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The Cultural Identity of Eating Disorders among Adolescent Girls

The Cultural Identity of Eating Disorders among Adolescent Girls. K1004821 Georgia Petherick. Anorexia - extensive determined efforts to avoid weight gain and lose weight by food avoidance and excessive exercise ( Dhakras , 2005).

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The Cultural Identity of Eating Disorders among Adolescent Girls

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  1. The Cultural Identity of Eating Disorders among Adolescent Girls K1004821 Georgia Petherick

  2. Anorexia - extensive determined efforts to avoid weight gain and lose weight by food avoidance and excessive exercise (Dhakras, 2005). • In Bulimia, a person will have eating ‘binges’ where they have a high intake of high-calorie food followed by vomiting or the use of laxatives to mitigate the effects of the ingested food (Blows, 2011). • 70 million individuals worldwide (NICE, 2004). • Over 50% of 9 and 10 year old girls feel better about themselves if they are on a diet. • 81% have reported to be scared of getting fat (The Renfrew Centre Foundation for Eating Disorders, 2002). Introduction

  3. Steady decline in female wellbeing since the early 1970s, which is also consistent among socioeconomic and ethnic groups (Lakasing and Sargent, 2012). • Effects of celebrity culture have clearly created damage to women’s health, as the market is manipulating younger generations to conform to a ‘body type’ (Lakasingand Sargent, 2012). • Great number of women who will never seek medical help contributing to the morbidity and mortality among the undiagnosed (Perry, 2000). • Women often turn to nurses in difficult situations (Lakasing and Sargent, 2012), nurses should be aware of the risk factors and health behaviour within this group. Rationale

  4. Behaviours and Beliefs of Eating Disordered Adolescent Girls • Implications to Health • NICE guidelines of management • Interventions - Cognitive Behaviour Therapy - Screening for Eating Disorders - Health Education 5. Nursing Implications 6. Conclusion Outline of Presentation

  5. Morris (2002) contends that adolescent girls with eating disorders feel socially isolated from society, and use pro anorexic and bulimic sites to gain a sense of belonging. Often these websites are used to; • Share crash dieting techniques • Advise on how best to induce vomiting or use laxatives • Suggest ways on how to suppress hunger pains • Give tips on how to hide weight loss from parents and doctors • Compete with each other to lose weight or fast together in displays of solidarity • Post pictures of themselves and their body measurements to solicit acceptance and affirmation (Fox et al, 2005). Behaviours and Beliefs of Eating Disordered Adolescent Girls

  6. Aim - Fisher et al. (1991) conducted a study in order to determine whether adolescent females with abnormal eating attitudes display lower levels of self-esteem and higher levels of anxiety than their peers, and whether these adolescents participate in health-risk behaviours. • Method – questionnaires given to (n= 268) females aged 16 • Result - 18% of the students had a score suggestive of an eating disorder. The study revealed that those with more unhappiness with their weight were more likely to have lower self-esteem and higher anxiety, and to participate more in health-risk behaviours, including cigarette smoking, alcohol use, drug use, and sexual activity with more total partners

  7. Implications to Health

  8. Outpatient basis with psychological treatment • Evidence-Based self help programme/Anti-depressants • Inpatient treatment - re-feeding with careful physical monitoring in combination with psychosocial interventions • Cognitive Behaviour Therapy • Family interventions NICE Guidelines

  9. INTERVENTIONS

  10. Aim - Hay et al (2009) conducted a review to evaluate the efficacy of Cognitive Behaviour Therapy in Bulimia nervosa and other psychotherapies in the treatment of eating disorders. • It involved reviewing 48 studies, with (n= 3054) participants that had bulimia and other eating disorders that had not been specified. • The results supported the efficacy of CBT in the treatment of people with bulimia nervosa and also related eating disorder syndromes. Self-help approaches that used highly structured CBT treatment manuals were promising too. Cognitive Behaviour Therapy

  11. NICE (2004) states target groups for screening should include; -Adolescents with low BMIs -Patients consulting with weight concerns who are not overweight -Women with menstrual disturbances -Patients with gastrointestinal symptoms -Patients with physical signs of starvation or repeated vomiting -Children with poor growth. • Scoff questionnaire (Morgan et al, 1999) and the Eating Attitudes Test (EAT-26) (Garner et al, 1983) are the main two screening tools for eating disorders. • Limited amount of school nurses Screening for Eating Disorders

  12. The UK appears to be the only country that has developed national guidelines on measuring children's height and weight in school settings (Ikeda et al., 2006). • However, this is only to gather local data on childhood obesity. • Currently three main programmes in the prevention of eating disorders: Promoting healthy eating, Promoting body acceptance and Promoting self-esteem (Miller & Coverdale, 2010). Health Education

