Causes and Effects of Disordered Eating

1. Causes and Effects of Disordered Eating 1.3 What are the causes and effects of disordered eating?

2. Disordered Eating • Many people have difficulty achieving good nutrition due to disordered eating patterns. • Disordered eating patterns include: • Fad Dieting • Yo-Yo dieting • Anorexia Nervosa • Bulimia Nervosa

3. Disordered Eating Dissatisfaction with body size and shape and dealing with stress, self-hatred, hurt and shame may trigger disordered eating patterns. ‘… A serious risk factor in the development of an eating disorder, particularly bulimia nervosa and binge eating disorder with adolescent girls who diet at a severe level being 18 times more likely to develop an eating disorder within 6 months… Over 12 months they have a 1 in 5 chance of developing an eating disorder.’ (Butterfly Foundation 2009)

4. Fad Dieting A highly publicised diet that offers quick weight loss. Often promoted in magazines and in the media as used by celebrities. Often requires the reduction of a particular food group. This food group will be blamed as the cause of the weight gain.

5. Fad Dieting Recommended for a limited time; thus, do not support long term dietary improvements. Initial accelerated weight loss can occur, but is generally due to water loss. Weight loss is short lived and generally does not meet the promises made by the diet.

6. Fad Dieting Q1. Can you think of any examples of ‘Fad Diets’?

7. Research - Fad Diets Cabbage Soup Diet Israeli Army Diet Atkins Diet The Grapefruit diet The Dukan Diet Cheater’s Diet 2005 Task 1: Research two fad diets listed above and describe the details of each diet. Task 2: Find a fad diet of your choice and share with the class.

8. Yo-Yo Dieting When followers of fad diets swap between different diets or alternate between their normal eating pattern and dieting. Food restrictions tend to reduce basal metabolic rate. Any return to “normal” eating patterns usually results in rebound weight gain. Often more weight is gained than lost when on the diet.

9. Anorexia Nervosa A person with Anorexia Nervosa will weigh less than 85% of what is expected for his/her age and height and may look emaciated. (National Eating Disorders Collaboration 2013) ‘…characterised by low body weight and body image distortion with an obsessive fear of gaining weight which manifests itself through depriving the body of food.’ (Eating Disorders Victoria 2011) ‘…the most fatal of all psychiatric illnesses… can lead to starvation, malnutrition and a dangerously low body weight – all of which are synonymous with a host of health problems, and in some cases death.’ (Eating Disorders Victoria 2011)

10. Causes • Genetic Vulnerability • ‘The genes that are most implicated in passing on eating disorders are within biological systems that relate to food intake, appetite, metabolism, mood, and reward-pleasure responses.’ (National Eating Disorders Collaboration 2013) • Psychiatric factors • Perfectionism • Obsessive-compulsiveness • Negative emotionality • Harm avoidance • Core low self-esteem • Socio-cultural influences • ‘Evidence shows that socio-cultural influences play a role in the development of eating disorders, particularly among people who internalise the Western beauty ideal of thinness.’(National Eating Disorders Collaboration 2013) • ‘…images in our culture today suggest that beauty is equated with thinness for females and a lean, muscular body for males. People who internalise this ‘thin ideal’ have a greater risk of developing body dissatisfaction which can lead to eating disorder behaviours.’(National Eating Disorders Collaboration 2013)

11. Who does it affect? Eating disorders are most frequent in young women, usually presenting at the onset of puberty or in later adolescence, with an increasing incidence in boys and young men. (The Butterfly Foundation 2009) In adolescence, it often results from an inability to cope with adult pressures and difficulty in resolving conflicts, emotional problems and adult responsibilities. In adulthood it is usually caused by grief or depression: Tardive Anorexia

12. Risk Factors – Psychological and Social Source: Eating Disorders Victoria 2012 Low self-esteem and feelings of inadequacy Incidence of depression or anxiety Fear of the responsibility of adulthood Difficulty expressing emotions and feelings, particularly ‘negative’ emotions such as anger, sadness. Ineffective coping strategies Perfectionism Fear or avoidance of conflict Impulsive or obsessive behaviours A need to please others Highly concerned with the opinions of others Prone to extremes, such as ‘black and white’ thinking Cultural value placed on ‘thinness’ as an inextricable part of beauty. Current cultural emphasis on the need for a ‘perfect body’. Valuing of people according to outward appearance and not inner qualities. Media and popular culture's portrayal of men and women's shapes and bodies that are not representative of ‘real’ men and women. Pressure to achieve and succeed Professions with an emphasis on body shape and size (eg. dancers, models, athletes)

