Eating disorders

Seminar on Eating Disorders

1. WELCOME

2. Presenter Jaspreet Kaur M.Sc .(Foods And Nutrition) Reg.No . 04- HOMMA- 01229 Minor Guide Dr. (Mrs.) S . Ahlawat Professor and Head Department of Ext. Edu . and Communication SDAU, S.K.Nagar . A SEMINAR ON Effects of Eating Disorders on Health 2 Major Guide Dr. V. H. Kanbi Associate Professor Department of Food Science and Nutrition SDAU, S.K.Nagar .

3. 3 4 . Aetiology 2. Need of Study 3. classification . 5. most prevalent eating disorders 6. case studies Introduction 7. assessment 9. Conclusion Content 10. Future Thrust 8. Treatment .

4. Introduction An eating disorder is when a person experiences severe disturbances in eating behaviour, such as extreme reduction of food intake or overeating, or feelings of intense distress or concern about body weight or shape. Society, today promote the ideals of a slim body and models are often taken as role models of success. conversely they may be underweight to look perfect on televisions and magazines. In order to look good they practice abnormal pattern of eating. Socioeconomic-cultural changes and westernization could result of eating disorders in India ( Shroff and Thompson 2004). 4

5. Definition Eating disorders are psychological illnesses defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. 5

6. Why we should know about eating disorders Eating disorders involves self-starvation and over eating. The body is denied the essential nutrients which needs to function normally, so it is forced to slow down all of its processes to consume energy and other nutrient. This slowing down can have serious medical consequences (Gupta, 2007). The prevalence of eating disorders in India is lower than that of western countries but appears to be increasing significantly in the country. Thus a study on eating disorders is felt needed realizing the increased current prevalence, incidence of eating disorder, its complications and increasing mortality in different age groups mainly in adolescent girls. The study also fulfils the need to improve knowledge and attitude regarding eating disorders to promote a disease free or healthy life. 6

7. 7 Classification of eating disorders Anorexia Nervosa (AN) Bulimia Nervosa (BN) Binge eating disorder  (BED) Other Specified Eating Disorder (OSED ) Compulsive Overeating, (COE) Diabulimia Orthorexia nervosa Drunkorexia Pregorexia Food Craving Pica Other Prevalent Eating Disorders Currently not recognized in medical manual Currently recognized in medical manual

8. Rarely prevalent eating Disorders 8 Pregorexia Drunkorexia Orthorexia nervosa Dibulimia

9. AETIOLOGY Genetics Vulnerability to ED Biological Socio-cultural Nutritional Deficiency Stress Media Family problems/ tension Life transition EATING DISORDER Ongoing stress Ongoing low self -esteem Ongoing family tension PREDISPOSING FACTORS PRECIPITATING FACTORS PERPETUATING FACTORS Environment 9 Low Self-esteem

10. Most prevalent Eating Disorder 10

11. Anorexia Nervosa 11

12. Anorexia Nervosa The term anorexia nervosa was first formulated in 1873 by Sir William Gul . The term is Greek origin which means : A lack of desire to eat. It is characterised by self-induced weight loss of at least 15% below the expected weight. 12

13. Signs & symptoms of Anorexia Nervosa A Person With Anorexia Starve Her Or Him Self So She Or He Can Be Skinny . Dramatic weight loss Constipation or Diarrhoea Electrolyte imbalance Cavities Cardiac arrest Amenorrhea Osteoporosis Hyponatremia Hypokalemia Brain atrophy 13

14. 14 Chilblains , also known as Perniosis . Heart rate problems Slow heart rate ( bradicardia ) Optic neuropathy Osteopenia Lanugo Tooth loss Leukopenia

15. Conti.... Preoccupation with food, recipes or cooking, may cook elaborate dinners for others but not eat themselves. Cuts food into tiny pieces, refuses to eat around others. Hides or discards food. Perceives self to be overweight despite being told by others they are too thin. Purging : uses laxatives, diet pills, ipecac syrup, or water pills; may engage in self-induced vomiting. May run to the bathroom after eating in order to vomit and quickly get rid of the calories. Becomes intolerant to cold. 15

16. Diagnostic Criteria-Anorexia Nervosa Refusal or inability to maintain body weight over a minimum normal weight. Intense fear of gaining weight despite being underweight. Disturbance in perception of body shape. Absence of three consecutive menstrual cycles. 16

