Eating Disorders

307.1 Anorexia Nervosa Refusal to maintain a normal body weight An intense fear of gaining weight, and the fear is not reduced by weight loss In females, accompanied by amenorrhea A distorted sense of their body shape Two subtypes: –Restricting –Binge-eating

Associated Features of Anorexia 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 Nervosa 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)

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

Bulimia Nervosa (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! Which is a distinction between anorexia nervosa and bulimia nervosa? a Bingeing b physiological complications common c pronounced weight loss d depression

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

Sociocultural Variables The 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 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 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 from society about weight related issues?

Cultural Ideals

Advertising and Eating Disorders

Cultural Ideals

Magazine Ad

The Change over 40 years

Unrealistic Goals: Average Fashion Model vs Average Woman HeightWeightBMI5'4" 142 lb 24.3 Average Fashion Model Average Woman 5'9" 110 lb 16.3 Personal communication from Wadden TA, July 1997.

Cognitive-Behavioral Influences Fear of fatness and body-image disturbance make self-starvation reinforcing Criticism from peers and parents about being overweight Perfectionism and personal inadequacy Portrayals 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 Disorders 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 Treatments Fluoxetine 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 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 Nervosa Immediate goal - help gain weight Second 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 End

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

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

Obesity in Australian Aboriginal People Jones & White, Annals of Human Biology (1994)

Indian Migrants and Non-migrant Siblings CHD Risk Factors West London Punjab MenBM I26.8(5.2)22.9(4.7) Cholesterol6.5(1.4)4.9(1.1) WomenBM I27.4(4.9)22.7(4.0) Cholesterol6.2(1.2)5.1(1.0) Bhatnagar et. al., The Lancet (1995)