Health Psychology

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Health Psychology

• Obesity and eating disorders Part 2
• Chapter 8
• PY470 Hudiburg

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What factors help prevent obesity?

• Preventing obesity must begin in childhood
• Breastfed children less obesity Box 8.3, p. 289
• Encouraging children to exercise and eat healthy
  foods
• dont use special food as a reward Stanek et
  al. (1990)
• children tend to be more interested in a
  forbidden food F 8.9, p. 289 Mennella et
  al. (2001)
• Limiting television watching
• Problem with adult modeling, increase consumption
  of snacks low in nutrients and watching TV during
  meals increase consumption of salty snacks and
  pop and less fruit and vegetables Goldberg et
  al. (2001)
• Many ads have low-nutrient beverages and sweets
  Story and Faulkner (1990)

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How is obesity treated?

• Fad Diets
• Exaggerated claims based on false theories
• Potentially harmful
• Weight Cycling
• Set point theory?
• Psychological ramification

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Weight Cycling
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Psychology of Weight Cycling
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Pills, Procedures and other Possibilities

• Diuretics - rapid loss of water and minerals
• Amphetamines (speed)
• historical use, not approved by FDA, Addictive,
  ineffective
• Prescription drugs
• interfere with fat absorption, suppress
  appetite
• dexfenfluramine
• increased serotonin (neurotransmitter)
• psychological problems
• Heart problems
• Over-the-Counter Drugs
• taste suppressants

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Pills, Procedures and other Possibilities

• Very-Low-Calorie Diets (VLCD)
• promote rapid weight loss
• physician supervised
• 800 kcal, 1 gram protein/kg body weight
• little or no fat
• little CHO (not enough to spare protein)
• starvation
• Potential cardiovascular and respiratory problems
• Not very successful in keeping weight off (long
  term)

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Pills, Procedures and other Possibilities

• Weight management approaches
• gastric stapling, intestinal bypass, gastric
  balloons, wiring jaw closed (liquid diet)
• Bariatric surgery there were 16,200 in 1992 and
  the American Society for Bariatric Surgery
  estimates that in 2006 there were 177,600 obesity
  surgeries.

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A protest in San Francisco
Photo From NGS
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How is obesity treated?

• Eating less
• Realistic energy intake
• rapid weight loss is protein and water loss
• rule of thumb 10 kcal/pound promotes weight loss
• Nutritional Adequacy/Nutrient Dense Foods
• difficult to achieve on less than 1200 kcal
• food guide pyramid principles
• adequate water - sense of fullness

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How is obesity treated?

• Physical Activity - Increasing exercise
• Activity and BMR- activity increases BMR
• Activity and appetite control
• energy released from stores (plasma glucose
  normal)
• digestive functions are suppressed
• Physical Activity
• setting short-term goals
• reminders or prompts
• making behavior fit into daily schedule/ routine

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How is obesity treated?

• Operant conditioning approaches
• Make small changes to behavior
• Having the support of family members, and friends
  social support
• Other self-control approaches
• Behavior and Attitude
• stimuli ? ? behavior ? ? consequence
• Awareness of behavior
• why do I eat, when, where

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Eating Disorders
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Eating Disorders An Overview

• Two Major Types of DSM-IV Eating Disorders
• Anorexia nervosa and bulimia nervosa
• Both involve severe disruptions in eating
  behavior
• Both involve extreme fear and apprehension about
  gaining weight
• Both have strong socio-cultural origins
  Westernized views
• http//www.laurengreenfield.com/?pY6QZZ990
  Thin
• Other Subtypes of DSM-IV Eating Disorders
• Binge-eating disorder
• Rumination disorder
• Pica
• Feeding disorder

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Anorexia Nervosa (pursuit of thinness)