17. Isabelle Caro 17 The French model died in 2010 due to the complications of anorexia at the age of 28.

18. Bulimia Nervosa 18

19. Bulimia Nervosa Bulimia Nervosa literally means ‘hunger of an ox for nervous reasons’ . Bulimia is characterised by cycles of bingeing (eating a large amount of food) and then experiencing guilt, fear, or stomach pains, causing sufferers to purge. Those who suffer from the non-purging type compensate for binges by exercising. A person with bulimia eats a lot of food in a short amount of time. This is called binging. Binging can cause feelings of shame and guilt. So, the person tries to "undo" the binge by getting rid of the food by throwing it up. 19

20. Signs and symptoms of bulimia nervosa Chronic gastric reflux after eating Dehydration and hypokalemia caused by frequent vomiting Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat Gastroparesis or delayed emptying Constipation Infertility 20

21. Conti.... Inflammation of the esophagus Peptic ulcers Electrolyte imbalance, which can lead to cardiac arrest and even death. Russell's sign :scarring of the knuckles from placing fingers down the throat to induce vomiting. 21

22. Diagnostic Criteria-Bulimia Minimum of 2 binge-eating episodes weekly for 3 months/recurrent binge eating. A feeling of lack of control over binge-eating behavior. Regular use of self-induced vomiting, laxatives, diuretics, or vigorous exercise to prevent weight gain. Disturbance of body shape perception. 22

23. Bulimia in Movies 23 Kate's Secret (1986) Girl, Interrupted (1999) Life is Sweet (1990)

24. Famous Athletes and Celebrities with Bulimia Nadia Comaneci (9x gold medalist gymnast) Victoria Beckham (Posh Spice) Kelly Clarkson (American Idol Winner) Princess Diana (Princess of Wales) Elton John (Musician)

25. Binge Eating Disorder(BED) 25

26. Binge Eating Disorder(BED) Binge eating disorder is characterized by consuming large quantities of food in a very short period of time until the individual is uncomfortably full.  Binge eating disorder is much like bulimia except the individuals do not use any form of purging (i.e. vomiting, laxatives, fasting, etc.) following a binge.  26

27. Conti.... Individuals usually feel out of control during a binge episode, followed by feelings of guilt and shame.  Many individuals who suffer with binge eating disorder use food as a way to cope with or block out feelings and emotions they do not want to feel.  Individuals can also use food as a way to numb themselves, to cope with daily life stressors, to provide comfort to themselves.   Like all eating disorders, binge eating is a serious problem but can be overcome through proper treatment. 27

28. Signs & symptoms Significant weight gain Digestive problems Breathlessness Periodically does not exercise control over consumption of food. Eats an unusually large amount of food at one time, far more than an average person would eat in the same amount of time. Eats much more quickly during binge episodes than during normal eating episodes. Eats until physically uncomfortable and nauseated due to the amount of food just consumed. Eats when depressed or bored. 28

29. Conti.... Eats large amounts of food even when not really hungry. Usually eats alone during binge eating episodes, in order to avoid discovery of the disorder. Often eats alone during periods of normal eating, owing to feelings of embarrassment about food. Feels disgusted, depressed, or guilty after binge eating. Rapid weight gain, and/or sudden onset of obesity. 29

30. Food Craving 30

31. Food craving Food Craving is an intense desire to consume a specific food and is different from normal hunger. It may or may not be related to specific hunger. 31

32. Craving specific in male & female Male typically crave protein, fat and sodium :  Roast beef, burgers, fries, steak, pizza and chips etc. Female are more likely to crave sweet, high-carbohydrate and high-fat foods :   Chocolate, cookies, ice cream, pasta, and bread etc. 32

33. Most craved foods 33

34. craving related deficiencies Craving Related deficiency Eat this Chocolate & Cold drinks Magnesium Nuts ,whole grain, Legumes, fruits Sweet Carbon Fresh fruits Phosphorus Fish, egg, Dairy Products, Legumes, whole grain Sulphur Cruciferous vegetables Coffee & Tea NaCl Fruits and Salads Iron Meat, Lotus stem, leafy vegetables Burned food Carbon Fresh fruit Chewing ice Iron Meat, Lotus stem, leafy vegetables Oily snacks, fatty food calcium Milk products, Legumes, Seasum , Ragi 34

35. 35

36. Pica 36

37. Pica Comes from the Latin word magpie - a bird which eat anything. An eating disorder in which non-nutritional objects are eaten. Characterized by a compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition. 37

38. Most Prevalent In Children ages 1-6 Pregnant women Certain cultures Mentally deficient 38

39. Possible Causes Nutrient deficiencies- especially iron and zinc Stress OCD- Obsessive Compulsive Disorder Developmental disorders Mental disorders 39

