Cultural Health Care Case

1. Cultural Health Care Case Eating Disorders vs. Disordered Eating in the Intercollegiate Athlete

2. What is Culture? • Definition : The quality in a person or society that arises from a concern for what is regarded as excellent in arts, letters, manners, scholarly pursuits, etc. • Our Culture Case is different than some of the others presented in class. Our culture isn’t identified by a race, religion, or ethnicity but as a lifestyle. • Dealing with athletes who have eating disorders or exhibit behaviors of disordered eating is challenging not only physically but mentally. You are dealing with a problem the has psychological and physical side effects.

3. Case • 18 year old freshman wrestler • Preseason weight :155 lbs • Weight class : 125 lbs • Daily meal routine • Breakfast: ½ piece wheat toast, banana and ½ cup of OJ • Lunch: Tuna Sandwich (1 piece of bread) and 8 oz chocolate milk • Dinner: Option 1- 1 cup of pasta, can of vegetables, and 8 oz water. Option 2 – Tilapia, rice, can of vegetables, and 8 oz water • Total Average Daily Caloric Intake: 800 cal

4. Case • Seasonal Trends • On average this athlete will lose 5-6 lbs per practice • 4-3 days prior to competition, athlete will remove 1 of the 3 meals from his daily meal routine. • 1-0 days prior to competition, athlete will remove 2 of the 3 meals from his daily meal routine. • If necessary, purging or laxative abuse occurs to make weight • Binge eating follows competition weigh-in • 1-2 days post-competition, athlete will be 10-15 lbs over weight and the vicious cycle repeats itself.

5. Discuss • Does this athlete struggle from an eating disorder? • What are the consequences of his disordered eating? • How would you handle this situation?

6. Eating Disorders • Anorexia Nervosa • Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss. • Bulimia Nervosa • Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

7. Warning Signs of Anorexia Nervosa • Preoccupation with food, calories, and weight. Obsessed with these topics all the time. • Dramatic Weight Loss • Mood swings, depression, anxiety, and irritability • Consistent excuses to avoid meals or situations involving food • Excessive, rigid exercise regimen despite weather, fatigue, illness

8. Health Consequences of Anorexia • Abnormally low blood pressure and low body temperature • Reduction of bone density, osteoporosis • Muscle loss and weakness • Fainting, fatigue, overall weakness, malaise • Female Athlete Triade • Anorexia, amenorrhea, osteoporosis

9. Criteria of Anorexia Nervosa • Refusal to maintain body weight at or above a minimally normal weight for age and height: Weight loss leading to maintenance of body weight <85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected. • Intense fear of gaining weight or becoming fat, even though under weight. • Disturbance in the way one's body weight or shape are experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight. • Amenorrhea (at least three consecutive cycles) in post-menarchalgirls and women. Amenorrhea is defined as periods occurring only following hormone (e.g., estrogen) administration.

10. Warning Signs of Bulimia Nervosa • Evidence of binge eating or purging behaviors • Excessive, ridged exercise regimen • Laxative abuse • Calluses of back of hands, knuckles • Cavities, discoloration of teeth • Creation of schedules or rituals to make time for binge and purge

11. Health Consequences of Bulimia • Dehydration • Heart Irregularities/failure • Inflammation and possible rupture of esophagus from frequent vomiting • Tooth decay and staining from stomach acids • Chronic irregular bowel movements and constipation from laxative abuse.

12. Criteria for Bulimia Nervosa • Recurrent episodes of binge eating characterized by both • 1. 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 during a similar period of time and under similar circumstances. • 2. A sense of lack of control over eating during the episode, (such as a feeling that one cannot stop eating or control what or how much one is eating). • Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise. • The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months. • Self evaluation is unduly influenced by body shape and weight. • The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

13. Disordered Eating • Counting Calories • Counting can indicate increasing preoccupation with food/eating demonstrated by reading recipes, food labels, counting fat grams, weighing and measuring food, and ultimately further limiting acceptable amounts to be consumed. • For some, when the pre-established limit is exceeded, they engage in compensatory behaviors such as purging, exercise, restriction to "un-do" amounts consumed. • Fasting • Refraining from eating for periods of time. Could be due to a religious observance, “making weight”, etc. • Binge Eating Disorder • Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

14. Sport Types Related to Body Image and Disordered Eating • Lean Sports : Wrestling, Cross Country • Cutting weight with the idea that you’ll be wrestling a smaller, weaker opponent. Being in the best possible shape for success. Having a competitive edge • Weighing less and using less energy makes for a faster race compared to a larger opponent • Judged Sports : Gymnastics • Appearance • Aesthetic Sports : Swimming and Diving, Dance • Body Image Perception, “fitting the role”

15. Good Athlete Trait Vs. Anorexic Characteristics • Mental Toughness • Commitment to training • Pursuit to Excellence • Coachability • Unselfishness • Performance despite pain • Abstinence • Excessive Exercise • Perfectionism • Over-compliance • Selflessness • Denial of discomfort “Good Athlete” Anorexic Patient

16. Race Ethnicity, and Culture • Although eating disorders affect non-hispanic whites most commonly, eating disorders do not discriminate against race. • Be aware of different ethnicities. • Ex) The orthodox community teaches their young women how being thin is important for dating. • Ex) Food is the central part of the Jewish culture. Preoccupations with food can intensify eating disorders for those who struggle. Thoughts that you want to “save” your calories during the week in order to indulge when a feast such as Shabbat begins.

17. Race Ethnicity, and Culture Cont. • The number of unique struggles related to sexuality and gender expression, such as coming out and harassment in school or in the locker room, can impact experiences of anxiety, depression, low self-esteem, trauma and developing unhealthy coping mechanisms. • All of these are common contributing factors in the development of an eating disorder. • In General, be accepting of all different cultures. Make yourself aware of different cultures and their observances.

18. The Silent Epidemic • Eating Disorders Among Males • Muscularity in the Media • The perception of the ideal male with a virtual unattainable muscular body type. • Likeliness to Get Help • Higher levels of gender role conflict and traditional masculine ideals are associated with negative attitude toward seeking psychological help. Only the weak need to seek help. • The mindset that they are only improving themselves, so the notion of getting help seems unneeded.

19. Interventions • Do you suspect an eating disorder? • Set time to talk privately • Communicate your concerns by using specific observations • Ask the athlete to discuss concerns with counselor, doctor, or nutritionist • Be sure to avoid conflicts or battle of wills. Just be sure you state your concern but know your limits • Do NOT place shame, blame, or guilt • Avoid giving simple solutions. This is a deeper problem with underlying factors • Express you continual support • Lastly, you need to consult with your preceptor if you foresee an immediate health concern • If this behavior is being pushed by a coach, make sure to first educate the coach on the dangers of certain eating habits.

20. References • National Eating Disorders Association. Diversity. Available at: http://www.nationaleatingdisorders.org/size-diversity. Accessed November 6, 2013. • National Eating Disorders Association. A Coaches Guide to Eating Disorders. Available at: http://loveyourbody.nowfoundation.org/neda-week-2012/CoachesGuide2EatingDisorders. Accessed November 6, 2013. • National Institute of Mental Health. What are Eating Disorders? Available at: http://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml. Accessed November 6, 2013. • National Institutes of Health National Heart Lung and Blood Institute. Why obesity is a health problem. http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/healthy-weight-basics/obesity.htm. Accessed November 6, 2013.