• Successful Weight Loss Hallmark of Anorexia
• Defined as 15 below expected weight
• Intense fear of obesity and losing control over
  eating
• Anorexics show a relentless pursuit of thinness,
  often beginning with dieting
• DSM-IV Subtypes of Anorexia
• Restricting subtype Limit caloric intake via
  diet and fasting
• Binge-eating-purging subtype About 50 of
  anorexics
• Associated Features
• Most show marked disturbance in body image
• Most are comorbid for other psychological
  disorders
• Methods of weight loss can have severe life
  threatening medical consequences

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Bulimia Nervosa (avoidance of obesity)

• Associated Features
• Most are within 10 of target body weight
• Most are over concerned with body shape, fear
  gaining weight
• Most are comorbid for other psychological
  disorders
• Purging methods can result in severe medical
  problems

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Eating Disorder, Not Otherwise Specified

• All criteria for AN, except still menstruating
• All criteria for AN, except normal weight
• All criteria for BN, except frequency or duration
• Compensatory weight control after small amounts
  of food
• Chewing/spitting out, but not swallowing, large
  amounts of food
• Binge eating disorder

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Binge-Eating Disorder

• Binge-Eating Disorder Appendix of DSM-IV
• Experimental diagnostic category
• Engage in food binges, but do not engage in
  compensatory behaviors
• Associated Features
• Many persons with binge-eating disorder are obese
• Most are older than bulimics and anorexics
• Show more psychopathology than obese people who
  do not binge
• Share similar concerns as anorexics and bulimics
  regarding shape and weight

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Anorexia Facts and Statistics

• Anorexia
• 0.5-5 15-19 year old females with AN
• Majority are female (90-95) and white(gt 95),
  from middle-to-upper middle class families
• Usually develops around age 13 or early
  adolescence
• Tends to be more chronic and resistant to
  treatment than bulimia
• 3rd most common chronic illness in adolescents

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Bulimia Facts and Statistics

• Bulimia
• Majority are female, with onset around 16 to 19
  years of age
• Lifetime prevalence is about 1.1 for females,
  0.1 for males
• 5-10 of college women suffer from bulimia
• Tends to be chronic if left untreated
• Both Bulimia and Anorexia Are Found in
  Westernized Cultures

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At-Risk Groups

• Adolescent females with low self-esteem
• Gymnasts
• Dancers (ballet)
• Wrestlers
• Runners
• http//chronicle.com/weekly/v53/i24/24a04401.htm
• When thinness is related to success

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Symptoms Of Inadequate Energy Intake
Physical health
Mental health

• Amenorrhea
• Cold hands/feet
• Constipation
• Dry skin/hair loss
• Headaches
• Fainting/dizziness
• Lethargy
• Anorexia

• Concentration
• Decisions
• Irritability
• Depression
• Social withdrawal
• Obsessiveness (food)

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Signs And Symptoms Of Binge Eating
Physical health
Mental health

• Weight gain
• Bloating
• Fullness
• Lethargy
• Salivary gland enlargement

• Guilt
• Depression
• Anxiety

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Signs And Symptoms Of Vomiting Or Laxative Abuse
Physical health
Mental health

• Weight loss
• Electrolyte disturbance
• K
• CO2
• Dental enamel erosion
• Hypovolemia
• Knuckle calluses

• Guilt
• Depression
• Anxiety
• Confusion

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Major Systems Affected

• Metabolic
• Hypometabolism/
• Refeeding Syndrome
• Cardiovascular
• Arrhythmias
• Musculoskeletal
• Osteoporosis
• Reproductive
• Amenorrhea

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Determinants of Eating Disorders

• Predisposing factors
• Individual
• Familial
• Cultural
• Precipitating factors
• Developmental
• Environmental
• Social
• Perpetuating factors
• Biological
• Psychological

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How do biological factors lead to eating
disorders?

• Women who have close relative with an eating
  disorder are 2-3 times more likely to suffer from
  one
• more likely to occur in both identical twins than
  fraternal twins
• bulimics are less sensitive to serotonin
• anorexics have higher levels of serotonin

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What psychological factors lead to eating
disorders?

