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MNT in Eating Disorders. The Ideal Body Image. Media promotion Social acceptance Influence and stress on young individuals. Food: More Than Just Nutrients. Linked to personal emotions Comfort Release of natural opioids Reward. Eating Disorders (APA Diagnoses). Anorexia nervosa

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MNT in Eating Disorders


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the ideal body image
The Ideal Body Image
  • Media promotion
  • Social acceptance
  • Influence and stress on young individuals
food more than just nutrients
Food: More Than Just Nutrients
  • Linked to personal emotions
  • Comfort
  • Release of natural opioids
  • Reward
eating disorders apa diagnoses
Eating Disorders (APA Diagnoses)
  • Anorexia nervosa
  • Bulimia nervosa
  • Eating disorder not otherwise specified (EDNOS)
  • Binge eating disorder (BED)

Schebendach in Krause, 12th ed., p. 564)

genetic link
Genetic Link?
  • Identical twins have a higher chance of eating disorders
  • Fraternal twins are less likely
profile of anorexia
Profile of Anorexia
  • Usually occurs between the ages of 12-18
  • Typically white female
  • Lifetime prevalence among women is .3 to 3.7%, depending on criteria used
  • 5%-10% are male
  • Middle-upper socioeconomic class
  • Often coexists with other psychiatric disorders: major depression or dysthymia (50-75%), anxiety disorders, OCD (40%)
  • 5-20% mortality rate, mostly from heart failure or arrhythmias

Schebendach in Krause, 12th Ed, p 564

anorexia nervosa psychological features
Anorexia Nervosa: Psychological Features
  • Perfectionism
  • Harm avoidance
  • Feelings of ineffectiveness
  • Inflexible thinking
  • Overly restrained emotional expression
  • Limited social spontaneity

Schebendach in Krause, 12th Ed., p. 564

anorexia nervosa
Anorexia Nervosa
  • Food rituals
    • Cuts food in small pieces
    • Rearranges food on plate
  • Eliminates foods gradually
    • 300-600 calories a day
    • Diet pop, sugarless gum
  • Prolonged exercise
  • Preoccupation with food
  • Cooks for others
  • Hungry, but refuses to eat
diagnostic criteria
Diagnostic Criteria
  • American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria are the standard
an apa diagnostic criteria
AN APA Diagnostic Criteria
  • Weight <85% standard
  • Intense fear weight gain/fat although underweight
  • Distorted body image
  • Women: amenorrhea: absence of 3 consecutive periods
  • Restricting type
    • Not regularly engaged in binge eating-purging behavior
  • Binge eating/purging type
    • Regularly engaged in binge eating and purging behavior
an diagnostic criteria
AN Diagnostic Criteria
  • Weight deficit is necessary (<85% of expected)
  • If AN develops in childhood or early adolescence, failure to make expected weight gains instead of weight loss may occur
    • Stunting possible in prepubertal children
    • Growth charts are essential
  • Amenorrhea may not be useful in younger patients as menarche may be delayed
related psych disorders in an
Related Psych Disorders in AN
  • Depression: May be due, in part, to the psychological stress of starvation
  • Obsessive-compulsive disorder: may be exacerbated by malnutrition
  • Comorbid personality disorders: poor impulse control, substance abuse, mood swings, and suicide tendencies
prevalence of an
Prevalence of AN
  • More prevalent in industrialized countries that idealize a thin body type although expected to become more widely distributed
  • Lifetime prevalence among women is .5% to 3.7%, depending on criteria used
  • Prevalence among men is one tenth of that among women