13. Risk Factors – Biological & External Source: Eating Disorders Victoria 2012 Research has indicated that in some people with eating disorders there is an imbalance of certain chemicals in the brain. Adolescence and the associated physical, hormonal and neural changes Genetic or environmental factors. For example, a person who is exposed to a parent or sibling with an eating disorder is at a higher risk of developing an eating disorder themselves. Some research suggests this is due to genetic predisposition - rather than just learned behaviour Life events, particularly those involving major changes (eg. loss of a family member or friend, the divorce or separation of parents, moving schools) Dieting Peer pressure Inability to effectively deal with stress Personal or family history of obesity, depression or substance abuse Troubled personal or family relationships Sexual or physical abuse History of teasing or bullying, particularly when based on weight or shape

14. Symptoms of Anorexia • Distorted body image • Seeing body as much larger than it is in reality • Very strict attitudes towards food and eating • Possibly leading to developing phobias about food • Amenorrhoea • Loss of menstrual periods, returning to a child like state of body and emotions

15. Symptoms of Anorexia • Lanugo • Excess fine body hair • Exercising to excess in order to burn kilojoules. • Self induced vomiting • Feeling cold when others may be warm • BMR is lowered due to fasting

16. Symptoms of Anorexia • Low self esteem • Mineral and Fluid imbalances • Causes kidney failure, heart attack and death • Dry scaly skin • Extreme fatigue • Tooth decay

17. Common Behaviours • Deceit and lying about food • Claiming they have already eaten. • Concealing food and then disposing of it. • Use of laxatives or diuretics • Vomiting after eating • Mood swings, agitated behaviour and personality changes • Perfectionist expectations of self, body, work, study and others close to them • Excessive exercise and/or food restriction • Aggressive when forced to eat ‘Forbidden Foods.’ • ‘About 40 per cent of people with Anorexia Nervosa will later develop Bulimia Nervosa.’ (Eating Disorders Victoria 2012)

18. Treatment • Counselling, monitoring of weight and food intake, often in hospital. • Psychological help to improve self esteem and self confidence. • Constant and close supervision with skilled medical care. • Patient is never left alone while eating and mechanisms are in place to prevent purging • Monitoring of meal planning and psychological counselling during the recovery phase which may be required for many years.

19. Effectiveness of Treatment • Relapses are common • ‘In 30% of cases where treatment is not received the person suffering from anorexia dies from lack of nourishment, heart/ kidney failure, dehydration, exhaustion or suicide.’ (Magee 2010) • The mortality rate for people with eating disorders is the highest of all psychiatric illnesses and over 12 times that seen in people without eating disorders.’ (National Eating Disorders Collaboration 2013) • ‘1 in 5 premature deaths of individuals with Anorexia Nervosa are caused by suicide.’ (National Eating Disorders Collaboration 2013)

20. Bulimia Nervosa • ‘Bulimia Nervosa is characterised by repeated episodes of binge eating followed by compensatory behaviours.’(National Eating Disorders Collaboration 2013) • Bulimia Nervosa often starts with weight-loss dieting in the ‘pursuit for thinness’.

21. Bulimia Nervosa ‘Binge episodes are associated with a sense of loss of control and immediately followed by feelings of guilt and shame, which leads the person to compensatory behaviour (purging) such as self-induced vomiting, fasting, overexercising and/or the misuse of laxatives, enemas or diuretics.’(Eating Disorders Victoria 2012)

22. Symptoms of Bulimia Nervosa • ‘Usually maintains an average weight, or may be slightly above or below average weight for height, which often makes it less recognisable than serious cases of Anorexia Nervosa. • Dental decay • Due to Hydrochloric acid from the stomach reacting with tooth enamel • Abdominal pain, Nausea, Headaches and fluid imbalances • Kidney problems • Potassium depletion • If laxatives are used

23. Treatment • ‘Many people, including some health professionals, incorrectly assume that a person must be underweight and thin if they have an eating disorder. Because of this, Bulimia Nervosa is often missed and can go undetected for a long period of time.’(Eating Disorders Victoria 2012) • Long term counselling for psychological problems • Success linked closely to encouraging sufferers to feel happy, confident and comfortable with their body shape. • Establishing strategies to maintain an appropriate diet which is monitored closely.