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Energy Balance and Healthy Body Weight

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Title: Energy Balance and Healthy Body Weight


1
Energy Balance and Healthy Body Weight
Chapter 9
2
Energy Balance and Healthy Body Weight
  • Being both overweight and underweight present
    risks to health
  • Extreme Obesity BMI 40 Too much fat
  • Obesity BMI 30-39.9 Too much fat
  • Overweight BMI 25.0 - 29.9 Too much fat
  • Healthy Weight 18.5- 24.9
  • Underweight BMI

3
Too Little or Too Much Body Fat
  • In the U.S.
  • Too little body fat is not a widespread problem
  • Obesity is an escalating epidemic
  • In the year 2000
  • 64 of U.S. adults were overweight
  • 30 were obese
  • One of every seven U.S. children and teenagers is
    overweight

4
Risks from Underweight
  • Underweight people are at risk of dying
  • During a famine
  • When hospitalized if they go without food for
    days when undergoing tests for surgery
  • Underweight people are at greater risk when
    fighting a wasting disease
  • People with cancer often die from starvation, not
    the cancer itself
  • Underweight people should gain body fat as an
    energy reserve

5
Risks from Overweight
  • Hypertension, diabetes, heart disease
  • Abdominal hernias, arthritis, complications in
    pregnancy and surgery, flat feet, gallbladder
    disease, gout, high blood lipids, liver
    malfunction, respiratory problems, sleep apnea,
    some cancers, varicose veins, high accident rate
  • Only tobacco contributes to more preventable
    diseases and premature deaths

6
Overweight
  • Central Obesity
  • Fat within the central abdominal area of the body
    (waist circumference)
  • Increases the risk of diabetes, stroke,
    hypertension, coronary artery disease
  • Apple Shape (visceral fat)
  • Pear shape (subcutaneous fat)

7
0
8
Risks from Overweight?
  • Who is prone to central obesity
  • Men and postmenopausal women
  • Smokers
  • Those with high alcohol intake
  • Those who are physically inactive

9
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10
Risks from Overweight
  • Social and Economic Costs of Obesity
  • Fat people are more likely to be judged on their
    appearance rather than their character
  • Our society places enormous value on thinness,
    especially for women
  • harder to get job, insurance, higher clothing
    costs
  • Prejudice often stereotypes obese people as lazy,
    stupid and self indulgent
  • Obese people suffer emotional pain when treated
    with hostility and contempt

11
What Is The Bodys Energy Balance
  • When more food energy is consumed than is needed,
    excess fat accumulates in the fat cells of the
    bodys adipose tissue
  • Energy Balance
  • Energy in Energy out
  • energy in foods and beverages
  • energy out lifestyle and metabolism

12
The Bodys Energy Balance
  • Estimated Energy Requirements (EER) on DRI chart
  • Apply only to the characteristics of the
    reference man and woman
  • Reference man active physical activity level,
    22.5 BMI, 510, 154 lb.
  • Reference woman active physical activity
    level, 21.5 BMI, 54, 126 lb.

13
The Bodys Energy Balance
  • Taller people have a greater surface area
    require more energy
  • Older people need less energy than younger
    people- 5 for each decade beyond the age of 30
    years
  • Due to a slower metabolism and reduced muscle
    mass

14
How Many Calories Do I Need Each Day?
0
  • Energy output
  • Basal metabolism
  • Sum total of energy expended on all of the
    involuntary activities needed to sustain life
  • Excludes digestion
  • Voluntary activities
  • Thermic effect of food
  • 5-10 of a meals energy is expended in
    stepped-up metabolism in the 5 hours after a meal

15
How Many Calories Do I Need Each Day?
  • Basal metabolic rate (BMR)
  • Varies from person to person
  • Varies with activity level
  • Positively correlates with thyroxin secretion
  • Lowest during sleep
  • Lean tissue has a higher BMR than fat tissue

16
How Many Calories Do I Need Each Day?
  • Estimated Energy Intake
  • EER is based on gender, age, weight , height, and
    physical activity
  • This was built into the Food Pyramid.
  • The equation is in your text book.