Schebendach in Krause, 12th edition, p. 564

risk periods for anorexia nervosa
Risk Periods for Anorexia Nervosa
  • Age 14 – puberty, high school
  • Age 18 – college, full time jobs
pathophysiology of an
Pathophysiology of AN
  • Physical and psychological consequences of malnutrition
pathophysiology of an1
Pathophysiology of AN
  • Depleted fat stores; muscle wasting
  • Amenorrhea
  • Cheilosis
  • Postural hypotension; dehydration or edema
  • Bradycardia; hypothermia
  • Sleep disturbances
pathophysiology of an osteopenia
Pathophysiology of AN: Osteopenia
  • Reduced bone mineral density
  • May result in vertebral compression, fractures
  • Caused by estrogen deficiency, elevated glucocorticoid levels, malnutrition, reduced body mass
  • Affects males and females
pathophysiology of an2
Pathophysiology of AN
  • Low body temperature/cold intolerance
  • Lower metabolism: low thyroid hormone
  • Bone marrow hypoplasia (50% of AN patients) results in leukopenia, anemia, thrombocytopenia
pathophysiology of an cardiovascular
Pathophysiology of AN: Cardiovascular
  • Decreased heart rate <60 bpm
    • Fatigue, fainting
  • Decreased blood pressure <70 mm/Hg systolic; orthostatic hypotension
  • Reduction in heart mass
  • Mitral valve prolapse related to hypovolemia or cardiomyopathy
    • Death from CHF
pathophysiology of an3
Pathophysiology of AN
  • Iron deficiency anemia
  • Increased infections
  • Dry skin, hair
  • Yellow skin due to hypercarotenemia
  • Desquamation, hair loss, alopecia
  • Hirsutism
  • Lanugo: fine body hairs
pathophysiology of an gi
Pathophysiology of AN: GI
  • Bloating, abnormal fullness after eating
  • Constipation
  • Digestive enzymes low
pathophysiology of an4
Pathophysiology of AN
  • Electrolyte imbalance → heart failure, death
    • Low intake potassium
    • Loss in vomiting, diuretics
    • Refeeding syndrome: electrolyte imbalances caused by too-rapid refeeding
bulimia nervosa
Bulimia Nervosa

An illness characterized by repeated episodes of binge eating followed by inappropriate compensatory methods

  • Purging, including self-induced vomiting or misuse of laxatives, diuretics, or enemas
  • Non-purging including fasting or engaging in excessive exercise
bulimia nervosa apa criteria
Bulimia Nervosa APA Criteria
  • Characterized by recurrent episodes of binge/purge eating
  • Average ≥ 2 binges/purge cycles/week
    • Uncontrollable eating during binge
    • Purge regularly: vomiting, laxatives, diuretics, strict dieting, fasting, vigorous exercise
  • Continues at least 2x/wk for ≥ 3 months

American Psychological Association. DSM-IV-TR, ed 4, Washington DC, 2000

bulimia nervosa prevalence
Bulimia Nervosa Prevalence
  • Lifetime prevalence of BN among young adult women is 1% to 3%
  • Rate of occurrence in males is 10% of that in females
  • Rarely seen in childhood

