Eating Disorders

Understanding Eating Disorders

• Psychological/Emotional Disorders-Mental Health

• 7 million females and ~1 million males• Sometimes eating disorders are linked to

bad experiences you have suffered.• When bad things happen to good people,

you can end up feeling a lot of badness inside.

• A negative belief or feeling about yourself can cause all kinds of problems, especially problems that are characterized by neglect or mistreatment of yourself and your well-being.

What Causes Eating Disorders?• Biological Factors: Genetically determined. Personality Types: Obsessive-Compulsive Person Sensitive-Avoidant Person Brain Chemicals: leading to behavior or moods.• Psychological Factors: Tend to be perfectionist Anger Unrealistic expectations.• Family Factors: Abandoned, misunderstood, feel alone. Families over protect Rigid family Mother has an eating disorder Food for rewards Families who really stress extreme weight control• Social Factors: TV, Movies, Magazines “Thin is Beautiful” Models, etc. Culture demand for thinness Men-Strong and powerful• Triggers: rape/incest, relationship break up, moving, new school, marriage and many others.

When you have no Control

A common theme in eating disorders iscontrol:

– People with anorexia tend to strive for perfection and control.

– Following an out-of-control binge, people with bulimia may attempt to regain control by purging or use of diuretics.

– People who compulsively overeat describe feeling uncontrollable urges to eat.

Anorexia

• Anorexia nervosa (also referred to simply as anorexia) is a condition characterized by significant weight loss due to an intentional attempt to stop eating.

• While the word anorexia is Greek for "without hunger," it is a misnomer, for when you have anorexia you're actually painfully hungry, despite your denial of food.

• You just won't admit the hunger.

One to three percent of teenage girls in the US develop anorexia and 10%-12% of them may die as a result.

A Formal Diagnosis of Anorexia is made when:• Average age 11-22 usually 90% by the age of 20. We

have both sexes at all ages.• Are still dieting to lose more weight, and you are

unwilling or unable to stop.

• When, you, if you are a female, have stopped menstruating for three consecutive months

• When there is a distortion in how you perceive

your shape and size • Put an excessive investment of your self-esteem into

your shape and size • Have an intense fear of being "fat" 15% below what

would be considered a normal body weight (for your height and size)

• If you take an average 5’2” woman, age 22 and normal weight of 125lbs, Barbie image would be 7’2’ tall

Causes for Anorexia• Want power and control• To achieve body perfection• Environmental Stress• Unrealistic Standards• Unhappy with their bodies, themselves• Distorted body image• Family Problems• Depression• Low self esteem• Want attention• Obsessive with food• Use of drugs or diet pills

• People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, and decreased levels of serotonin and norepinephrine, which are associated with feelings of well-being.

What are Danger Signs of

Anorexia? • Losing a significant amount of weight • Continuing to diet (although thin) • Excessive exercise• Feeling fat, even after losing weight • Fearing weight gain-checking weight on scale often • Losing monthly menstrual periods, also known as

amenorrhea• Preoccupation with food, calories, nutrition and/or cooking for others but not eating.• Guilt shame feeling after eating.• Fainting spells and or dizziness• Bingeing and purging

What are the Physical Complications?

• Carbohydrates, to fat, then to the proteins-muscle leading to heart and organ damage

• Hair loss • Constipation• Lanugo (growth of fine body hair)• Loss of menstruation-amenorrhea• Shrunken breasts • Dry skin • Bruises • Sharply protruding bones • Cold and blue hands and feet • Shrunken organs• Osteoporosis-loss of calcium• Dehydration• Lower body temperature• Lower blood pressure• Irregular heart beat.• Kidney Failure• Gaunt, hollow facial features

More Physical Complications?

• Delayed puberty: preadolescent females fail to menstruate and develop breasts at normal age. In males, testosterone levels might remain low, leading to impotence.

• Menstruation: hormone levels drop, alerting the body that it cannot support a fetus; menstruation becomes irregular or stops completely-can result in temporary or permanent infertility.