40. Subtypes Subtypes are characterized by the substance eaten Amylophagia   (consumption of  starch ) Coprophagy   (consumption of  feces ) Geophagy (consumption of  soil ,  clay , or  chalk ) Hyalophagia (consumption of  glass ) Lithophagia (consumption of  pebbles  or  rocks ) Mucophagia (consumption of  mucus ) Pagophagia (consumption of  ice ) Trichophagia (consumption of   hair  or  wool ) 40

41. Conti... Urophagia  (consumption of  urine ) Xylophagia  (consumption of  wood  or  paper ) Consumption of paint . Self-cannibalism (rare condition where body parts may be consumed) Odowa (soft stones eaten by pregnant women in Kenya) Consumption of dust or sand has been reported among iron-deficient patients. 41

42. Effects of pica In children: Malnutrition Severe stomach ache Muscle weakness Brain damage In adults : Infertility Increase blood pressure Nerve disorders Muscle/joint pain 42

43. Case studies related to Pica Sample size & characteristic of population Prevalence References 500 (school age children) 6 % Bhandari and Agarwala (1996) 246(learning disabled adults) 10.1% Tewari et al., (1995) 43

44. COMPLICATIONS of Eating Disorders 44

45.                                                 Increased production of ACTH Reduced production of TSH Changes in the production of specific hormone-releasing factors Reduced production of FSH and LH Reduced production of thyroxine , resulting in slowed heart rate, low blood pressure, poor thermal response and cold extremities THYROID GLAND Increased production of cortisol as a normal stress response, resulting in release of protein from muscle and muscle wasting GONADS ADRENAL CORTEX Reduced production of testosterone in males resulting in impotence Reduced production of oestrogen and progesterone in females, resulting in loss of ovulation and menstruation Trotter (1997) Endocrine effects of eating disorder 45

46. Conti…. Skeletal  oestrogen and  cortisol levels are largely implicated If menstruation interrupted for a prolonged period of time, bone loss results.  risk of fractures and osteoporosis. Refeeding syndrome Hypokalemia Hyponatremia Hypophosphatemia Hypomagnesemia Hyperglycaemia, nausea and vomiting, diarrhoea, possible cardiopulmonary failure….. death 46

47. GIT Salivary gland hypertrophy Occasionally pancreatitis Oesophagitis Gastric dilatation – poses risk of gastric rupture Loss of bowel control Constipation Steatorrhoea 47

48. Pulmonary Aspiration pneumonia Recurrent chest infections Dental Erosion of dental enamel Projection of fillings above the surface of the teeth Chronic Diseases Obesity CVD (include: dyslipidaemia and HT) Diabetes 48

49. CASE STUDIES CASE STUDIES

50. 50 Result Source Affect up to 24 million Americans and 70 million individuals worldwide. Renfrew Centre Foundation for Eating Disorders, (2002) 20% of people suffering from anorexia will prematurely die from complications related to their eating disorder, including suicide and heart problems. Renfrew Centre Foundation for Eating Disorders, (2002) High prevalence of eating disorders among athletes, models, dancers and performers. ADA, (2001) 50

51. 51 Effect Subject Resource 38.6% engaged in NSSI (non-suicidal self-injury). 70 female patients with EDs Claes et al ., (2004) A number of micronutrient deficiencies have been identified. 100 Anorexic Patient Hadigan et al ., (2000) Suicide attempts approaching approximately 17%. 1000 people (Anorexia Nervosa ) Bulik et al . , (2008) Disturbed eating attitudes and behaviours were present in 26.6% of adolescents girls and they had earlier menarche and lower BMI. 120 adolescent girls from Crosthwaite Girl’s College, Allahabad, UP. Upadhyah et al ., (2014) 51

52. 52 Result Place Subject Resouce 32 were diagnosed as anorexia nervosa (AN), 12 as bulimia nervosa (BN) and 30 as eating disorders not otherwise specified (EDNOS). Bangalore, India 74 patient with eating disorders Prabha et al., (2011) Particularly among urban girls from families with a higher economic status are about two times more likely to report dissatisfaction with their body weight and these girls are five times more likely to report the need for dieting. Sikkim, India 577 adolescent girls about eating and weight concerns Mishara and Mukhopadhyay , (2010) 52