Schebenbach, in Krause, 12th edition, p. 565

bulimia nervosa prevalence1
Bulimia Nervosa Prevalence
  • 5% of college women
  • 20% of college women exhibit symptoms (Sx)
  • 50% of those with anorexia nervosa develop bulimia nervosa
  • Gorging and purging/vomiting
  • Susceptible populations—athletes, actors, dancers, wrestlers, runners
profile of bulimia
Profile of Bulimia
  • Young (usually female) adults (college students)
  • May be predisposed to becoming overweight
  • Usually at or slightly above normal weight
  • Tried frequent weight-reduction diets as a teen
  • Impulsive
  • Often goes undiagnosed
profile of bulimia nervosa
Profile of Bulimia Nervosa
  • Other psychological disorders, including major depression, dysthymia, anxiety disorders, personality disorders, substance abuse
  • Low self esteem
  • Guilt
  • Preoccupied with food
  • Recognize behavior is abnormal
binge definition
Binge Definition
  • 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 under similar circumstances
  • A sense of lack of control over eating during the episode
binge
Binge
  • Relieves stress
  • Common binge foods:
    • High carbohydrate, high fat
    • Convenience foods
    • Cakes, cookies, ice cream
    • Soft, easier to purge
  • High food bills
purge
Purge
  • Laxatives, enemas
    • Act on large intestine
    • 90% of calories are absorbed in small intestine
    • Damages large intestine → constipation
vomiting
Vomiting
  • Most commonly used compensatory behavior (80%-90% of BN)
  • 33-75% of calories still absorbed
  • Fingers down throat
    • Damaged knuckles
  • Syrup of Ipecac
    • Toxic to heart, liver, kidneys
    • Poison if taken repeatedly
vomiting1
Vomiting
  • Teeth
    • Stomach acid erodes enamel
    • Pain, decay
diuretics
Diuretics
  • Water loss
  • Electrolyte loss
  • NO fat loss!
hypergymnasia excessive exercise
Hypergymnasia: Excessive Exercise
  • Compulsive exercise: that which significantly interferes with life activities
  • Occurs at inappropriate times or in inappropriate settings
  • Continues despite injury or other medical complications
symptoms of bn
Symptoms of BN
  • Usually normal weight and secretive in behavior
  • Scarring of the dorsum of the hand used to stimulate the gag reflex, known as Russell’s Sign
  • Parotid gland enlargement
  • Erosion of dental enamel with increased dental caries resulting from gastric acid in the mouth
pathophysiology of bn vomiting
Pathophysiology of BN: Vomiting
  • Dehydration
  • Alkalosis
  • Hypokalemia
  • Sore throat, esophagitis, mild hematemesis
  • Abdominal pain
pathophysiology of bn vomiting1
Pathophysiology of BN: Vomiting
  • Subconjunctival hemorrhage
  • Mallory-Weiss esophageal tears
  • Esophageal ruptures (rare)
  • Acute gastric dilatation or rupture
  • Salivary gland infections
pathophysiology of bn laxative abuse
Pathophysiology of BN: Laxative Abuse
  • Dehydration
  • Elevation of serum aldosterone and vasopressin levels
  • Rectal bleeding
  • Intestinal atony
  • Abdominal cramps
pathophysiology of bn
Pathophysiology of BN
  • Cardiac arrhythmias related to electrolyte and acid-base imbalance caused by vomiting, laxative, and diuretic abuse
  • Ipecac may cause irreversible myocardial damage and sudden death
  • Menstrual irregularities
eating disorder not otherwise specified ednos
Eating Disorder Not Otherwise Specified (EDNOS)
  • A diagnostic category for eating disorders that fail to meet full criteria for either anorexia nervosa or bulimia nervosa
  • May have partial symptoms of either AN or BN
  • For example, all criteria for AN may be met except patient has regular menses
  • OR significant weight loss but wt still in normal range
an treatment
AN: Treatment

Nutrition

  • Increase food intake to raise the BMR
  • Prevent further weight loss
  • Restore appropriate food habits
  • Ultimately weight gain
  • Some weight restoration and treatment of malnutrition may make psychotherapy more effective
an treatment1
AN: Treatment