• Mood changes: impatience, irritability, depression,

• Suicidal tendencies • Insomnia • Sensitivity to cold • Kidney failure• Cardiac arrhythmias, heart failure, and death.

Conclusion to Physical Complications?

Anorexia and Pregnancy

• In order to have a healthy child, the average pregnant woman should gain between 25 and 35 pounds. Telling this to a person with anorexia is like telling a normal person to gain 100 pounds.

• An anorexic women may have trouble conceiving a baby and carrying it to term.

• Have difficulty conceiving a baby.• Have a higher rate of miscarriages,

stillborn and babies born prematurely.

Anorexia and Pregnancy

All pregnant women should receive proper prenatal care. Those recovering from anorexia or bulimia need special care. you should always take your pre-natal vitamins and have regular pre-natal visits. you should not exercise unless your doctor says it is okay and it is a good idea to enroll in a prenatal exercise class to be sure you are not overexerting yourself.

Why Deprive Yourself of Food? • Anorexia often begins with a diet or an intent

to shape up physically.

• You don't start this with the intention of developing anorexia.

• If you become anorexic, the dieting and weight loss take on psychological functions that, although unanticipated and unplanned, are very powerful. As you begin to lose weight, for instance, you may enjoy having a new sense of control in a life in which you previously did not feel effective or strong at all.

Psychological Dynamics?

• You live with a great amount of secret emotional pain.

• You have feelings and beliefs about being inadequate or incompetent.

• You may struggle with very negative views of yourself, even when others see you as almost perfect.

• You must win the approval of others -- even if this means squelching your own feelings or acting in ways that make you feel uncomfortable.

Denial

• With anorexia, you will strongly deny that anything is wrong. You will deny the fatigue and weakness you feel constantly, you will deny that you need more food than you are eating, and when confronted by concerned others, you will typically deny that there is a problem or that you need help for it.

The Progression of Anorexia

Anorexia, more than other eating disorders, can be fatal!!!*The more entrenched the behavior becomes, the more damage is done to your body.*Much of this (is) may be reversible with treatment, and with restoration of a healthy body weight and healthy nutrition.

What is Bulimia?

• Bulimia nervosa, commonly referred to as bulimia, is usually characterized by a pattern of binge eating (i.e., eating large amounts of food in a short period of time) followed by an attempt to get rid of the food and calories in what is called a "purge."

95% are females 5% are malesAverage age to start seeing 16 years and up (Any age)

What Constitutes a Binge?

• A binge can range from an intake of 1000 or more calories. However, sometimes a bulimic will consider a small amount of food (i.e., a piece of cake) to be a "binge.“

• A binge normally ends when there is no more food or when the body is painfully bloated.

• It usually occurs in secret; it may be planned in advance; or it may be the case that any unplanned eating--even one bite--can suddenly cascade into a binge.

• Some people binge occasionally, while others will binge many times a day.

• Bingeing, or eating uncontrollably • Purging by strict dieting, fasting, vigorous exercise,

vomiting or abusing laxatives or diuretics in an attempt to lose weight

• Diuretics-using laxatives or water pills-causing body to lose water

• Using the bathroom frequently after meals-Go to purge! • Preoccupation with body weight • Depression or mood swings • Irregular periods • Developing dental problems, swollen cheek glands,

heartburn and/or bloating • Personal or family history of problems with alcohol or drugs • Steals food 1/4

What are the Warning Signs of Bulimia?

Causes of Bulimia

Same as the Anorexia:

Biological/Genetics

Psychological Factors

Personality Factors

Social Issues

Culture/Media/TV/Magazines

Low Self Esteem/Depression

Want Attention/Isolation

Environmental Factors

What are the Physical Complications of

Bulimia? • Gastrointestinal problems: irritation of esophagus, stomach ulcers, swollen salivary glands and throat from persistent vomiting, ulcers, tearing of the esophagus

• Tooth decay: damaged or discolored teeth: gastric acids erode tooth enamel

• Chronic loss of bodily fluids: Dehydration• depletes blood potassium, sodium and chloride levels,

resulting in muscle spasms, weakness, irregular heartbeat and kidney disease

• Puffiness around the face and cheeks• Weakness, fatigue• Menstrual changes• Gum disease/disorders• Headaches• Bad Breath• Bursting of the eye blood vessels.• Poor nutrition leading to malnutrition• Blood levels and electrolytes can become severely

imbalanced

What do Emotions Have to do with Eating?

