1. The Nutrition Care Process for Binge Eating Disorder Leah Bekkerus Concordia College Moorhead, MN

2. Objectives:  Be able to identify Binge Eating Disorder (BED)  Identify the two types of binge eating disorder  Identify the factors that contribute to binge eating disorder  Understand the nutrition care process associated with binge eating disorder  Understand motivational interviewing  Be able to identify ethical issues associated with binge eating disorder

3. Statistics  1 in 142 people in the United States suffer from binge eating disorder  Approximately 1.9 million people  2% of United States population  Has become the most common eating disorder

4. What is Binge Eating Disorder?  Binge Defined:  An act of excessive or compulsive consumption  Binge Eating Disorder Defined:  An eating disorder characterized by recurring episodes of binge eating accompanied by a sense of lack of control and often negative feelings about oneself but without intervening periods of compensatory behavior. Merriam- Webster’s Medical Dictionary

5. What is Binge Eating Disorder? (cont.)  Frequent episodes of uncontrollable binge eating  Feeling extremely distressed or upset during or after the binge  No regular attempts to “make up” for the binge  Vomiting  Fasting  Overexercising

6. Types of Binge Eating  Objective Binge Eating (OBE)  Loss of control over eating  Large amount of food is consumed  Subjective Binge Eating (SBE)  Sense of out of control over eating  Large amount of food not consumed

7. Binge Eating Disorder vs. Objective Overeating  Binge Eating Disorder  Sense the loss of control  Feel remorse  Consume excess amounts of food  Objective Overeating  Do not sense the loss of control  Consume excess amounts of food

8. Who is at Risk for Binge Eating Disorder?  Everyone  2% of men  3.5% of women  Usually late onset (40’s)  Can happen in younger years  People who are over weight or obese  Over weight: BMI 25-29.9  Obese: BMI > 30  People of a healthy weight  BMI 18.5-24.9

9. Causes of Binge Eating Disorder  Negative self image  Depression  Negative mood  Sadness  Emotional eating  Boredom  Worry  Stress  Anger  Failed dieting

10. Psychological effects of Binge Eating Disorder  Can elevate negative self image  Can enhance depression  Becomes an addiction  Begin to obsess over self control

11. Risk Factors of Binge Eating Disorder  Binge eating causes  Weight gain  Results  obesity  Obesity causes:  Type 2 diabetes  High cholesterol  High blood pressure  Heart disease  Sleep apnea

12. Signs of Binge Eating Disorder:  Eating more rapidly than usual  Eating until uncomfortably full  Eating large amounts of food when not hungry  Eating alone to hide actual food intake  Feelings of disgust, depression, or guilt after eating

13. The Cycle of Binge Eating Disorder

14. The Nutrition Care Process  Assessment  Collect and interpret laboratory values  Diagnosis  Determine illness or disorder  Find contributing factors  Intervention  Care plan  Monitor  Evaluate the Nutrition Care Process

15. Nutrition Care Process: Assessment  Assess the patients caloric intake  Determine if it is within their acceptable range  Record patient’s:  Height (cm)  Weight (kg)  Ideal Body weight  Males: 106 lbs./5 ft. + 6 lbs./ in.  Females: 100 lbs./5 ft. + 5 lbs./in.  Ideal Caloric intake (Mifflin- St. Jeor)  Males: (9.9 x wt) +(6.25 x ht) – (4.92 x age) + (5 x SF)  Females: (9.9 x wt) + (6.25 x ht) – (4.92 X age) – (161 x SF)  SF: Stress Factor 1.3-1.5

16. Nutrition Care Process: Assessment  Determine why the over eating occurs  Stress levels  Emotional eating  Depression  Determine if the patient is overweight or obese  BMI: Body Mass Index  Weight (kg)  Height (m squared)  Overweight: BMI 25-29.9  Obese: BMI > 30

17. Nutrition Care Process: Assessment

18. Nutrition Care Process: Diagnosis  Binge eating disorder  Overweight or obese  Determine contributing factors to the binge eating disorder

