eating disorders

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modern food habits and health issues

• NAMETHOUFEEK
• CLASSX

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Learning Objectives

• Residents will be able to
• Distinguish between Anorexia and Bulimia Nervosa
• Describe the primary clinical findings in
  Anorexia and Bulimia Nervosa
• Identify rational diagnostic evaluation methods
  for affected children and adolescents and their
  families
• Determine evidence-based treatments for patients
  affected by Eating Disorders

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Facts and Stats

• Among normal weight female teens, 40-60 view
  themselves as too heavy
• Up to 60 of female teens diet regularly
• Over 50 of teens exercise in order to improve
  their shape or lose weight
• Approximately 45 of female teens smoke
  cigarettes to control weight
• Most female teens are preoccupied with their food
  intake
• 70 of girls report that body shape is important
  to their self-esteem (Strober and Schneider,
  2005).

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History

• In Western Europe of the 12th and 13th centuries,
  miracle maidens, or women who starved
  themselves, were highly regarded, and their
  behavior was imbued with religious
  interpretations.
• Catherine of Siena (1347 1380), whose complete
  control over her food intake was seen as a sign
  of religious devotion, was regarded as a saint
  (Heywood, 1996).
• Holy anorexia was, however, short-lived
• By the 16th century the Catholic Church began to
  disapprove of asceticism.
• Some anorexics were subsequently viewed as
  witches and burned at the stake (Brumberg, 2000).
  

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History contd

• First cases reported in 1689 by Richard Morton
  wasting disease of nervous etiology in one male
  and one female (Gordon, 2000).
• The first formal description of AN, however, is
  credited to Sir William Gull, physician to Queen
  Victoria, who in 1868 named the disorder anorexia
  hysterica, emphasizing what he believed to be its
  psychogenic origins.

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History Anorexia Nervosa

• Gull later changed the name to nervosa to avoid
  confusion with hysteria
• Although quite descriptive, the word anorexia is
  a misnomer, as the term literally means lack of
  appetite, which is, in fact, rare.
• Not simply a product of the modern society
• Both Anorexia Nervosa and Bulimia Nervosa
  patients share an intense preoccupation with body
  weight and shape

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History Bulimia Nervosa

• Bulimia Nervosa (BN), by contrast, was first
  clinically described in 1979
• Historical accounts date to 1398, when true
  boulimus was described in an individual having
  an intense preoccupation with food and over
  eating at very short intervals, terminated by
  vomiting (Stein Laakso, 1988).
• The word bulimia is derived from Greek and means
  ravenous hunger, quite the opposite of
  anorexia.
• Much less has been historically made of bulimic
  behavior, and consequently, we have significantly
  less knowledge of this disorder.

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Eating Disorders

• Anorexia Nervosa
• Restricting Type
• Binge Eating/Purging (Bulimic) Type
• Bulimia Nervosa
• Purging Type
• Nonpurging Type
• Eating Disorder NOS

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Anorexia Nervosa

• Diagnosis requires
• Refusal to maintain body weight at or above a
  minimally normal weight for age and height (e.g.,
  weight loss leading to maintenance of body weight
  less than 85 of that expected or failure to
  make expected weight gain during period of
  growth, leading to body weight less than 85 of
  that expected)
• Intense fear of gaining weight or becoming fat,
  even though underweight
• Disturbance in the way in which ones body weight
  or shape is experienced, undue influence of body
  weight or shape on self-evaluation, or denial of
  the seriousness of the current low body weight
• In post-menarcheal females, amenorrhea, i.e., the
  absence of at least 3 consecutive menstrual
  cycles. (A woman is considered to have
  amenorrhea if her periods occur only following
  hormone, e.g., estrogen, administration)

