Eating Disoders

1. A SEMINAR ON Effects of Eating Disorders on Health Presenter Jaspreet Kaur M.Sc.(Foods And Nutrition) Reg.No. 04- HOMMA- 01229 Major GuideDr. V. H. Kanbi Associate Professor Department of Food science and Nutrition SDAU, S.K.Nagar. Minor GuideDr. (Mrs.) S. Ahlawat Professor and Head Department of Ext. Edu. and Communication SDAU, S.K.Nagar.

2. Content • Introduction • Need of Study • classification • Aetiology • most prevalent eating disorders • case studies • assessment • Treatment • Conclusion

3. Introduction • An eating disorder is when a person experiences severe disturbances in eating behaviour, such as extreme reduction of food intake or overeating, or feelings of intense distress or concern about body weight or shape. • Society, today promote the ideals of a slim body. Models are pretty and thin, they are often taken as role models of success. However they must be underweight to look perfect on televisions and magazines. In order to look good they practice abnormal pattern of eating. Socioeconomic-cultural changes and westernization could result in the culture-change syndrome of eating disorders in India today (Shroff and Thompson 2004).

4. Definition Eating disorders involve series disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feeling of distress or extreme concern about body shape or weight.

5. Need of study • Eating disorders involves self-starvation and over eating. The body is denied the essential nutrients which needs to function normally, so it is forced to slow down all of its processes to consume energy and other nutrient. This slowing down can have serious medical consequences (Gupta, 2007). • The prevalence of eating disorders in India is lower than that of western countries but appears to be increasing significantly in the country. • Thus a study on eating disorders is felt needed realizing the increased current prevalence, incidence of eating disorder, its complications and increasing mortality in different age groups mainly in adolescent girls. The study also fulfils the need to improve knowledge and attitude regarding eating disorders to promote a disease free or healthy life.

6. Currently not recognized in medical manual Other Prevalent Eating Disorders Currently recognized in medical manual Classification of eating disorders • Anorexia nervosa (AN) • Bulimia nervosa (BN) • Binge eating disorder  • (BED) • Other Specified • Eating Disorder • (OSED) • Compulsive overeating, • (COE) • Diabulimia • Orthorexia nervosa • Drunkorexia • Pregorexia • Food Craving • Pica

7. Orthorexia nervosa • Pregorexia • Drunkorexia • Dibulimia

8. AETIOLOGY Genetics Socio-cultural Biological PREDISPOSING FACTORS Environment Nutritional Deficiency Stress Life transition Vulnerability toED PRECIPITATING FACTORS Media Family problems/ tension Low Self-esteem PERPETUATING FACTORS Ongoing low self -esteem Ongoingstress Ongoing family tension EATING DISORDER

9. Most prevalent Eating Disorder

10. Anorexia Nervosa

11. Anorexia Nervosa • The term anorexia nervosa was first formulated in 1873 by Sir William Gul. The term is Greek origin which means : A lack of desire to eat. • It is characterised by self-induced weight loss of at least 15% below the expected weight.

12. Signs & symptoms of Anorexia Nervosa A Person With Anorexia Starve Her Or Him Self So She Or He Can Be Skinny. Osteoporosis Osteopenia Hyponatremia Hypokalemia Optic neuropathy Brain atrophy Leukopenia • Dramatic weight loss • Lanugo • Constipation or Diarrhoea • Electrolyte imbalance • Cavities • Tooth loss • Cardiac arrest • Amenorrhea

13. Conti.... • Preoccupation with food, recipes or cooking ; may cook elaborate dinners for others but not eat themselves • Cuts food into tiny pieces; refuses to eat around others; hides or discards food. • Perceives self to be overweight despite being told by others they are too thin. • Purging: uses laxatives, diet pills, ipecac syrup, or water pills; may engage in self-induced vomiting; • May run to the bathroom after eating in order to vomit and quickly get rid of the calories. • Becomes intolerant to cold.

14. Chilblains, also known as Perniosis. Heart rate problems Slow heart rate (bradicardia)

15. Diagnostic Criteria-Anorexia Nervosa • Refusal or inability to maintain body weight over a minimum normal weight. • Intense fear of gaining weight despite being underweight. • Disturbance in perception of body shape. • Absence of three consecutive menstrual cycles.

16. Isabella Caro The French model died in 2013 due to the complications of anorexia atthe age of 28.

17. Bulimia Nervosa

18. Bulimia Nervosa • Bulimia Nervosa literally means ‘hunger of an ox for nervous reasons’ . • Bulimia is characterised by cycles of bingeing (eating a large amount of food) and then experiencing guilt, fear, or stomach pains, causing sufferers to purge. Those who suffer from the non-purging type compensate for binges by exercising. • A person with bulimia eats a lot of food in a short amount of time. This is called binging. Binging can cause feelings of shame and guilt. So, the person tries to "undo" the binge by getting rid of the food by throwing it up.

19. Signs and symptoms • Chronic gastric reflux after eating • Dehydration and hypokalemia caused by frequent vomiting • Esophagitis or inflammation of the esophagus • Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat • Gastroparesis or delayed emptying • Constipation • Infertility

20. Conti.... • Peptic ulcers • Electrolyte imbalance, which can lead to cardiac arrhythmia, cardiac arrest, and even death. • Russell's sign :scarring of the knuckles from placing fingers down the throat to induce vomiting.

21. Diagnostic Criteria-Bulimia • Minimum of 2 binge-eating episodes weekly for 3 months/recurrent binge eating. • A feeling of lack of control over binge-eating behavior. • Regular use of self-induced vomiting, laxatives, diuretics, or vigorous exercise to prevent weight gain. • Disturbance of body shape perception.