  13. One of the most serious effects of anorexia is hormonal changes, which can have severe health consequences such as fertility problems in later life (UMMC, 2011). Thus causing more people requiring fertility treatments. • Almost 90% of women with anorexia experience osteopenia, and 40% have osteoporosis (UMMC, 2011). In future, this will cause higher admission rates in orthopaedic and trauma units. • Adolescents with eating behaviours associated with anorexia are at high risk for anxiety and depression in young adulthood (UMMC, 2011). This therefore implicates all mental health facilities around the UK. Nursing Implications

  14. School nurses are a very pertinent role, as they are one of the few health professionals who will deliver prevention programmes to young people in a variety of settings, and screening (UMMC, 2011). Following this presentation, it has been found there is a great need to employ more school nurses. • The research has shown that a cause of eating disorders is the huge emphasis there is on school children today to not become fat, and this has caused a ripple in adolescents to become eating disordered. It has also shown the need for screening adolescents without signs of disordered eating, due to the secretive nature of this cultural group, and improving future practice by lowering admission rates. Conclusion

  15. Bardone-Cone, A. M. and Cass, K. M. (2007) ‘What does viewing a pro-anorexia website do? An experimental examination of website exposure and moderating effects’, International Journal of Eating Disorders, 40(6), pp. 537–548. • Coombs, A. (2011) ‘Treating eating disorders in the Community’, British Journal of School Nursing, 6(6), pp. 284-288 internurse[Online]. Available at: http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=85204;article=BJSN_6_6_284_288 (Accessed: 13 March 2013). • Fisher, M., Schneider, M., Pegler, C. and Napolitano, B. (1991) ‘Eating attitudes, health-risk behaviours, self-esteem, and anxiety among adolescent females in a suburban high school’, Journal of Adolescent Health, 12(5), pp. 377-384 ScienceDirect[Online]. Available at: http://www.sciencedirect.com/science/article/pii/019700709190051M (Accessed: 15 April 2013). References

  16. Fox, N., Ward, K. and O'Rourke, A. (2005), ‘Pro-anorexia, weight-loss drugs and the internet: an "anti-recovery" explanatory model of anorexia’, Sociology of Health & Illness, 27(7), pp. 944-971. • Hay, P. P. J., Balcaltchuk, J., Stefano, S. and Kashyap, P. (2009) ‘Psychological treatments for bulimia nervosa and binging (review)’, The Cochrane Collaboration [Online]. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000562.pub3/pdf (Accessed: 21 March 2013). • Ikeda, J. P., Crawford, P. B. and Woodward-Lopez, G. (2006) ‘BMI screening in schools: helpful or harmful’, Oxford Journals, pp. 761-769. Available at: http://her.oxfordjournals.org/content/21/6/761.full (Accessed: 25 April 2013). • Jett, S., LaPorte, D. J. and Wanchisn, J. (2010) ‘Impact of exposure to pro-eating disorder websites on eating behaviour in college women’, European Eating Disorders Review, 18(5), pp. 410-416. • Miller, K. and Coverdale, G. (2010) ‘Exploring views on primary prevention of eating disorders’, British Journal of School Nursing, 5(9), pp. 441-446 internurse [Online]. Available at: http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=79780;article=BJSN_5_9_441_446 (Accessed: 12 March 2013). • Morgan, J. F., Reid, F. and Lacey, J. H. (1999) ‘The SCOFF questionnaire: assessment of a new screening tool for eating disorders’, BMJ [Online]. Available at: http://www.bmj.com/content/319/7223/1467 (Accessed: 21 March 2013).

  17. Morris, B. R. (2002), ‘A Disturbing Growth Industry: Web Sites That Espouse Anorexia", New York Times. • NICE (2004) Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Available at: http://publications.nice.org.uk/eating-disorders-cg9/full-guideline (Accessed: 20 March 2013). • Shaw, G (2013) WebMD. Available at: http://www.webmd.com/mental-health/anorexia-nervosa/features/anorexia-body-neglected (Accessed: 20 March 2013). • The Renfrew Center Foundation for Eating Disorders (2002) Eating disorders 101 guide: A summary of issues, statistics and resources. Available at: http://www.ndsu.edu/fileadmin/counseling/Eating_Disorder_Statistics.pdf (Accessed: 20 March 2013). • Udovitch, M. (2002) ‘A Secret Society of the Starving’, New York Times. • University of Maryland Medical Center (2011) Eating Disorders – Complications of Anorexia. Available at: http://www.umm.edu/patiented/articles/how_serious_anorexia_nervosa_000049_5.htm (Accessed: 1st May 2013). •  World Health Organization (2003) Eating disorders. pp. 42-43. Available at: http://apps.who.int/iris/bitstream/10665/41852/1/0889371482_eng.pdf (Accessed: 20 March 2013).

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