Psychological

  • Cognitive behavior therapy
  • Determine underlying emotional problems
  • Reject the sense of accomplishment associated with weight loss
  • Family therapy, support group
assessment of intake in eating disorders
Assessment of Intake in Eating Disorders
  • Calories compared with DRI
  • Evaluate macronutrient mix (carbohydrate, protein, fat)
  • Evaluate micronutrient intake compared with DRI
  • Estimate fluids and compare with needs
  • Evaluate alcohol, caffeine, drugs, dietary supplements
dietary intake in an
Dietary Intake in AN
  • Generally inadequate caloric intake, <1000 kcals/day
  • Tend to avoid fat
  • Many follow a vegetarian lifestyle
    • Identify whether vegetarian lifestyle coincided with onset of disease
dietary intake in bn
Dietary Intake in BN
  • Highly variable; in one study mean intake of 4446 kcals; 44% overeating, 19% undereating
  • When not binge eating may follow a low fat diet
eating behavior in an bn
Eating Behavior in AN/BN
  • Unusual or ritualistic behaviors
  • Unusual food combinations
  • Nontraditional utensils
  • Excessive spices, vinegar, lemon juice, noncaloric sweeteners
  • Meal spacing, length of time allocated for a meal
  • BN: may eat quickly
  • AN: may eat in excessively slow manner
an bn eating attitudes
AN/BN Eating Attitudes
  • Food aversions
  • “Safe” foods
  • Magical thinking
  • Binge trigger foods
  • Ideas on appropriate amounts of food
  • Misconception that purging eliminates all calories from a binge episode
lab assessment
Lab Assessment
  • Visceral proteins: generally normal in AN
  • Lipids: elevated cholesterol and abnormal lipid profile; may be due to hepatic dysfunction, decreased bile acid secretion, hypothalamic dysfunction, eating patterns
    • Does not warrant prescription of low fat, low cholesterol diet
    • Reassess after weight restored
lab assessment1
Lab Assessment
  • Serum glucose: low due to lack of precursors for gluconeogenesis and production
  • Low T3 syndrome: low levels of active form of thyroid hormone; resolves with refeeding
vitamin mineral abnormalities
Vitamin-Mineral Abnormalities
  • Hypercarotenemia: in AN restrictors; mobilization of lipid stores, catabolic changes, metabolic stress; normalizes with rehab
  • Deficiency diseases rare in AN, possibly due to use of supplements, catabolic state, use of nutrient-dense foods
  • Osteopenia and osteoporosis are common
metabolic changes
Metabolic Changes
  • AN: low metabolic rates (REE 62-70% of expected, or 700-1000 kcals)
  • Refeeding causes increases in REE
  • Elevated diet-induced thermogenesis (DIT) and ↑ REE may require high calorie prescriptions in nutritional rehab
  • BN: unpredictable metabolic rate
  • Helpful to measure REE using indirect calorimetry
anthropometric assessment
Anthropometric Assessment
  • AN patients meet criteria for marasmus (depleted adipose and somatic protein stores but intact visceral proteins)
  • Body composition: underwater weighing or DEXA; BIA of questionable validity
  • Skinfolds from 4 sites (triceps, biceps, subscapular, suprailiac crest)
  • MAMC
body weight assessment
Body Weight Assessment
  • Goal weight determined by various methods (NCHS growth tables to age 18)
  • Daily preprandial early morning weight in hospital
  • Gowned weight on the same scale once a week in outpatient (pt should void and urine specific gravity checked or patient examined to determine if bladder is full)
management of eating disorders
Management of Eating Disorders
  • Multidisciplinary team including physicians, nutritionists, psychotherapists
  • May include inpatient medical or psychiatric hospitalization, partial hospitalization and residential treatment, intensive outpatient, or outpatient programs
treatment goals
Treatment Goals
  • AN: weight gain and correction of malnutrition disorders; normalization of eating patterns and behaviors
  • BN: weight maintenance in the short term even if patient is overweight until eating habits are stabilized
factors affecting weight gain in an
Factors Affecting Weight Gain in AN
  • Fluid balance
    • Polyuria seen in starvation
    • Edema from starvation or refeeding
    • Hydration ratio in tissues
  • Metabolic rate
    • Resting energy expenditure
    • Postprandial energy expenditure
factors affecting weight gain in an1
Factors Affecting Weight Gain in AN
  • Energy cost of tissue gained
    • Lean body mass
    • Adipose tissue
  • Previous obesity
  • Physical activity
nutritional care in an
Nutritional Care in AN
  • Often require hospitalization to begin refeeding
  • Some require enteral feedings, but most can be rehabbed with oral feedings
  • Goal is increase in energy intake with weight gain
  • Energy intake must be increased gradually while minimizing caloric expenditure
nutritional care in an1
Nutritional Care in AN
  • Initial calorie prescriptions 1000-1600 kcals, or 30-40 kcals/kg
  • Increase 100 to 200 kcals q 2-3 days; may be as high as 70-100 kcal/kg/day
  • Hospitalized patients: goal is 2-3 lb/week
  • Outpatients: 1 pound/week

