11-Eating disorder

Nutrition and fitness

Dr. Siham Gritly

Objectives

• At the end of this lecture students should be able to identify and understand the following concepts;

• Hunger, Satiation, and Satiety• The Female Athlete Triad• Anorexia Nervosa, • Bulimia, • Compulsive Exercise • The Binge-Purge Cycle• Dietary strategies to combat those disorders

Dr. Siham Gritly

Dr. Siham Gritly

Terms to be understood

• appetite: the integrated response to the sight, smell, thought, or taste of food that initiates or delays eating.

• hunger: the painful sensation caused by a lack of food that initiates food-seeking behavior

• hypothalamus: a brain center that controls activities such as maintenance of water balance, regulation of body temperature, and control of appetite.

Dr. Siham Gritly

• satiation: the feeling of satisfaction and fullness that occurs during a meal and halt (stop) eating. Satiation determines how much food is consumed during a meal.

• satiety: the feeling of fullness and satisfaction that occurs after a meal and inhibits eating until the next meal. Satiety determines how much time passes between meals.

• binge-eating disorder: an eating disorder with criteria similar to those of bulimia nervosa, excluding purging or other compensatory behaviors.

• Bulimia nervosa: an eating disorder characterized by repeated episodes of binge eating usually followed by self induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise.

Dr. Siham Gritly

Hunger, Satiation, and Satiety

• hunger is the physiological response to a need for food caused by nerve signals and chemical messengers originating and acting in the brain, primarily in the hypothalamus. Hormones of hypothalamus promotes thoughts of eating

• hunger: the painful sensation caused by a lack of food that initiates food-seeking behavior

Dr. Siham Gritly

Dr. Siham Gritly

Exercise 1

• Look for the hypothalamus gland

• Hunger can be influenced by;• * the presence or absence of nutrients in the bloodstream,• * the size and composition of the previous meal,• * usual eating patterns, • *climate, exercise,• * hormones, • * physical and mental illnesses. Hunger determines what to eat, when to eat, and how much

to eat.

Dr. Siham Gritly

• Satiation or (to stop eating): the feeling of satisfaction and fullness that occurs during a meal and stop eating.

• Satiation determines how much food is consumed during a meal.

• During the course of a meal, as food enters the GI tract and hunger diminishes, satiation develops.

• As receptors in the stomach stretch and hormones such as cholecystokinin become active, the person begins to feel full. The response: satiation occurs and the person stops eating

Dr. Siham Gritly

Dr. Siham Gritly

• Satiety; the feeling of fullness and satisfaction that occurs after a meal and inhibits eating until the next meal.

• Satiety determines how much time passes between meals

• After a meal, the feeling of satiety continues to suppress hunger and allows a person to not eat again for a while.

Dr. Siham Gritly

Relation between Hunger, Satiation, and Satiety

• Hunger• 1-Physiological influences• Empty stomach• Gastric contractions • Absence of nutrients in small intestine GI• hormones• Endorphins (the brain’s pleasure chemicals) are

caused by the smell, sight, or taste of foods, enhancing the desire for them

Dr. Siham Gritly

Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011

• Seek food and start meal• 2-Sensory influences• Thought, sight, smell, sound, taste of food

Dr. Siham Gritly

Keep eating3-Cognitive influences• Presence of others,social stimulation• Perception of hunger,awareness of fullness• Favorite foods, foods with special meanings• Time of day• Abundance of available food

Adapted from; Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011

Dr. Siham Gritly

• Satiation: End meal• 4-Postingestive influences (after food enters

the digestive tract)• Food in stomach activates stretch receptors• Nutrients in small intestine elicit hormones

(for example, fat elicit cholecystokinin, which slows gastric emptying)

Dr. Siham Gritly

• Satiety: Several hours later• 5-Postabsorptive influences (after nutrients

enter the blood)• Nutrients in the blood signal the brain (via

nerves and hormones) about their availability, use, and storage

• As nutrients decrease, satiety diminishes • Hunger develops

Dr. Siham Gritly

The healthy eating cycle

Dr. Siham Gritly

The Female Athlete Triad• The Female Athlete Triad; (fatal combination of

disordered eating, amenorrhea, and osteoporosis)Women athletes with eating disorders often fit into a condition called the female athlete triad, a combination of:

• Low energy availability (eating disorder) • menstrual irregularities (amenorrhea)

• Weak bones (increased risk of stress fractures and osteoporosis)

Dr. Siham Gritly

• Amenorrhea (menstrual irregularities) • is characterized by low blood estrogen,

infertility, and often bone mineral losses.

• Risk factors;-Excessive training, • depleted body fat,• low body weight, • inadequate nutrition.

Dr. Siham Gritly

Eating disorders• Eating disorders are most common in athletes that

participate in the following sports: • ballet and other dance • skating • gymnastics • running • swimming • rowing • horse racing • wrestle (fight)

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• Both men and women are susceptible to eating disorders, although a greater percent of eating disorders are found in women.

• The three most common eating disorders found in athletes are:

• 1-Anorexia Nervosa, • 2-Bulimia, • 3-Compulsive Exercise

Dr. Siham Gritly

Warning Signs of an Eating Disorder

• be troubled with food and weight • concerns about being fat • Increasing criticism of one's body • Frequent eating alone • Use of laxatives • Trips to the bathroom during or following meals • Continuous drinking of diet soda or water • Compulsive, excessive exercise • Complaining of always being cold

Dr. Siham Gritly

1-Anorexia nervosa• Anorexia nervosa: an eating disorder

*characterized by a refusal to maintain a minimally normal body weight and a distortion in perception of body

shape and weight. *may lose 15 to 60 percent of their normal body weight by severely restricting their food intake or exercising excessively.