• Food turns into an outlet for all those feelings and conflicts that cannot be exposed.

• Binge eating can be a way of cramming yourself so full that the difficult feelings are pushed out of the way, or simply numbed during the intense activity of eating.

• Purging, on the other hand, gets the difficult feelings out of your system. If you can flush it (by vomiting or using laxatives) or pound it (by heavy exercise) out of your body, a disturbing feeling really doesn't have to be dealt with. Or at least it can seem that way, until the feeling recurs.

Bulimia Seems to Take on a Life of its

Own • Binge leads to purge, leads to binge, leads to

purge, and on and on.• The cycle of behavior can become powerfully

fixed and difficult to break apart.• If you have been bulimic for some time, you

tell yourself you are fully in control and can stop whenever you want, while deep down doubting you will ever be able to find a way out of the behavior.

• It is a very lonely existence being bulimic. So much hiding and pretending, you never get to feel known and valued by others in any real way.

Bingeing:Compulsive OvereatingWhat is it???

*Compulsive overeating is characterized by uncontrollable eating followed by feelings of guilt and shame.*It is different from bulimia in that it does not involve any purging.*While it inevitably results in weight gain, it is also not to be confused with obesity.*Not everyone who is overweight has an eating disorder.

How does Compulsive Overeating Start?

• Compulsive overeating generally has a gradual beginning, often starting in early childhood when eating patterns are formed.

• It usually starts very subtly, when a child turns to food whenever they were upset.

• Over time, you learn that food in fact will soothe the upset feelings. The destructive pattern continues as you do not learn to trust that feelings pass and that you are capable of self-soothing without food.

Why do People Compulsively Overeat?

• While people who compulsively overeat are usually very preoccupied with issues of food, eating, and weight, uncontrollable bouts of eating are an attempt to manage other hidden issues.

• As a compulsive overeater, you use food to cope with stress, upset, emotional distress, and other problems (depression, anxiety, and low self-esteem). However, the negative feelings blocked by the overeating are only momentarily avoided, as you inevitably feel guilty and shameful about the overeating.

What are the Warning Signs of Compulsive

Eating? • Binge eating• Eating when not physically hunger• Frequent dieting• Feeling unable to stop eating voluntarily• Weight fluctuations• Depression• Feeling Ashamed• Gaining weight

What are the Physical Complications of

Bingeing? • Hypertension-high blood pressure • High Cholesterol levels-LDLs• Diabetes• Gall Bladder stones • Fatigue • Nausea • Weight gain • Increase risk for diabetes• Increase risk for heart diseases• Increase risk to some forms of cancer

How to Change…

• Recovery is completely possible for compulsive overeaters through a gradual process of lifestyle change and with the help of others.

• Along with the medical, psychological and nutritional assistance helpful to anyone with distorted eating habits, oftentimes groups such as Overeaters Anonymous are very useful.

• Olean General Hospital

Obesity20%+ over your set point

• 14%-17% of teenagers• 40 Million ¼ of adults 1 out of 3• 56%-65% of American people are overweight• 30+% of students• 300 thousands deaths per year• 147 billion dollars per year.• Obesity is a physical condition.• Obesity is one of the most common disorders when a persons

body weight is over 20% or more above their set point.• Overweight is an excess of body weight up to 20% over a

persons set point. (10 percent over your body set point to 20%)Because body fat is difficult to measure precisely, in practice the measure commonly used instead is your weight in pounds, which is referenced against a set of weight standards based on a your gender, height and body type.

• If you were to weigh 20% above the expected weight for a person of your

gender height and body type, you would be considered obese.