APA Practice Guidelines for the Treatment of Eating Disorders, January, 2006

refeeding syndrome
Refeeding Syndrome
  • Refeeding malnourished patients with AN can result in life-threatening hypophosphatemia, cardiac arrhythmia, and delirium
  • May be precipitated by high-calorie feeding regimens
  • Patients weighing less than 70% desirable body weight at greatest risk
  • Serum phos, mg, K+, calcium must be closely monitored and supplements provided as needed
energy needs in an
Energy Needs in AN
  • 70-100 kcals/kg may be needed for continued weight gain (depends on REE and type of tissue gained)
  • AN more physically active than controls; require ↑ kcals for weight maintenance
  • May require 3000-4000 kcals/day later in wt restoration (males 4000-4500)
energy needs in an1
Energy Needs in AN
  • If unsuccessful in weight gain, evaluate for discarding food, vomiting, exercising, increased motor activity, metabolic resistance
  • Use indirect calorimetry in fasting and post-prandial state
  • Once at goal rate, 40-60 kcals/kg should promote wt maintenance and continued growth and development in adolescents
macronutrient mix
Macronutrient Mix
  • Fat intake of 25%-30% of calories is recommended as added fat or less obvious sources (whole milk or peanut butter)
  • Protein: 15%-20% of calories; RDA for age and sex in grams/kg of IBW; high biological value sources; vegetarian diets should be discouraged during rehab
  • Carbohydrate: 50%-55%; include sources of insoluble fiber to relieve constipation
micronutrients
Micronutrients
  • Vitamin-mineral supplements: may have increased need in anabolism; 100% RDA multivitamin with minerals (iron may ↑ constipation)
  • Encourage calcium-rich foods and Vitamin D
mnt in an
MNT in AN
  • Early treatment: caloric intake usually low, can be provided in 3 meals per day; snacking may relieve some physical discomfort
  • Later treatment: as caloric prescription increases, snacks become unavoidable
  • Defined formula liquid supplements may be helpful; patients may be more willing to accept them than large volumes of food
mnt in bn
MNT in BN
  • Immediate goal interruption of the binge and purge cycle with weight maintenance
  • Rarely hospitalized except for electrolyte disturbances
energy needs in bn
Energy Needs in BN
  • May be hypocaloric; poor correlation between predicted and actual REE
  • Measured REE preferable; provide calories at 120%-130% measured REE
    • Signs of low metabolism: history of chronic dieting, low T3 level, cold intolerance
    • In presence of low metabolism, provide 1500-1600 kcals/day) or determine average calories/day based on current intake
energy needs in bn1
Energy Needs in BN
  • Monitor anthropometric status and adjust caloric prescription for weight maintenance
  • Avoid weight reduction diets until eating patterns and body weight are stabilized
  • May be on low-calorie intakes for longer periods than anorectic patients
monitoring of bn patients
Monitoring of BN Patients
  • Bingeing, purging, restrained intake impair recognition of hunger and satiety cues
  • Many patients with BN are afraid to eat early in the day as they might binge later
  • May digress from meal plan after a binge, attempting to compensate
macronutrients in bn
Macronutrients in BN
  • Protein: 15-20% of calories; meet RD in g/kg IBW; HBV sources
  • Carbohydrate: 50%-55% of calories; encourage insoluble fiber
  • Fat: 25%-30% of calories
    • Provide source of essential fatty acids
  • MVI: multivitamin with minerals
cognitive behavioral therapy
Cognitive Behavioral Therapy
  • Structured psychotherapeutic method alters attitudes and problem behaviors
  • Identifies and replaces negative, inaccurate thoughts
  • Typically a 20-week intervention that
    • Establishes a regular eating pattern
    • Evaluates and changes beliefs about shape and weight
    • Prevents relapse
three components
Three Components
  • Eating disorder
  • Lack of menstrual periods
  • Osteoporosis
    • Bones like 60-year-old
    • Caused by low estrogen
    • Often irreversible
    • Early warning: stress fractures