• Cultural norms
• thinness norm is portrayed in media F 8.11, p.
  301
• Box 8.5, p. 302, Fredrickson et al. (1988) study
  of affects of body perception, data Figure 8.12,
  p. 303
• Social pressures
• Table 8.3 8.9, p. 304

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What psychological factors lead to eating
disorders?

• Family dynamics
• families of women with eating disorders are
  particularly focused on weight and shape
• families of anorexics have potentially
  dysfunctional dynamics
• families of bulimics have more conflict, and less
  nurturance

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What psychological factors lead to eating
disorders?

• Personality
• The perfect child expectation in families
• Anorexics rigid, anxious, perfectionists, and
  obsessed with order and cleanliness
• Bulimics depressed, anxious, lack clear sense of
  self-identity, have negative self-views

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What approaches help prevent eating disorders?

• Little research suggests that interventions that
  target large groups of women are effective
• interventions specifically targeting women with
  poor body images can be effective

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Weight Gain

• Rate ? 1 lb/week, Target weight gt85 average, if
  low...
• 70 of weight gain is lean body mass (muscle)
• Must eat adequately to gain lean body mass
• ? Lean body mass will result in
• Higher metabolism
• More energy
• Fewer symptoms
• Cognitive-behavioral therapy is used to design
  programs for weight gain

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Engaging Patients In Treatment

• Symptoms/Signs related to weight control habits
  What your body is telling me
• Focus on health, rather than weight
• Nurturant-authoritative approach
• Acknowledge conflict explicitly
• Emphasis on will-power, self-determination
• Avoid blame, fault, guilt

(after Levenkron S Treating and Overcoming AN,
1990)
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But, Im Not Hungry
Physiologic Fact
Reframing for patient

• Body burns calories throughout life
• Appetite ? need to eat
• Eating Disorder ? Appetite ?
• If only respond to appetite, will not get enough
  energy
• If eat on regular schedule, more likely to get
  energy
• Higher energy fuel ensures greater likelihood of
  getting enough energy

• Even if youre not hungry, your body burns
  calories
• Appetite ? cars gas gauge
• Eating Disorder ? broken gas gauge
• If drive car with broken gas gauge can run out of
  gas
• Fill car with gas based on miles driven gas
  mileage
• Fat has more energy than carbohydrate or protein
  and is a necessary body fuel

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Engaging Parents in Treatment

• Developmental framework (child ? adult)
• Discuss blame, fault, guilt openly
• Realignment of roles in family
• Positive framing of family attributes
• Future orientation
• Authority to treat, and empowerment of,
  professionals comes from parents

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Problems Addressed In Mental Health Treatment

• Low Self-esteem
• Distorted body-image
• Dysfunctional coping behaviors and habits
• Depression
• SSRIs for BN and weight recovered AN
• Ineffective communication
• Conflict resolution
• Lack of assertiveness
• Post-trauma recovery (sexual abuse, etc)

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Indications for Hospitalization

• Severe malnutrition Weight for height lt75
• Dehydration
• Electrolyte disturbances
• Cardiac dysrhythmia
• Physiologic instability
• Severe bradycardia or hypotension
• Hypothermia
• Orthostatic pulse changes
• A link to a pdf file on eating disorders
• http//www.adolescenthealth.org/PositionPaper_Eati
  ng_Disorders_in_Adolescents.pdf

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Indications for Hospitalization

• Arrested growth and development
• Failure of outpatient treatment
• Acute food refusal
• Uncontrollable bingeing and purging
• Acute medical complication of malnutrition
• Acute psychiatric emergencies
• Comorbid diagnosis interfering with treatment

(Fisher et al JAH 199516420-437)
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Lingering issues

• Is obesity really unhealthy?
• upper-body fat is particularly bad
• Can eating disorder prevention programs have
  dangerous effects?
• Eating disorder prevention programs can sometimes
  lead to an increase in disordered behavior
• Nova film, Dying to be Thin - emaciated women
  are triggering girls who want to be thin.
• Instead Show the videos Body Talk, or
  Killing Us Softly. Shows being able to express
  their body image and resist media messages.