19. Nutrition Care Process: Intervention  Four common practices of treatment  Psychotherapy  Cognitive behavioral therapy  Interpersonal therapy  Dialectal behavior therapy  Medication  Antidepressants  Anticonvulsants (Topamax)  Anti-obesity medication (Meridia)  Behavioral weight-loss programs  Self help strategies

20. Nutrition Care Process: Intervention (cont.)  The Goal of the RD Help the patient  Learn self monitoring skills  Develop regular eating patterns  Learn alternatives to binge eating  Develop problem solving skills  Reduce restrained eating  Evaluate thoughts on eating and self control

21. Motivational Interviewing  A method of communication with your patient.  Started as a tool for addiction counseling  What can the RD do?  Give them insight  Give them knowledge  Give them skills  Give them a hard time

22. Motivational Interviewing cont.  The focus is where the patient is.  Example: Tell me what you know…  The Spirit of Motivational Interviewing:  Collaboration- not confrontation  Autonomy- not authority  Evocation- Not education/ advice  Example: What are you willing to try to do ?

23. Motivational Interviewing cont.  Principles of Motivational Interviewing  Express Empathy  Self Efficacy  Develop Discrepancy  Role with Resistance

24. Motivational Interviewing cont.  Using Motivational Interviewing  Must use different communication methods  Open End Questions  Affirm  Reflective Listening (key skill!)  Summarize

25. Motivational Interviewing cont.  Reach for change: Have the client  Think about it  Read about it  Agree to talk about it at another session  Take on a small step  Follow up

26. Nutrition Care Process: Monitoring  Monitor the patient’s progress  Encourage them to keep a journal  Schedule future meetings  Assess the progression of their recovery  Evaluate the Nutrition care process

27. Ethical issues:  Obesity and Binge Eating Disorder  Which is treated first?  Using Topomax (anticonvulsant medication)  Binge eaters are not convulsing  Do we risk the possible side effects?  Are we doing more harm than good?  Binge eating disorder is mainly a psychological disorder  Do we use autonomy or a surrogate decision maker?

28. Binge eating self check:  Do you:  Feel out of control when you are eating?  Think about food all the time?  Eat in secret?  Eat until you feel sick?  Eat to escape from worries or to comfort yourself?  Feel disgusted or ashamed after eating?  Feel powerless to stop eating, even if you want to?

29. Summary  Binge eating disorder sends people into episodes where they can not control the amount of food they are consuming.  Binge eating can affect anyone  There are many psychological factors to binge eating disorder  Binge eating can result in obesity and other serious future complications.

30. Summary (cont.)  There are definite signs of BED  It is important as a RD to use the Nutrition Care Process when assessing BED.  Motivational Interviewing is an intervention technique that helps you work with your patients to make progress.  It is important to remain in contact with your patients to check their progress.

31. Summary (Cont.)

32. Questions?

33. References:  Arbaizar, B., Gomez-Acebo, I., & Llorca, J. (2008). Efficacy of topiramate in bulimia nervosa and binge-eating disorder: A systematic review. General Hospital Psychiatry, 30(5), 471-475. nervosa and binge-eating disorder: A systematic review. General Hospital Psychiatry, 30(5), 471-475.  Binge eating disorder. Retrieved 10/2/2008, 2008, from http://www.athealth.com/Consumer/disorders/Bingeeating.html  Binge eating status influences pre-diet weight change and test meal intake in obese individuals.(2008). Appetite, 51(2), 408. obese individuals.(2008). Appetite, 51(2), 408.  Binge-eating disorder - MayoClinic.com. Retrieved 10/2/2008, 2008, from http://www.mayoclinic.com/health/binge-eating-disorder/DS00608  Binge-eating disorder: What's the best treatment? Retrieved 10/2/2008, 2008, from http://www.apa.org/monitor/mar02/binge.html http://www.apa.org/monitor/mar02/binge.html  Bisaga, A., Danysz, W., & Foltin, R. W. (2008). Antagonism of glutamatergic NMDA and mGluR5 receptors decreases consumption of food in baboon model of binge- eating disorder. European Neuropsychopharmacology : The Journal of the European College of Neuropsychopharmacology,  The contributions of weight problem perception, BMI, gender, mood, and smoking status to binge eating among college students ☆.(2008). Eating Behaviors,