22. Bulimia in Movies Kate's Secret (1986) Girl, Interrupted (1999) Life is Sweet (1990)

23. Famous Athletes and Celebrities with Bulimia • Nadia Comaneci (9x gold medalist gymnast) • Victoria Beckham (Posh Spice) • Kelly Clarkson (American Idol Winner) • Princess Diana (Princess of Wales) • Lady Gaga (Pop Star) • Elton John (Musician)

24. Binge Eating Disorder(BED)

25. Binge Eating Disorder(BED) • Binge eating disorder is characterized by consuming large quantities of food in a very short period of time until the individual is uncomfortably full.  • Binge eating disorder is much like bulimia except the individuals do not use any form of purging (i.e. vomiting, laxatives, fasting, etc.) following a binge. 

26. Conti.... • Individuals usually feel out of control during a binge episode, followed by feelings of guilt and shame.  • Many individuals who suffer with binge eating disorder use food as a way to cope with or block out feelings and emotions they do not want to feel.  • Individuals can also use food as a way to numb themselves, to cope with daily life stressors, to provide comfort to themselves. • Like all eating disorders, binge eating is a serious problem but can be overcome through proper treatment

27. Signs • Periodically does not exercise control over consumption of food. • Eats an unusually large amount of food at one time, far more than an average person would eat in the same amount of time. • Eats much more quickly during binge episodes than during normal eating episodes. • Eats until physically uncomfortable and nauseated due to the amount of food just consumed. • Eats when depressed or bored.

28. Conti.... • Eats large amounts of food even when not really hungry. • Usually eats alone during binge eating episodes, in order to avoid discovery of the disorder. • Often eats alone during periods of normal eating, owing to feelings of embarrassment about food. • Feels disgusted, depressed, or guilty after binge eating. • Rapid weight gain, and/or sudden onset of obesity.

29. Food Craving

30. Food craving • Food Craving is an intense desire to consume a specific food and is different from normal hunger. It may or may not be related to specific hunger.

31. Specific in male & female • Male typically crave protein, fat, and salt:  Roast beef, burgers, fries, steak, pizza and chips etc. • Female are more likely to crave sweet, high-carbohydrate, high-fat foods:  Chocolate, cookies, ice cream, pasta, and bread etc.

32. Most craved foods

33. craving related deficiencies

35. Pica

36. Pica • Comes from the Latin word for magpie- a bird which eat anything. • An eating disorder in which non-nutritional objects are eaten. • characterized by a compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition.

37. Most Prevalent In • Children ages 1-6 • Pregnant women • Certain cultures • Mentally deficient

38. Possible Causes • Nutrient deficiencies- especially iron and zinc • Stress • OCD- Obsessive Compulsive Disorder • Developmental disorders • Mental disorders

39. Subtypes Subtypes are characterized by the substance eaten • Amylophagia(consumption of starch) • Coprophagy (consumption of feces) • Geophagy (consumption of soil, clay, or chalk) • Hyalophagia(consumption of glass) • Lithophagia (consumption of pebbles or rocks) • Mucophagia (consumption of mucus) • Pagophagia (consumption of ice) • Trichophagia(consumption of  hair or wool)

40. Conti... • Urophagia (consumption of urine) • Xylophagia (consumption of wood or paper) • Consumption of paint. • Odowa (soft stones eaten by pregnant women in Kenya) • Self-cannibalism (rare condition where body parts may be consumed; Consumption of dust or sand has been reported among iron-deficient patients.

41. Effects of pica • In children: • Malnutrition • Severe stomach ache • Muscle weakness • Brain damage • In adults : • Infertility • Increase blood pressure • Nerve disorders • Muscle/joint pain

42. Case studies related to Pica

44. COMPLICATIONS of Eating DIsorders HYPOTHALAMUS Changes in the production of specific hormone-releasing factors Reduced production of TSH Increased production of ACTH Reduced production of FSH and LH THYROID GLAND Reduced production of thyroxine, resulting in slowed heart rate, low blood pressure, poor thermal response and cold extremities ADRENAL CORTEX Increased production of cortisol as a normal stress response, resulting in release of protein from muscle and muscle wasting GONADS Reduced production of oestrogen and progesterone in females, resulting in loss of ovulation and menstruation Reduced production of testosterone in males resulting in impotence Trotter (1997) Endocrine effects of eating disorder

45. Conti…. • Skeletal •  oestrogen and  cortisol levels are largely implicated • If menstruation interrupted for a prolonged period of time, bone loss results. •  risk of fractures and osteoporosis. • Refeeding syndrome • Hypokalemia • Hyponatremia • Hypophosphatemia • Hypomagnesemia • Also: hyperglycaemia, rebound hypoglycaemia, possible nausea and vomiting, possible diarrhoea, possible cardiopulmonary failure….. death

46. GIT • Salivary gland hypertrophy (parotid gland) (“chipmonk cheeks”) • Occasionally pancreatitis • Oesophagitis & oesophageal perforation • Gastric dilatation – poses risk of gastric rupture • Loss of bowel control • Constipation • Steatorrhoea

47. Pulmonary • Aspiration pneumonia; recurrent chest infections Dental • Erosion of dental enamel • Projection of fillings above the surface of the teeth • Chronic Diseases • Obesity • CVD (include: dyslipidaemia; HT) • Diabetes

48. CASE STUDIES CASE STUDIES