How Does a Person Become

Obese? • More than one-half (50-60%) of American adults are overweight, and about half of those (or one in four Americans) could be considered obese.

• There is no single understood cause of obesity, but data shows that genetic predisposition, environmental factors, and behavior are the most common causes.

• Certain medical conditions or medical treatments can also result in obesity.

• Obesity is found to be more common among:

*lower socioeconomic status *certain minority populations

Causes for Obesity

• Imbalance between energy intake and energy expenditure Simply put: Lack of physical activity

• Age -As we grow older our body metabolism slows down, most need less calories.

• Gender-Males have a higher resting metabolic rate than females, so males require more calories to maintain their body weight.

• Activity Levels: Active people need more calories than less active people. 3,500 calories equals one pound. Environmental factors

Automobiles, TV, Computers/games, Sedentary lifestyle-sit/lay around.

• Weight-Heavier people require more calories to maintain their body weight than lighter people.

• “Apple Shape”-stomach area• “Pear Shape”-hips and thighs• Foods-fast foods, snacks, high sugar fat content foods eating in

between meals.

What Health Problems are Associated

with Obesity? Hypertension (high blood pressure), which is associated with serious health problems and premature death 5-6xs greater risk between 20-45• Diabetes-53xs greater chance for obesity people 3.8-10xs greater risk Can lead to kidney failure• Coronary Heart Disease-4-25xs greater risk for a heart attack Cholesterol levels are high• Cancers-3xs greater risk for female incidence for breast, uterine, cervical and ovarian cancers 7xs greater risk for endometrial cancer• For men increase risk for prostate and colon, rectum cancers• Strokes• Sleep Disorders-Sleep Apnea-snoring and stop breathing during sleep• Osteoporosis• Gall Stones• Arthritis-wear and tear on the joints from the weight• Breathing problems

Psychological Factors

• One may become very overweight because of psychological or emotional factors.

• Excessive overeating or becoming obese may be ways of coping with other personal problems.

• One may, for instance, use food for a purpose it cannot fulfill (e.g., love, comfort, escape, problems, stress), and thereby end up very overweight.

What you Can do:

• If a person needs to loose weight for the sake of their health, or they want to lose weight for the sake of their self-esteem, medical providers and the nutritionist at Health Services can work with them to develop a realistic plan for weight loss.

• Friends, family, or peers in similar situations may be very helpful in maintaining motivation.

• Most importantly, a person should be gentle with themselves. Losing weight in a healthy manner is hard work and it is normal to have setbacks.

Eating Disorders and Men

A Few Facts:

*1% to 5% of all men have seriously unhealthy eating behaviors that would qualify as eating disorders.*That's several million in the entire US 10% to 15% of people with eating disorders are male.

Of Men with Eating Disorders:

• 79% to 83% have binge eating disorder, described as impulsive gorging or continuous eating

• 10% to 13% have bulimia, described as binge eating and then purging by use of self-induced vomiting, laxatives, prolonged fasting and excessive exercise

• 4% to 6% have anorexia, described as self-starving and, even if extremely underweight, having a distorted image of their bodies as fat

Some Signs of Eating Disorders in Men…

• It often shows up at the gym.• The athletic type, who doesn't eat much, but

exercises a lot.• Men very intent on molding their body into a

certain bulk or musculature.• Men who compulsively run long distances to the

point that you are just muscle and bone. • Men who binge eat, or eat compulsively ("all the

time"), or at the other extreme, they may restrict their food intake to the point of starvation.

• Men may also vomit to get rid of what they have eaten, but make excuses for their behavior that at first may seem plausible.

Men are Subject to Cultural Messages

• Men are affected by society's messages about the importance of their physical appearance.

• The trim and buff aesthetic for men has subtly infected our culture through billboards, ads --it's everywhere.

• Guys can be very critical of themselves, saying things like: "You don't look good. You're out of shape. What a gut! That guy looks better.”

• This negative self-talk, so influenced by cultural messages, can make you feel you need to change your appearance, setting yourself on the path to developing unhealthy eating or exercise habits.