  • Also meet criteria for EDNOS
female athlete triad1
Female Athlete Triad
  • Female athletes participating in appearance-based and endurance sports
  • Seen in 15% swimmers, 62% gymnasts, and 32% of all other sport
female athlete triad2
Female Athlete Triad
  • Performance thinness: the commonly held belief that achieving a lower weight and percentage of body fat will enhance performance
  • Appearance thinness: trend to reward thinner athletes in adjudicated sports such as gymnastics and figure skating
treatment for female athlete triad
Treatment for Female Athlete Triad
  • Reduce preoccupation with food, weight, and body fat
  • Increase meals and snacks gradually
  • Rebuild body to healthy weight
  • Establish regular menses
  • Decrease training
binge eating disorder compulsive overeating
Binge-Eating Disorder (Compulsive Overeating)
  • Complex and serious eating disorder
  • Occurs in ~30% -50% of subjects in weight control programs (40% are males)
  • More common with obese individuals with history of restrictive dieting
  • ~50% exhibit clinical depression
  • Not preoccupied with body shape
  • Onset adolescence or early 20s
binge eating disorder diagnostic criteria apa
Binge Eating Disorder Diagnostic Criteria (APA)
  • Recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of BN
  • At least 2x week over 6 month period
  • Distress, disgust, guilt, depression
binge eating disorder compulsive overeating1
Binge-Eating Disorder (Compulsive Overeating)
  • Eat more rapidly than usual
  • Eat until uncomfortable
  • Eat when not hungry
  • Cannot control binges
  • Embarrassed, guilty after binge
binge eating process
Binge Eating Process
  • Precondition
  • Trigger phase
  • Maintenance phase
  • Ending phase
  • Post-binge phase (consequences)
characteristics of a binge eater
Characteristics of a Binge-Eater
  • Consider self as hungrier than normal
  • Isolate self to eat large quantities
  • Triggered by stress, depression, anxiety, loneliness, anger, frustration
  • Usually binge on “junk” foods
  • Eat without regards to biological need
  • Food is used to reduce stress, provide feeling of power and well-being
treatment for binge eating
Treatment for Binge-Eating
  • Learn to eat in response to hunger
  • Learn to eat in moderation
  • Avoid restrictive diets which can intensify problems
  • Increase activity
treatment for binge eating1
Treatment for Binge-Eating
  • Increase self-acceptance and improved body image
  • Address hidden emotions
  • Overeaters Anonymous
  • Antidepressants
baryophobia
Baryophobia
  • “The fear of becoming heavy”
  • Children are given a low-fat, restricted diet in hopes to ward off obesity or heart disease
  • Detrimental to children; affect growth and development
  • Self-imposed restrictive diets by young adults to avoid obesity
  • Lack of appropriate nutrition information
treatment for baryophobia
Treatment for Baryophobia
  • Nutrition education
  • Nutrition required for proper growth
  • Appropriateness of sweets and fats in the diet
childhood eating disorders
Childhood Eating Disorders
  • DSM criteria not appropriate in young children
  • Cases of AN reported in children as young as 8 years old
  • BN rare in childhood
  • C/o nausea, abdominal pain, difficulty swallowing, concerns about weight, shape, and body fatness
five warning signs of childhood eating disorder
Five Warning Signs of Childhood Eating Disorder
  • Decreasing weight goal
  • Increasing criticism of the body
  • Increasing social isolation
  • Disruption of menstruation
  • Reports of purging in the context of dieting
eating disorders in dietetics students
Eating Disorders in Dietetics Students
  • There is some evidence that the prevalence of disordered eating is higher in dietetics students than in other majors, though the research has been mixed
eating disorders in ug college students
Eating Disorders in UG College Students
  • Worobey and Schoenfeld surveyed 165 undergraduate women (mean age 21.6+4.9 years and 46 men (22.4+6.6 years) from dietetics, exercise science, dance, psychology, and biology/nursing