17
Body Weight versus Body Fatness
  • Body Mass Index (BMI)
  • Correlates with body fatness
  • Used to evaluate health risks associated with
    underweight or overweight
  • In general, for adults
  • Overweight is defined as a BMI of 25.0 - 29.9
  • Obesity as BMI 30
  • Body Mass Index (BMI)
  • BMI (weight in kg)/(height in m2)
  • BMI ((weight in lb)/(height in in2)) x 705

18
Body Weight versus Body Fatness
0
  • BMI values fail to distinguish between how much
    of a persons weight is fat and where the fat is
    located.
  • This limits the value of BMI with
  • Athletes highly developed muscle falsely
    increases BMI
  • Pregnant and lactating women increased weight is
    normal during childbearing
  • Adults over 65 because BMI values are based on
    data collected from younger people and because
    people shrink with age

19
Body Weight versus Body Fatness
  • Methods used to Measure Body Composition and Fat
    Distribution
  • Anthropometry
  • Fat fold tests
  • Waist circumference
  • Density
  • Underwater weighing
  • Conductivity Radiographic techniques
  • Bioelectrical impedance
  • Dual energy X-ray absorptiometry (DEXA)
  • Radiographic techniques

20
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21
Body Weight versus Body Fatness
  • How Much Body Fat Is Ideal?
  • Varies with gender, age, stage of life
  • Percent body fat
  • Man of healthy weight 12 - 20
  • Overfat greater than 22
  • 25 if over 40 years
  • Female of healthy weight 20 - 30
  • Overfat greater than 32
  • 35 if over 40 years

22
Obesity
  • Factors that correlate with obesity
  • Birth order, Number of brothers
  • Divorced/single parents, Nonprofessional parents
  • Unemployed parents
  • Early menstruation
  • Ethnicity
  • Exposure to a variety of foods
  • Fast-food consumption
  • Fat, protein, carbohydrate intake-too much
    food!!!
  • Increased wealth (In developing nations)
  • Less leisure time
  • International travel
  • Geographic location

23
Obesity
  • More factors that correlate with obesity
  • Lower education level
  • Lower social class
  • Maternal famine
  • Obesity during gestation
  • Meal skipping, Meals eaten away from home
  • Napping habits, Sleep deprivation
  • Reduced alcohol intake, Increased alcohol intake
  • Sedentary behavior, Television watching
  • Substandard housing
  • Everything!!! But mostly eating too much!!!!

24
Eating Behavior
  • Eating behavior is regulated by mechanisms that
    stimulate eating and mechanisms that signal the
    body to stop eating
  • 1 Hunger and Appetite
  • 2 Seek Food and Eat
  • 3 Keep Eating
  • 4 Satiation, End Meal
  • 5 Post Absorptive Influences

25
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26
Eating Behavior
  • What is Hunger?
  • Sensation that signals a need for food
  • Occurs roughly 4-6 hours after eating
  • After the food has left the stomach and much of
    the nutrient mixture has been absorbed
  • Triggered by a contracting empty stomach and
    empty small intestine
  • The stomach hormone ghrelin produced between
    meals signals the hypothalamus (brain) to
    simulate eating
  • The hunger response quickly adapts to changes in
    food intake (to larger or smaller quantities of
    food)
  • Food deprivation can lead to overeating to
    overcompensate for the calories lost during
    deprivation

27
Eating Behavior
  • What is Appetite?
  • The psychological desire to eat
  • Can be experienced without hunger
  • The sight and smell of food can stimulate the
    brains endorphins, molecules that create an
    appetite despite an already full stomach
  • Illness or stress may result in the loss of
    appetite in a person in physical need of food

28
Eating Behavior
  • Other factors affecting appetite
  • Hormones
  • Inborn appetites (for salt, sweet, fat)
  • Learned preferences, aversions, timings
  • Customary eating habits
  • Social interactions (companionship)
  • Some disease states (cold flu)
  • Appetite stimulants, depressants, mood-altering
    drugs
  • Environmental conditions (hot and cold)