53. Some studies related to causes of eating disorders Result Reference Prevalence of anorexia nervosa has shown an increase in India. Socio-cultural variables like familial interaction patterns, parental attitude towards weight control, desirability for slimness, and thinness have a deciding role. Stress of any kind can act as a precipitating factor. Chadda et al., (1987) Many religions, including Judaism, Christianity, Hinduism, Buddhism and Islam, include some dietary exclusion or periods of fasting as part of religious observance. Collins et al ., (1993) Abnormal serotonin metabolism may play a greater role in individuals with Bulimia nervosa. Murphy et al., (2001) A portion of the vulnerability to develop eating disorders can be inherited. Patel et al., (2002) 53

54. case studies related to westernisation influenced 54 Westernisation influenced case Place No. of subject (Pt. with ED) Source 54 Patients with AN South Africa 100 Norrois (1979) 5 case United Arab 80 Abou-Saleh et al., (1998) 5 cases India 60 Gandhi et al., (1991) 3 cases India 33 Chandra et al., (1995) 7 cases reported – 1 case with no formal education from lowest social class Malaysia 71 Ong et al., (1982) 54

55. Case studies related to prevalence of eating disorder by gender Country Year Sample size and type Incidence Resource Australia 2008 1,943 adolescents (ages 15–17) 1.0% male 6.4% female Patton et al., (2008) Brazil 2004 1,807 students (ages 7–19) 0.8% male 1.3% female Vilela et al., (2004) USA 1992 799 college students 0.4% male 5.1% female Heatherton (1995) Norway 1995 19,067 psychiatric patients 0.7% male 7.3% female Gotestam et al., (1995) 55

56. 56

57. 57 National Australian Eating Disorders Collaboration ,(2012)

58. Assessment & Treatment 58

59. ASSESSMENT Full physical examination & appropriate medical investigations is required for proper treatment. Assess patients height & weight If any of the following features are present in patient then treatment is indicated: Wt < 70% of that expected Or BMI < 15 Acute rapid weight loss Marked dehydration Electrolyte imbalance Convulsions Uncontrolled vomiting GIT bleeding Acute pancreatitis Self - injurious behaviour Severe depression, suicide risk Intolerable family situation 59

60. 60 Treatment Treatment varies according to type and severity of eating disorder and usually more than one treatment option is utilized. NUTRITIONAL INTERVENTION Goals of Nutrition Intervention To normalise the relationship with food. To gain an understanding of nutrient needs for growth, development, tissue maintenance, wt control, appropriate body weight. To provide an increased/ adequate energy intake (macronutrient) to promote weight gain (initially 800-1200kcal/d and gradually increased to achieve goal weight gain of 0.5 to 1 kg/ wk) OR weight stabilisation. Introduction of fear foods Adequate vit & min intake (Ca, Mg, K, Zn, Fe, B- vits ) Promote energy expenditure in BED.

61. Formulation of Nutritional Plan Nutrient Requirements: Energy Must observe energy intake with regard to weight gain Must be aware that refeeding in AN increases Be aware of individual response may be a period of abnormal energy requirements for weight gain and maintenance Restrictors have greater energy requirements than BN’s and BED. Protein 1.2 - 1.5g/ kg IBW Vitamins B-complex Vit D Vit E Vit A and B-carotene 61

62. Conti..... Minerals Calcium Zinc Iron Zinc: supplementation has been shown in various studies to be beneficial in the treatment of AN even in patients not suffering from zinc deficiency, by helping to increase weight gain. Ideally use low-dose multivit -mineral . 62

63. Cognitive behavioural therapy  Cognitive behavioural therapy (CBT) : which postulates that an individual's feelings and behaviours are caused by their own thoughts instead of external stimuli such as other people, situations or events, the idea is to change how a person thinks and reacts to a situation even if the situation itself does not change. Teach the patient to recognize the cognitions around eating and to confront the maladaptive cognitions. Introduce “ forbidden foods ” and regular diet and help the him/her confront irrational cognitions about these. 63

64. Conclusion Eating disorders are unhealthy diet practices that can easily get in of hand and are difficult habits to break. Eating disorders are serious clinical problems that require professional treatment by doctors, therapists, and nutritionists. 64

65. Future thrust Future studies are needed to explore the risk of autoimmune diseases and immunological mechanisms in individuals with eating disorders and their family members. It is imperative that practices which increases the risk of eating disorders are minimized as they appear to inadvertently increase the risk of depression in athletes and other performers. Further research needs to formulate comprehensive and holistic theoretical framework . Future research should examine gene–environment interactions for dieting. Efforts are needed to raise awareness of the clinical implications of different types of eating disorders for all age groups so that their appropriate screening and treatments can seek out. 65

66. THANKYOU 66