34. References (Cont.):  Dingemans, A. E., Martijn, C., Jansen, A. T., & van Furth, E. F. (2008). The effect of suppressing negative emotions on eating behavior in binge eating disorder. Appetite,  Laura Alderman, M. E. (2007). Motivational interviewing. Unpublished manuscript.  Melinda Smith, M. A., Suzanne Barston, Robert Segal, M.A. & Jeanne Segal, P. D. (2008). Binge eating disorder. Retrieved September 25, 2008, from http://helpguide.org/mental/binge_eating_disorder.html http://helpguide.org/mental/binge_eating_disorder.html  The onset and course of binge eating in 8- to 13-year-old healthy weight, overweight obese children.(2008). Eating Behaviors, obese children.(2008). Eating Behaviors,  Position of the american dietetic association nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS).(2001). Journal of the American Dietetic Association, 101(7), 810.  Raynor, H., & Zemel, P. (1996). Binge eating disorder and the dietitian's role. Journal of the American Dietetic Association, 96(9), 854.  ScienceDirect - appetite : The effect of suppressing negative emotions on eating behavior in binge eating disorder. Retrieved 10/2/2008, 2008, from http://www.sciencedirect.com.cordproxy.mnpals.net/science?_ob=ArticleURL&_udi=B6WB2-4T7XGJW- 1&_user=10&_coverDate=08/19/2008&_alid=799344857&_rdoc=1&_fmt=high&_orig=search&_cdi=669 8&_sort=d&_docanchor=&view=c&_ct=1&_acct=C000050221&_version=1&_urlVersion=0&_userid=1(T RUNCATED) http://www.sciencedirect.com.cordproxy.mnpals.net/science?_ob=ArticleURL&_udi=B6WB2-4T7XGJW- 1&_user=10&_coverDate=08/19/2008&_alid=799344857&_rdoc=1&_fmt=high&_orig=search&_cdi=669 8&_sort=d&_docanchor=&view=c&_ct=1&_acct=C000050221&_version=1&_urlVersion=0&_userid=1(T RUNCATED) http://www.sciencedirect.com.cordproxy.mnpals.net/science?_ob=ArticleURL&_udi=B6WB2-4T7XGJW- 1&_user=10&_coverDate=08/19/2008&_alid=799344857&_rdoc=1&_fmt=high&_orig=search&_cdi=669 8&_sort=d&_docanchor=&view=c&_ct=1&_acct=C000050221&_version=1&_urlVersion=0&_userid=1(T RUNCATED)  WIN - publication - binge eating disorder. Retrieved 10/2/2008, 2008, from http://win.niddk.nih.gov/publications/binge.htm

35. Photo References  http://www.medmaps.co.uk/Mindmaps/Psychiatry/Binge%20eating %20disorder.htm http://www.medmaps.co.uk/Mindmaps/Psychiatry/Binge%20eating %20disorder.htm http://www.medmaps.co.uk/Mindmaps/Psychiatry/Binge%20eating %20disorder.htm  http://www.mhguidelines- leics.nhs.uk/default.aspx?page=eating_care http://www.mhguidelines- leics.nhs.uk/default.aspx?page=eating_care http://www.mhguidelines- leics.nhs.uk/default.aspx?page=eating_care  http://www.brookes.ac.uk/student/services/health/Images/binge.gif http://www.brookes.ac.uk/student/services/health/Images/binge.gif  http://www.aweighout.com/binge-eating/binge-eating.shtml http://www.aweighout.com/binge-eating/binge-eating.shtml  http://dorischua.com/wp-content/uploads/2007/11/eating.jpg http://dorischua.com/wp-content/uploads/2007/11/eating.jpg  http://sfhelp.org/art/Overeat.gif http://sfhelp.org/art/Overeat.gif  http://keetsa.com/blog/wp-content/uploads/2007/10/ask-these- questions-to-green-your-business.jpg http://keetsa.com/blog/wp-content/uploads/2007/10/ask-these- questions-to-green-your-business.jpg http://keetsa.com/blog/wp-content/uploads/2007/10/ask-these- questions-to-green-your-business.jpg