29
Eating Behavior
  • What are Satisfaction and Satiety?
  • The perception of fullness that builds throughout
    a meal
  • The stomach sends signals to the brain to tell it
    that its full
  • The brain also detects nutrients in the blood
  • Hunger strongly stimulates eating behavior
  • Satiation and satiety exert weaker control over
    food intake and can be ignored
  • (keep eating)

30
Eating Behavior
0
  • Leptin A Satiety Hormone
  • Leptin
  • An appetite-suppressing hormone
  • Produced by adipose tissue
  • Travels to the brain
  • Directly linked to appetite and body fatness
  • Gain of body fatness stimulates leptin production
  • Reducing food consumption resulting in fat loss
  • Loss of body fat reduces leptin secretion
  • Increasing appetite

31
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32
Why Did I Eat That?
  • Energy Nutrients and Satiety
  • At least 15 studies show that a low-glycemic
    index diets reduced or delayed hunger
  • 16 studies have found the opposite or no effect
  • Showed that diets based on refined grains are
    just as satisfying as diets based on low-glycemic
    index diets

33
Why Did I Eat That?
  • Of the energy-yielding nutrients, protein may be
    the most satiating
  • May account for the popularity of high-protein
    weight-loss diets
  • Fat is also known for its satiety effects
  • Protein and fat trigger the release of an
    intestinal hormone that slows stomach emptying
    and prolongs feelings of fullness
  • Satiety is also associated with
  • High-fiber foods
  • Water
  • Foods that have been puffed up from air
  • ???What works for you???

34
Inside-the-Body Causes of Obesity
  • Selected Metabolic Theories of Obesity
  • Attempt to explain the ease with which people
    gain/lose weight when eating more/less food
    energy than they use

35
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36
Causes of Obesity
  • Genetics
  • Decrease energy expended in activities required
    for daily living
  • Inactivity
  • Food Price, Availability, and Advertising
  • High-calorie fast foods are relatively
    inexpensive, widely available
  • A steady diet of them correlates with obesity
  • External Cues to Overeating
  • eat even when not hungry
  • Loneliness, Yearning, Craving, Addiction,
  • Compulsion, Depression, Time of day
  • ???Do thin people deal with these things??

37
Causes of Obesity
  • End of Story?
  • There is no clear evidence as to which factor(s)
    bears the greatest responsibility for obesity
  • For most people, the best way to obtain a healthy
    body weight is to
  • Maintain a proper diet
  • Engage in daily physical activity
  • Practice behavior modification
  • Can low price, advertising and availability of
    healthy foods attract consumers????

38
Activity for Healthy Body Weight
  • Moderate exercise is defined by NIH as using 150
    calories per day (1,000 calories per week)
  • Exercise does not have to be excessive to achieve
    fat loss
  • The DRI definition of an active lifestyle
    requires walking for 1 hour per day
  • Is this enough activity?????

39
Activity for Healthy Body Weight
  • Physical activity for weight loss or maintenance
  • Moderate activities
  • Use large muscle groups
  • Increase in physical activity
  • Adopt informal strategies to be more active
  • Physical activity for building body mass
  • Strength-building exercises
  • Perform exercises with increasing intensity,
    resistance training

40
Weight Loses and Gains
  • Moderate Weight Loss versus Rapid Weight Loss
  • When energy input is less than energy output, the
    body draws on its energy stores
  • With exercise, moderate calorie restriction and a
    balanced diet, a body will use its stores of fat

41
How the Body Loses and Gains Weight
  • Rapid wt loss
  • The Bodys Response to Fasting
  • Less than 1 day into the fast liver glycogen
    stores are exhausted
  • Protein is broken down and converted to
    carbohydrate to meet the brains need for glucose
  • If left unchecked the breakdown of protein
    (muscle of the heart, skeletal muscle, liver,
    etc) results in death within about 10 days
  • To prevent this, the body converts fat into
    ketone bodies, a fuel the nervous system can
    adapt to using

