Lecture 15: Diets and Eating Disorders

1. Lecture 15: Diets and Eating Disorders Will Brown 02/28/2012

2. What is a Diet? • What do you think people mean when they say, “I am going on a diet”? • A diet comprises everything that you eat • A “Diet” usually refers to an attempt to change eat patterns for the purposes of losing weight • Why is the underlying reason to lose weight? • What are the motivations behind a “Diet”?

5. Diet Reality • Roughly 45 million Americans will go on diets over the course of the year • 85% will fail • In 2009 a study was published in Annuls of Internal Medicine said that most commercial diet plans do not have data to back up their claims of helping people lose weight • The one exception was Weight Watchers

6. Why don’t we succeed?

7. Fad Diet • What is a “Fad Diet”? • Diet that becomes popular very quickly and may fall out of favor very quickly • Important to note that “Fad” does not mean failure • Recommendations that promise a quick fix • Dire warnings of dangers from a single product or regimen • Claims that sound too good to be true • Simplistic conclusions drawn from a complex study • Recommendations based on a single study • Dramatic statements that are refuted by reputable scientific organizations • Lists of "good" and "bad" foods • Recommendations made to help sell a product • Recommendations based on studies published without review by other researchers • Recommendations from studies that ignore differences among individuals or groups • Eliminated one or more of the five food groups

8. Fad Diets: Categories • Extreme diets • Low Carb diets • Low fat/high carb • Food combining • Liquid diets • Diet pills • http://www.faddiet.com/

9. Extreme Diets • HCG Diet • Eat 500 calories while taking a growth hormone • No longer approved by the FDA • Cabbage soup diet • Eat cabbage soup every time you feel hungry • Claims of losing 10 pounds a week; a near physiological impossibility • Extreme flatulence is a side effect

10. Low Carb • Grapefruit diet; a.k.a. the Hollywood diet • Eat half a grapefruit with every meal • Grapefruit can interfere with medications • Atkins diet • Carb addict diet • Zone diet

11. Why don’t these work? • They are unrealistic • It is not possible to eat in those ways or long term • They are to restrictive • They deny to much from what a body needs • They do not address underlying causes • They address weight and weight only • Most weight issues are lifestyle related not just food

12. What happens when diets lead to disorders?

13. Eating Disorders: Causes • Root cause for each person is different • Not just physical but psychological as well • What kind of images are we subjected to? • To “skinny” • To “fat” • What kind of messages are sent? • Fad Diets • Fashion and Magazines • What does food represent? • Currency • Power • Bribe • Comfort

14. Eating Disorders • Severe changes in eating patterns linked to physiological changes. • The main four • Anorexia nervosa • Bulimia nervosa • Binge eating • Female athlete triad • Affect about 5 million Americans • Women more than men; 5:1 ratio

15. Eating Disorders: Anorexia Nervosa and Bulimia Nervosa • Affects ~5% of women • Nervosa refers to the belief that one is disgusted with themselves • Anorexia – “Loss of appetite” but is a denial of appetite • Affects 1:200 adolescent girls typically blame themselves for age related weight gain • Men account for 10% of cases; mainly athletes that require weight loss • Bulimia – binge eating followed by attempts to purge by vomiting and laxatives

16. Anorexia • First described in 1689 • Patients suffer from extreme fear of being fat or obese • Although it is an “eating disorder” it is more psychological in nature • Only 25% recover, after ~6 years, but most go on to suffer other eating disorders as well • Numerous reasons why anorexia begins • Affects primarily Caucasian females from middle to upper socioeconomic backgrounds • Conflict within family structure is common • Also, power and control issues are common

17. Anorexia • Early patterns • Extreme dieting; diet because single focus • Odd eating behavior • Cutting peas in half • Making but not eating a large meal • Compulsive exercise • As disease progresses, safe and unsafe food lists develop • Internally, these behaviors are seen as rational

18. Anorexia • Physical effects • Body weight less then 85% of expected weight • BMI <17.5 • Low body temp intolerance to cold • Slowed metabolic rate • Decreased heart rate • Anemia • Rough, cold, dry, skin • Low WBC • Loss of hair • Etc. Etc. Etc. • All are attempts of the body to hold onto what weight it can

19. Anorexia: Treatment • For success, requires a team of experts and most importantly a strong support structure • Nutrition Therapy • Goal is to increase oral food intake • Switches to stopping weight loss then gaining weight • Psychological treatment – Once dietary needs are met treatment switches to underlying causes

20. Bulimia Nervosa • Categorized by binge eating and purging by vomiting or laxatives • Most common in college ages, some high school students are at risk • Usually successful females – different from anorexia in that bulimics are typically above average weight • Rather than turning away from food, food is a coping mechanism in critical situations • Bulimics acknowledge they have a problem • Many report childhood abuse • Many are impulsive in other areas of life

21. Bulimia: Typical Behavior • Harder to diagnose – patients must binge and purge twice weekly for 3 months • Eating large amounts of food in a short time followed by periods of strict food consumption • Most binge eating occurs at night • No set time frame for cycles • Binges typically last ½ - 2 hours • Common foods include those high in carbohydrates and convenience foods • Problem is that 33-75% of calories can still be absorbed leading to more weight gain • If laxatives are used because of the fact that they act in the LI after absorption occurs • Excessive exercise

22. Bulimia • Health issues • Demineralization of teeth • Low blood potassium resulting in heart problems • Swollen salivary glands • Stomach and esophageal tears and ulcers • Constipation from laxative use • Certain vomit inducing agents are toxic; ipecac • Debilitating disease that can lead to death due to suicide, low blood potassium, or infection

23. Bulimia: Treatment • Similar to anorexia requires a team of professionals • Most do not start treatment underweight so psychological treatment by begin before food therapy • Food therapy starts with reducing amount of food consumed in a binge • Leads to less damage to esophagus • Psychotherapy aims to reduce all-or-nothing thinking • Medication can also be used to combat the depression associated with bulimia • Nutritional counseling to re-establish proper food habits • Overall goal is to not stop binge/purge cycles but to reset good eating habits

24. Other eating disorders • Binge eating – binge cycles not accompanied by purges • Generally not diagnosed • Severe dieting increases likelihood of developing binge eating disorder • 40% are male • Perceive hunger when not hungry • Depression is common • Night eating syndrome • Female athelete triad

25. An Ounce of Prevention… • The best treatment is prevention • Change outlooks and perception as to what is “acceptable” • Learn principles of good nutrition • Begin this earlier in life • Supportive environments • Etc. Etc. Etc…