Worobey J, Schoenfeld D. Eating disordered behavior in dietetics students and students in other majors. JADA 1999;99:1100-1102

eating disorders in ug college students1
Eating Disorders in UG College Students
  • Nursing/biology majors had significantly higher BMI and weight
  • Dietetics students scored highest on Cognitive concerns and binge/purge behavior

Worobey J, Schoenfeld D. Eating disordered behavior in dietetics students and students in other majors. JADA 1999;99:1100-1102

eating disorders in college students
Eating Disorders in College Students
  • Dietetics and dance majors scored highest on Life Interference
  • Dance students scored highest on Excessive Exercise

Worobey J, Schoenfeld D. Eating disordered behavior in dietetics students and students in other majors. JADA 1999;99:1100-1102

eating disorders in college students1
Eating Disorders in College Students
  • Fredenberg et al surveyed 5 groups of students in DPD dietetics, CP dietetics, non-food home economics curricula, college basketball or volleyball programs, and sororities

Fredenberg JP, Berglund PT, Dieken HA. Incidence of eating disorders among selected female university students. J Am Diet Assoc 1996;96:64-65.

eating disorders in college students2
Eating Disorders in College Students
  • Fredenberg and colleagues found no significant differences among the groups of college women surveyed in EAT scores (Eating Attitude Test.)
  • However, 17.7% of DPD students had EAT scores symptomatic of eating disorders compared with 3.3% and 2.9%, respectively for CP and home economics students (NS)
  • This was lower than in a previous study (24%) (Drake et al, JADA, 1989)

Worobey J, Schoenfeld D. Eating disordered behavior in dietetics students and students in other majors. JADA 1999;99:1100-1102

prognosis
Prognosis
  • Mortality has declined for AN from 10% to 2%.
  • 20% to 30% will have a lifelong struggle with food
  • Bulimics may need long-term counseling to correct underlying philosophies and beliefs.
  • Family counseling is useful for both AN and bulimia.
  • High relapse rate after treatment
topics for nutrition education
Topics for Nutrition Education
  • Impact of malnutrition on growth and development
  • Impact of malnutrition on behavior
  • Set-point theory
  • Metabolic adaptation to dieting
  • Restrained eating and disinhibition
  • Causes of bingeing and purging
  • What does “weight gain” mean?

Modified from Schebendach J, Nussbaum MP: Nutrition management in Adolescents with eating disorders. Adoles Med: State Art Rev 3 (3): 556, 1992.

topics for nutrition education cont d
Topics for Nutrition Education —cont’d
  • Impact of exercise on caloric expenditure
  • Ineffectiveness of vomiting, laxatives, and diuretics in long-term weight control
  • Portion control
  • Food exchange system
  • Social dining and holiday dining
  • Food Guide Pyramid
  • Hunger and satiety cues
  • Interpreting food labels
  • Nutrition misinformation

Modified from Schebendach J, Nussbaum MP: Nutrition management in Adolescents with eating disorders. Adoles Med: State Art Rev 3 (3): 556, 1992.

dying to be thin
Dying To Be Thin
  • Normal to be concerned about diet, health, and body weight
  • Weight normally fluctuates
  • Treat physical and emotional problems early
  • Discourage restrictive diets
  • Correct misconception about foods
  • Thin is not necessary better
summary
Summary
  • Nutritional intervention supports psychologic strategy