42
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43
How the Body Loses and Gains Weight
  • Ketosis
  • In ketosis, instead of breaking down fat to CO2
    and H2O, the body takes partially broken-down fat
    fragments and combines them to form ketone bodies
  • Some amino acids that cannot be converted to
    glucose, are converted to ketone bodies
  • After about 10 days of fasting, most of the
    nervous systems energy needs are met by ketone
    bodies

44
How the Body Loses and Gains Weight
  • Fasting may harm the body
  • Ketosis upsets the acid-base balance of the blood
  • Promoting excessive mineral loss in the urine
  • In as little as 24 hours of fasting, the
    intestinal lining deteriorates
  • Food deprivation leads to overeating/ binging
    when food becomes available
  • Fasting breaks down the bodys lean tissues
  • The body adapts to fasting by slowing its
    metabolic rate

45
How the Body Loses and Gains Weight
  • The Bodys Response to a Low-Carbohydrate Diet
  • Responses are similar to those of fasting
  • As carbohydrate runs low the body breaks down fat
    and protein for energy and ketones form to feed
    the brain
  • To prevent this the DRI for carbohydrates is set
    at 130 grams/day 45-65
  • Initial weight loss is the water and glycogen
    losses when carbohydrate is lacking
  • Loss of appetite accompanies any low-calorie diet

46
How the Body Loses and Gains Weight
  • Weight Gain Energy-yielding nutrients contribute
    to excess body stores
  • Protein excess amino acids have their nitrogen
    removed and are used for energy or converted to
    glucose or fat
  • Fat fatty acids can be broken down for energy or
    stored as fat with great efficiency glycerol
    enters a pathway similar to carbohydrate
  • Carbohydrate (other than fiber) glucose may be
    used for energy or excess may be converted to
    glycogen or fat and stored
  • Alcohol used for fuel or converted to body fat
    and stored as visceral fat
  • Excess consumption of any food will be turned to
    fat within hours

47
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48
Popular High-Protein, Low-Carbohydrate Diets
  • Laboratory studies have shown that, when energy
    intake is the same, there is no difference in
    weight loss on a high-protein, low-carbohydrate
    diet or a lower-protein, higher-carbohydrate
    diet

49
Popular High-Protein, Low-Carbohydrate Diets
  • High in saturated fat
  • Increased cardiovascular disease risk
  • Increased risk of breast cancer
  • Low Carbohydrate Intake
  • Mixed results with regard to cardiovascular risk
  • Missing nutrients from the diet
  • Chronic ketosis

50
What Strategies Are Best for Weight Loss?
  • Dietary Guidelines for Americans 2005
  • Energy in must be less than energy expended
  • Calorie intake must decrease to attain weight
    loss
  • Diet based on all the food groups may be the
    safest and easiest in the long term
  • Increase physical activity

51
What Diet Strategies Are Best for Weight Loss?
  • Setting Goals
  • For an overweight person
  • First reasonable goal may be to prevent weight
    gain
  • Reduce body weight by 5-10 over the course of a
    year
  • Recognize that maintenance is often more
    difficult than weight loss
  • Keep Records
  • A tool for spotting trends and identifying areas
    in need of improvement
  • Measure waist circumference to track changes in
    central obesity

52
What Diet Strategies Are Best for Weight Loss?
  • Realistic Calorie Intakes
  • Energy intakes lower than 800 calories are not
    good for achieving lasting weight loss, and may
    promote eating disorders
  • Diets for weight management should provide the
    DRI recommended ranges
  • Carbohydrate 45 - 65 of total calorie intake
  • Fat 20 - 35 of total calorie intake
  • Protein 10 - 35 of total calorie intake

53
What Diet Strategies Are Best for Weight Loss?
  • Fats
  • Avoid saturated and trans fats
  • Include enough of the health-supporting fats to
    provide satiety but not so much as to oversupply
    calories olive, canola oil
  • Protein
  • Choose lean meats or other low-fat protein
    sources
  • Limit these foods but dont eliminate them
  • Carbohydrates
  • Choose whole grains and starchy vegetables rather
    than refined grains, added fats, and sugars
  • High-fiber, unprocessed or lightly processed
    foods offer bulk and satiety for fewer calories
    than quickly consumed refined foods