Adapted from . Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011

Dr. Siham Gritly

Anorexia nervosa of Two types:

• 1- Restricting type: During the episode of anorexia nervosa, the person does not regularly engage in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

• 2- Binge eating/purging type: During the episode of anorexia nervosa, the person regularly engages in binge (lacking control of over eating) eating or purging behavior (i.e., self induced vomiting or the misuse of laxatives, diuretics).

Dr. Siham Gritly

Health Complications from Anorexia

• Anorexia poses life-threatening complications for athletes, these complications including:

• malnutrition • Abnormal Heart Rhythms • low blood pressure • Dehydration • electrolyte imbalance• amenorrhea (interruption of the menstrual cycle)• osteoporosis (decreased bone mass) • sleep disorder

Dr. Siham Gritly

Signs and Symptoms of Anorexia

• Excessive weight loss • Always thinking about food, calories, and

body weight • Wearing layered clothing • Mood swings or depression • Inappropriate use of laxatives, or diuretics in

order to lose weight • Avoiding activities that involve food

Dr. Siham Gritly

Diet Strategies for Anorexia nervosa

• Appropriate diet is vital to recovery and must be according to each individual’s needs. Experts classified anorexia as BEM

• *first food intake may be only 1200 kcalories per day.

• *A variety of foods and foods with a higher energy density should be eaten

• *athletes with anorexia should gradually increase his or her energy intake as soon as eating become easy.

Dr. Siham Gritly

2-Bulimia

• Bulimia is one such eating disorder that describes a cycle of binging and purging• Like anorexia nervosa, the person• with bulimia nervosa spends much • time thinking about body weight and food

• Bulimia can begin when the feeling of hunger associated with reduced calorie intake leads to reduce eating.

Adapted from . Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011

Dr. Siham Gritly

• In response to the binge, an athlete may feel guilty and purge by vomiting or taking laxatives, diet pills, and drugs to reduce fluids.

Dr. Siham Gritly

Bulimia is of Two types:

• 1-Purging type: The person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics.• 2-Nonpurging type: The person uses other

compensatory behaviors, such as fasting or excessive exercise, but does not regularly engage in self-induced vomiting or the misuse of laxatives, diuretics,

Dr. Siham Gritly

• binge is characterized by a sense of lacking control over eating, usually progress through several emotional stages:

• anticipation• planning, • Anxiety • urgency to begin ,• rapid and uncontrollable consumption of food, • relief and relaxation,• disappointment,• finally shame or disgust.

Dr. Siham Gritly

The Binge-Purge Cycle has no beginning or end, Bulimia is an addictive cycle on both physical and emotional levels

Dr. Siham Gritly

Signs and Symptoms of Bulimia

• Excessive weight loss

• Visiting the bathroom after meals • Depression

• Excessive dieting, followed by binge eating • Always criticizing one's body

Dr. Siham Gritly

Diet Strategies for CombatingBulimia Nervosa

• Planning Principles• Plan meals and snacks;• record plans in a food diary prior to eating.• Plan meals and snacks that require eating at

the table and using utensils.• avoid doing finger foods.• Refrain from “dieting” or skipping meals

Dr. Siham Gritly

• Nutrition Principles• Eat a well-balanced diet and regularly timed

meals consisting of a variety of foods.• Include raw vegetables, salad, or raw fruit at

meals to prolong eating times.• Choose whole-grain, high-fiber breads, pasta,

rice, and cereals to increase bulk.• Consume adequate fluid, particularly water.

Dr. Siham Gritly

3-Compulsive Exercise

• compulsive exercise is a form of eating disorder that results in excessive and addictive exercise in an attempt to control or lose weight.

• Addictive exercisers may use extreme training as

one way to expend calories and maintain or lose body weight in the attempt to improve performance or achieve a desired body shape or weight.

Dr. Siham Gritly

Warning Signs of a Compulsive Exercise

• Force to exercise even if you don't feel well. • almost never exercise for fun • Every time you exercise, you go as fast or hard as

you can. • experience severe stress and anxiety if he or she

miss a workout.• You can't relax because you think you're not

burning calories. • You worry that you'll gain weight if you skip

exercising for one day.

Dr. Siham Gritly

Unspecified Eating Disorders,Binge-Eating Disorder

• People with binge eating disorder exert less self control during eating

• Such an eating disorder does not meet the criteria for either anorexia nervosa or bulimia nervosa

• Obesity alone is not an eating disorder

Dr. Siham Gritly

• There are also differences between obese binge eaters and obese people who do not binge.

• Obese binge eaters tend to consume more kcalories and more dessert

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Criteria for Diagnosis of Binge-Eating Disorder

• *Eating, in a separate period of time (e.g., within any two-hour period) an amount of food that is larger than most people would eat

• *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).

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• *Eating much more rapidly than normal and eating until feeling uncomfortably full.

• *Eating large amounts of food when not feeling physically hungry and usually eating alone

• *Feeling disgusted or very guilty after overeating.

Dr. Siham Gritly

References

• Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning.

• Sareen Gropper, Jack Smith and James Groff, Advanced Nutrition and Human Metabolism, fifth ed. WADSWORTH

• Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. 9th ed, McGraw Hill

• Heymsfield, SB.; Baumgartner N.; Richard and Sheau-Fang P. 1999. Modern Nutrition in Health and Disease; Shils E Maurice, Olson A. James, Shike Moshe and Ross A. Catharine eds. 9th edition

• Guyton, C. Arthur. 1985. Textbook of Medical Physiology. 6th edition, W.B. Company

The American College of Sports Medicine