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AN Characteristics

• The discrepancy between weight and perceived body
  image is key to the diagnosis of anorexia
  anorexic patients delight in their weight loss
  and express a fear of gaining weight
• Have changes in hormone levels which, in females,
  result in amenorrhea (if the weight loss occurs
  before puberty begins, sexual development will be
  delayed and growth might cease)
• Feel driven to lose weight because they
  experience themselves as fat, even when at a
  subnormal weight
• Intensely afraid of becoming fat and preoccupied
  with worries about their body size and shape
• Direct all their efforts towards controlling
  their weight by restricting their food intake,
  but may also binge eat, self induce vomiting,
  misuse laxatives or diuretics (purging
  behaviors), exercises excessively or misuse
  appetite suppressants

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Bulimia Nervosa

• Diagnosis requires
• Recurrent episodes of binge eating. An episode
  of binge eating is characterized by both of the
  following
• eating, in a discrete period of time (e.g.,
  within any 2-hour period), an amount of food that
  is definitely larger than most people would eat
  during a similar period of time and under similar
  circumstances
• a lack of control over eating during the episode
  (e.g., a feeling that one cannot stop eating or
  control what or how much one is eating)
• Recurrent inappropriate compensatory behavior in
  order to prevent weight gain, such as
  self-induced vomiting misuse of laxatives,
  diuretics, enemas, or other medications fasting
  or excessive exercise
• The binge eating and inappropriate compensatory
  behaviors both occur, on average, at least twice
  a week for 3 months
• Self-evaluation is unduly influenced by body
  shape and weight
• The disturbance does not occur exclusively during
  episodes of Anorexia Nervosa

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BN Characteristics

• Frequent episodes of binge eating, during which
  they consume a large amount of food within a
  short period of time
• Feels overwhelmed by the urge to binge and can
  only stop eating once it becomes too
  uncomfortable to eat any more
• Feels guilty, anxious and depressed, because they
  have been unable to control their appetite any
  they fear weight gain
• Tries to regain control by getting rid of the
  calories consumed ( the most common method is
  vomiting, but they might misuse laxatives,
  diuretics or appetite suppressants, fast or
  excessively exercise

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Subclassification

• 2 major subtypes of anorexia
• (1) Restricting Type fasting, introverted,
  decreased risk of substance abuse, family
  conflict is covert
• (2) Bulimic Type binge eating or purging, more
  volatile, family frequently disengaged, prone to
  substance abuse
• 2 major subtypes of bulimia
• (1) Purging Type self-induced vomiting or use
  of laxatives, diuretics, or enemas
• (2) Nonpurging Type use of other compensatory
  mechanisms, such as fasting or excessive exercise

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Anorexia vs. Bulimia

• Denies abnormal eating behavior
• Introverted
• Turns away food in order to cope
• Preoccupation with losing more and more weight

• Recognizes abnormal eating behavior
• Extroverted
• Turns to food in order to cope
• Preoccupation with attaining an ideal but often
  unrealistic weight

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Eating Disorders NOS

• Likely to be similar to people with AN or BN but
  not quite meet the diagnostic criteria
• Might vomit after eating small amounts of food
• Might chew food and then spit it out
• Might binge eat, but not attempt to get rid of
  the calories consumed (this behavior is now
  called Binge Eating Disorder BED, the phrase
  compulsive eating is sometimes used, but has
  never been adequately defined)

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Obesity

• Defined as 20 over ideal body weight or BMI gt 30
• Not an eating disorder per se and unlike an
  eating disorder is not an mental illness.
  However, many people who binge eat become obese
  and can have mental health problems
• 1/3 of NYC public high school students are
  overweight or obese

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What is a healthy weight?

• Body Mass Index (BMI) is the best currently
  accepted measure
• BMI (kg/m²) (pounds x 703) height in inches²
  or kilograms height in meters²
• BMI Parameters
• Underweight lt 18.5
• Normal weight 18.5 24.9
• Overweight 25 29.9
• Obese gt 30
• These next slides show 20 years of obesity in the
  United States

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Anxiety in FamiliesStavro et al (submitted)
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The end by .thoufeek