54
What Diet Strategies Are Best for Weight Loss?
  • Alcohol
  • Limit intake
  • Alcohol provides calories but no nutrients
  • Alcohol reduces inhibitions and can sabotage a
    dieters plans
  • Portion Sizes
  • Be aware of portions in restaurants and food
    packages
  • Use a measuring cup to learn portion sizes
  • Learn fat grams- they add calories more quickly
    than carbohydrate or protein

55
Demonstration Diet
56
What Diet Strategies Are Best for Weight Loss?
  • People who eat small, frequent meals are reported
    to be more successful at weight loss and weight
    management
  • Make sure that hunger, not appetite, prompts
    eating
  • Eat regularly, before becoming hungry
  • Eat the entire meal
  • Save calorie-free or favorite foods or beverages
    for a planned snack
  • Eat breakfast
  • Those who consume the majority of their calories
    after 600 p.m. often find it harder to lose
    weight

57
Physical Activity for Weight Loss
  • 30 - 60 minutes of moderate physical activity
    per day are needed to prevent weight gain and
    support weight loss
  • Diet, in combination with exercise, promotes fat
    loss, promotes muscle retention, inhibits weight
    gain
  • Exercise helps people follow diet plans more
    closely
  • Exercise reduces abdominal obesity
  • Improves BP, insulin resistance, heart and lung
    fitness even without weight loss

58
Physical Activity for Weight Loss
  • Benefits of Exercise
  • Short-term it increases energy expenditure
  • Long-term increase in BMR
  • increase lean tissue
  • Improved body composition
  • Appetite control??
  • Stress reduction and control of stress eating
  • Physical and psychological well-being
  • Improved self-esteem
  • Any activity is better than no activity
  • Expenditure of at least 2,000 calories per week
    in physical activity promotes weight management

59
What Strategies are Best for Weight Gain?
  • An underweight person should not necessarily try
    to gain weight
  • If you are healthy, maintain your current weight
  • Examples of those who may be at health risk from
    a too-low body weight
  • Physician has advised you to gain weight
  • You are excessively tired
  • You are unable to keep warm
  • You fall into the underweight category of the BMI
  • You are a woman who has missed at least three
    consecutive menstrual periods

60
What Strategies are Best for Weight Gain?
  • To Gain Muscle and Fat
  • Best achieved through physical activity
    especially strength training in combination with
    a high-calorie diet
  • Diet alone can bring about weight gain in the
    form of fat
  • Good for someone with a wasting disease
  • Gaining a pound of muscle and fat requires an
    intake of 3,500 extra calories

61
What Strategies are Best for Weight Gain?
  • Weight Gain Supplements
  • Most weight-gain supplements are useless
  • No benefits beyond adding calories and a few
    nutrients
  • Items such as instant breakfast powders or milk
    flavorings can do the same thing for less money
  • Tobacco (avoid)
  • Suppresses appetite
  • Makes taste buds less sensitive

62
What Strategies are Best for Weight Gain?
  • Choose Foods with High Energy Density
  • Chose nutritious energy-dense foods, for example
  • Peanut butter in place of lean meat
  • Avocado in place of cucumber
  • Increase portion sizes
  • Expect to feel full
  • Eat frequently
  • Make foods appealing

63
Drugs and Surgery to Treat Obesity
  • BMI30 and those with elevated disease risk may
    benefit from prescription medication, along with
    diet, exercise, and behavior therapy, to lose
    weight
  • Extreme obesity (BMI40 BMI35 with coexisting
    disease) surgery may be an option
  • Reduction of stomach size
  • Not a cure for obesity
  • Some do not lose the expected pounds
  • Some who initially lose weight gain it back
    through the course of time

64
Drugs and Surgery to Treat Obesity
  • Gastric surgery- Long-term safety depends on
    compliance with diet
  • Complications following surgery include
  • Infections
  • Nausea
  • Vomiting
  • Dehydration
  • Vitamin and mineral deficiencies
  • Psychological problems
  • Such surgery requires lifelong medical
    supervision