Interviews with Thousands of College Men Revealed that a

Large % of Them: • Feel invulnerable (unrealistically so) • Or feel a need to conceal it when

they do feel vulnerable • Know little about health issues • Are confused about their male peers • Find it hard to talk with peers about

self-harmful, questionable behavior

The Female Athlete Triad

• Some physically active women are at risk for a group of symptoms called the Female Athlete Triad. This often unrecognized disorder is a combination of three conditions: – Disordered eating – Amenorrhea (lack of menstrual periods) – Osteoporosis

Who's at Risk: are all Athletes on the Team?

• If you are a physically active woman, you are at risk for the Triad.

• The competitive nature and strong discipline that can help make you a good athlete.

• Competitive athletes may be at a higher risk.• Women are particularly at risk if they

participate in endurance sports, like cross-country running; aesthetic sports, like gymnastics or ballet; and sports which require formfitting uniforms, like swimming.

• The emphasis on a certain "look" and the perception that carrying less weight will universally improve performance lead to this risk.

Disordered Eating

-An under fueled athlete is a slowed and weakened athlete.

-If a person’s muscles lack sufficient and proper fuel, performance is impaired.

You may experience:*some early fatigue*loss of strength and muscle size*the inability to concentrate.*more injuries, which are slow to heal in a poorly

fueled body

Amenorrhea

• Loss of menstrual periods may signal a change in your body's intricate and complicated hormone system.

• Hormone imbalance from under fueling your body can result in lowered estrogen production, which can have many effects; the most immediately apparent one can be bone loss.

• Amenorrhea can often go unreported to medical providers because of the common belief it is "just part of the training effect, “ but it is NOT "just part of the training effect."

Osteoporosis

• Loss of bone, especially if you are an athlete, can be an unfortunate setup for an injury.

• Stress fractures can sideline sports activity and be slow to repair if you are under fueled. Repeated stress fractures and unexplained injuries should be a red flag to further evaluate your eating and exercise patterns.

• Bone loss that occurs because of amenorrhea can be permanent; osteoporosis is not just a disease grandmothers get!

What are the Warning Signs?

• Frequent or unexplained injuries, stress fractures

• Excessive or compulsive exercise (not being able to skip a day of exercise or reduce time spent exercising)

• Change in performance -- loss of endurance, speed, strength

• Impaired concentration • Absent or irregular menstrual periods • Restrictive eating masked as a

"performance enhancing" meal plan • Use of weight loss products or

supplements

Ways to Prevent the Female Athlete Triad

• Choose an activity that complements your natural body strengths and suits you as an individual.

• Realize your health is more important than competitive success. Taking health risks for a perceived competitive edge will make you lose in the long run.

• Be wary of those who value your competitive success over your well being.

• Frequent weigh-ins, weight comments and punitive consequences for weight gain may increase an athlete's risk for the Triad.

Ways to Prevent the Female Athlete Triad

• Appreciate your own healthy, active body. Don't compare yourself to others.

• Realize the thinnest athletes are not necessarily the fastest or the strongest.

• Think of fuel as the ultimate performance enhancer!

• Don't starve your bones. Part of your fuel mix should include several servings a day of good calcium sources like milk, yogurt, cheese, calcium-fortified juices and soy products.

• Be a role model with both your words and actions.

Treatment of Eating Disorders

• There are many types of treatments available. Some of the most common treatments are: counseling, and paying attention to medical and nutritional needs.

• The treatment should be tailored to the individual and will vary according to both the severity of the disorder and the patient's particular problems, needs, and strengths.

Do You Have a Problem with Food???

Go to the website below to take a quiz to see if you may have an eating disorder:

• http://www.counsel.ufl.edu/selfHelp/bodyAcceptance.asp

Sources & Useful Websites

• http://www.brown.edu/Student_Services/Health_Services/Health_Education/nutrition/ec_anorexia.htm

• http://www.mamashealth.com/eat/bulimia.asp