Eating DisordersEating Disorders

307.1 Anorexia Nervosa307.1 Anorexia Nervosa

Refusal to maintain a normal body weightAn intense fear of gaining weight, and the

fear is not reduced by weight lossIn females, accompanied by amenorrheaA distorted sense of their body shapeTwo subtypes:

– Restricting– Binge-eating

Associated Features of Associated Features of Anorexia NervosaAnorexia Nervosa

Symptoms of Depression (e.g., low mood, social withdrawal, irritability, insomnia, decreased interest in sex)

Obsessive-Compulsive Disorder Features - both related and unrelated to food

Others: concerns about eating in public, feelings of ineffectiveness, a strong need to control one’s environment, inflexible thinking, limited social spontaneity.

Physical Effects of Anorexia Physical Effects of Anorexia NervosaNervosa

Low Blood Pressure Bradycardia Reduce Bone Mass Dry Skin Brittle Nails Mild Anemia Hair Loss Constipation

Loss of Tooth Enamel Osteoporosis Emaciation Lethargy Amenorrhea Abdominal Pain Cold Intolerance Altered Electrolytes

(e.g., potassium, sodium)

307.51 Bulimia Nervosa307.51 Bulimia Nervosa

Recurrent episodes of binge eating– eating, in a discrete time, a large amount of food– a sense of lack of control over eating

Recurrent inappropriate compensatory behavior in order to prevent weight gain

Binges and compensatory behaviors occur at least twice a week for 3 months

Self-evaluation is unduly influenced by body shape and weight

307.51 Bulimia Nervosa 307.51 Bulimia Nervosa (cont.)(cont.)

The disturbance does not occur exclusively during episodes of Anorexia Nervosa

Two subtypes:– Purging type - during the current episode of Bulimia

Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

– Nonpurging type - the person uses other inappropriate compensating behaviors (e.g., fasting, excessive exercise)

This Is A Test!This Is A Test!

Which is a distinction between anorexia nervosa and bulimia nervosa?a Bingeingb physiological complications commonc pronounced weight lossd depression

The Societal Impact on Eating The Societal Impact on Eating Behaviors, Obesity, and Body Behaviors, Obesity, and Body

ImageImage

Sociocultural VariablesSociocultural VariablesThe cultural ideal for women (especially) and

men has changed dramatically over the years.Playboy centerfolds became thinner between

1958 and 1978, now has leveled off. Average American woman has become heavier.

1/3 of 10th grade girls feel they are overweight (most are not).

Models in women's magazine are becoming thinner.

Does Society Influence Does Society Influence Eating Behavior?Eating Behavior?

Have you ever eaten just because everyone else was?

Have you ever eaten somewhere you didn’t particularly want to just because everyone else wanted to?

Have you ever eaten alone in a restaurant?Do your celebrations and festivities involve

food?Have you ever paid $.25 to “supersize” a meal?

Does Society Influence Does Society Influence Body Image?Body Image?

Do you ever look at a model and wish you looked like him/her?

Do you compare yourself to others at the gym/beach/dance, etc.?

Have you ever been angry, upset, or depressed about how your body looks?

Do you feel ashamed or guilty if you gain a few pounds?

What messages do we get What messages do we get from society about weight from society about weight

related issues?related issues?

Cultural IdealsCultural Ideals

Cultural IdealsCultural Ideals

Advertising and Eating Advertising and Eating DisordersDisorders

Cultural IdealsCultural Ideals

Cultural IdealsCultural Ideals

Magazine AdMagazine Ad

The Change over 40 yearsThe Change over 40 years

Unrealistic Goals:Unrealistic Goals: Average Fashion Average Fashion

Model vs Average WomanModel vs Average Woman

HeightHeight

WeightWeight

BMIBMI

5'4"5'4"

142 lb142 lb

24.324.3

AverageAverageFashion ModelFashion Model

AverageAverageWomanWoman

5'9"5'9"

110 lb110 lb

16.316.3

Personal communication from Wadden TA, July 1997.Personal communication from Wadden TA, July 1997.

Cognitive-Behavioral Cognitive-Behavioral InfluencesInfluences

Fear of fatness and body-image disturbance make self-starvation reinforcing

Criticism from peers and parents about being overweight

Perfectionism and personal inadequacyPortrayals in the media of thinness as ideal, being

overweight as representing lack of willpower or weakness

Dieting itself is often the stimulus for binging

Biological Factors in Eating Biological Factors in Eating DisordersDisorders

Genetic component - concordance rate of 47% for monozygotic and 10% for dizygotic pairs

Although the hypothalamus is a key brain center for regulating eating, does not seem to be a factor in eating disorders

Starvation among anorexic patients may increase the levels of endogenous opioids, resulting in a reinforcing euphoric state

Several studies have found low levels of serotonin in bulimic patients. Antidepressant drugs somewhat effective

Biological TreatmentsBiological TreatmentsFluoxetine found to be superior to placebo in

reducing binge eating and vomiting, also lessened depression and distorted attitudes toward food and eating

Attrition in drug trials much higher than that found in cognitive-behavioral programs (nearly 1/3)

Most patients relapse when medication is withdrawn

Treatment of BulimiaTreatment of Bulimia

In CBT, patient encouraged to question society’s standards for physical attractiveness

Core dysfunctional belief - one’s shape and weight are of paramount importance for acceptance by others

Teach that weight control best accomplished by eating on a regular basis

Only about 1/3 of bulimics treated maintain their gains long-term

Treatment of Anorexia Treatment of Anorexia NervosaNervosa

Immediate goal - help gain weightSecond goal - long-term maintenance of gains

in body weight.Neither medical, behavioral, or traditional

psychodynamic interventions have been very effective

Family therapies, despite claims, has not been adequately studied

The EndThe End

Prevalence of NIDDM in Japanese Men Hara et. al., Diabetes Research & Clinical Practice, (1991)

02468

101214161820

Age-adjusted % Men with Diabetes, Ages 40-

70+

Diabetes

Japan Hawaii California

Nutritional Transition and Obesity in ChinaNutritional Transition and Obesity in ChinaPopkin et. al., European Journal of Clinical Nutrition (1993)

16.44

7.73 7.45

2.28

22.33

10.1411.98

4.75

0

5

10

15

20

25

Percent (%)

Rural Urban

Region

% Fat in Diet % with BMI<18.5 % with BMI>25 % with BMI>27

Obesity in Australian Aboriginal PeopleObesity in Australian Aboriginal PeopleJones & White, Annals of Human Biology (1994)

4.3 2.4

16.7

51

22

-5

5

15

25

35

45

55

65

Percent Obese

(BMI>30)

Least Most

Degree of Westernization

Women Men

Indian Migrants and Non-migrant Siblings CHD Indian Migrants and Non-migrant Siblings CHD Risk FactorsRisk Factors

West London

Punjab

Men BM I 26.8(5.2) 22.9(4.7)

Cholesterol 6.5(1.4) 4.9(1.1)

Women BM I 27.4(4.9) 22.7(4.0)

Cholesterol 6.2(1.2) 5.1(1.0)

Bhatnagar et. al., The Lancet (1995)