight
• Give them knowledge
• Give them skills
• Give them a hard time

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Motivational Interviewing cont.

• The focus is where the patient is.
• Example Tell me what you know
• The Spirit of Motivational Interviewing
• Collaboration- not confrontation
• Autonomy- not authority
• Evocation- Not education/ advice
• Example What are you willing to try to do?

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Motivational Interviewing cont.

• Principles of Motivational Interviewing
• Express Empathy
• Self Efficacy
• Develop Discrepancy
• Role with Resistance

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Motivational Interviewing cont.

• Using Motivational Interviewing
• Must use different communication methods
• Open End Questions
• Affirm
• Reflective Listening (key skill!)
• Summarize

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Motivational Interviewing cont.

• Reach for change
• Have the client
• Think about it
• Read about it
• Agree to talk about it at another session
• Take on a small step
• Follow up

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Nutrition Care Process Monitoring

• Monitor the patients progress
• Encourage them to keep a journal
• Schedule future meetings
• Assess the progression of their recovery
• Evaluate the Nutrition care process

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Ethical issues

• Obesity and Binge Eating Disorder
• Which is treated first?
• Using Topomax (anticonvulsant medication)
• Binge eaters are not convulsing
• Do we risk the possible side effects?
• Are we doing more harm than good?
• Binge eating disorder is mainly a psychological
  disorder
• Do we use autonomy or a surrogate decision maker?

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Binge eating self check

• Do you
• Feel out of control when you are eating?
• Think about food all the time?
• Eat in secret?
• Eat until you feel sick?
• Eat to escape from worries or to comfort
  yourself?
• Feel disgusted or ashamed after eating?
• Feel powerless to stop eating, even if you want
  to?

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Summary

• Binge eating disorder sends people into episodes
  where they can not control the amount of food
  they are consuming.
• Binge eating can affect anyone
• There are many psychological factors to binge
  eating disorder
• Binge eating can result in obesity and other
  serious future complications.

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Summary (cont.)

• There are definite signs of BED
• It is important as a RD to use the Nutrition Care
  Process when assessing BED.
• Motivational Interviewing is an intervention
  technique that helps you work with your patients
  to make progress.
• It is important to remain in contact with your
  patients to check their progress.

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Summary (Cont.)
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Questions?
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References

• Arbaizar, B., Gomez-Acebo, I., Llorca, J.
  (2008). Efficacy of topiramate in bulimia
• nervosa and binge-eating disorder A systematic
  review. General Hospital Psychiatry, 30(5),
  471-475.
• Binge eating disorder. Retrieved 10/2/2008, 2008,
  from
• http//www.athealth.com/Consumer/disorders/Bingee
  ating.html
• Binge eating status influences pre-diet weight
  change and test meal intake in
• obese individuals.(2008). Appetite, 51(2), 408.
  
• Binge-eating disorder - MayoClinic.com. Retrieved
  10/2/2008, 2008, from
• http//www.mayoclinic.com/health/binge-eating-dis
  order/DS00608
• Binge-eating disorder What's the best treatment?
  Retrieved 10/2/2008, 2008,
• from http//www.apa.org/monitor/mar02/binge.html
  
• Bisaga, A., Danysz, W., Foltin, R. W. (2008).
  Antagonism of glutamatergic
• NMDA and mGluR5 receptors decreases consumption
  of food in baboon model of binge-eating disorder.
  European Neuropsychopharmacology The Journal of
  the European College of Neuropsychopharmacology,
• The contributions of weight problem perception,
  BMI, gender, mood, and smoking
• status to binge eating among college
  students?.(2008). Eating Behaviors,

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References (Cont.)

• Dingemans, A. E., Martijn, C., Jansen, A. T.,
  van Furth, E. F. (2008).
• The effect of suppressing negative emotions on
  eating behavior in binge eating disorder.
  Appetite,
• Laura Alderman, M. E. (2007). Motivational
  interviewing. Unpublished manuscript.
• Melinda Smith, M. A., Suzanne Barston, Robert
  Segal, M.A. Jeanne Segal, P. D. (2008).
• Binge eating disorder. Retrieved September 25,
  2008, from http//helpguide.org/mental/binge_eatin
  g_disorder.html
• The onset and course of binge eating in 8- to
  13-year-old healthy weight, overweight
• obese children.(2008). Eating Behaviors,
• Position of the american dietetic association
  nutrition intervention in the treatment of
  anorexia
• nervosa, bulimia nervosa, and eating disorders
  not otherwise specified (EDNOS).(2001). Journal
  of the
• American Dietetic Association, 101(7), 810.
• Raynor, H., Zemel, P. (1996). Binge eating
  disorder and the dietitian's role.
• Journal of the American Dietetic Association,
  96(9), 854.
• ScienceDirect - appetite The effect of
  suppressing negative emotions on eating behavior
• in binge eating disorder. Retrieved 10/2/2008,
  2008, from http//www.sciencedirect.com.cordproxy.
  mnpals.net/science?_obArticleURL_udiB6WB2-4T7XG
  JW-1_user10_coverDate08/19/2008_alid79934485
  7_rdoc1_fmthigh_origsearch_cdi6698_sortd
  _docanchorviewc_ct1_acctC000050221_versio
  n1_urlVersion0_userid1(TRUNCATED)
• WIN - publication - binge eating disorder.
  Retrieved 10/2/2008, 2008, from
• http//win.niddk.nih.gov/publications/binge.htm

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Photo References

• http//www.medmaps.co.uk/Mindmaps/Psychiatry/Binge
  20eating20disorder.htm
• http//www.mhguidelines-leics.nhs.uk/default.aspx?
  pageeating_care
• http//www.brookes.ac.uk/student/services/health/I
  mages/binge.gif
• http//www.aweighout.com/binge-eating/binge-eating
  .shtml
• http//dorischua.com/wp-content/uploads/2007/11/ea
  ting.jpg
• http//sfhelp.org/art/Overeat.gif
• http//keetsa.com/blog/wp-content/uploads/2007/10/
  ask-these-questions-to-green-your-business.jpg