65
Drugs and Surgery to Treat Obesity
  • Liposuction
  • Cosmetic procedure-surgical
  • There can be serious complications, including
    death
  • Herbal Products
  • For many, their effectiveness and safety have not
    been proved
  • Natural does not mean safe
  • Belladonna, hemlock, and sassafras all contain
    toxins
  • Ephedra (ma huang) contains ephedrine
  • weight loss
  • Side effects--Cardiac arrest, abnormal heart
    beat, hypertension, stoke, seizure, death
  • FDA has banned sales, available on internet
  • TRIAC
  • Sold as diet aid
  • Hormone that interferes with thyroid function
  • Has caused heart attack and stroke
  • Marketed as dietary supplements and escape FDA
    scrutiny

66
Drugs and Surgery to Treat Obesity
  • Herbal laxatives containing senna, aloe, rhubarb
    root, cascara, castor oil, or buckthorn
  • Sold as dieters tea
  • Can cause temporary water loss of 1-2 pounds
  • Side effects include nausea, vomiting, diarrhea,
    cramping, fainting, possible deaths

67
Weight Control
  • Weight loss strategy
  • Behavior Modification
  • Learning to say No might be the first habit to
    establish
  • Learning not to clean your plate is another
    behavioral change
  • Change enviornment

68
Eating Disorders
  • 5 million people in the U.S. suffer from eating
    disorders
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
  • 85 of eating disorders start during adolescents

69
Eating Disorders
  • Causes of eating disorders
  • Excessive pressure to be thin is partly to blame
  • When low body weight becomes a goal, people begin
    to view normal, healthy body weight as too fat
  • Excessive dissatisfaction with body weight or
    feeling fat

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71
Eating Disorders
  • Eating Disorders in Athletes
  • Athletes and dancers are at special risk of
    eating disorders
  • Female athlete triad
  • Disordered eating, Amenorrhea, Osteoporosis
  • Female athletes often compare themselves to
    unsuitable weight standards
  • An ultra-slim appearance has long been considered
    desirable in activities such as dancing,
    gymnastics, and figure skating
  • Males have some of the same physical problems

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73
Eating Disorders
  • Practices by wrestlers trying to make weight
    can compromise their abilities and endanger their
    lives
  • Male athletes are susceptible to weight-gain
    problems
  • Athletes with well-muscled bodies see themselves
    as underweight and weak
  • Such distorted body image leads to frequent
    weighing, excessive exercise, overuse of special
    diets or protein supplements, or even abuse of
    steroid drugs

74
Eating Disorders
  • Characteristics of Anorexia Nervosa
  • Most anorexia nervosa victims come from middle or
    upper-class families
  • Males account for 5 to 10 of cases
  • The incidence among male athletes and dancers may
    be higher
  • Central to its diagnosis is a distorted body
    image that overestimates body fatness
  • Family attitudes contribute to eating disorders
  • Families of anorexics are likely to be critical
    and to overvalue outward appearances rather than
    inner self-worth

75
Eating Disorders
  • Anorexics may be perfectionists
  • Respectful of authority polite, controlled,
    rigid
  • Rejecting food is a way of gaining control
  • Anorexia Nervosa Self-Starvation
  • Discipline is used to strictly limit portions of
    low-calorie foods
  • Hunger is denied
  • Become accustomed to little food
  • Calorie contents of foods are memorized
  • Calorie expended during exercises are memorized

76
Eating Disorders
  • Anorexia Nervosa
  • Causes the same damage as classic protein-energy
    malnutrition
  • Body tissues are depleted of needed fat and
    protein
  • In young people, growth ceases and normal
    development stops
  • So much lean tissue is lost that BMR slows for
    self preservation
  • In athletes
  • The loss of lean tissue impairs performance
  • The heart pumps inefficiently and irregularly
  • Heart muscle becomes weak and thin
  • Blood pressure falls
  • Electrolytes that help to regulate heart beat go
    out of balance
  • Many deaths are due to heart failure

77
Eating Disorders
  • Treatment of Anorexia Nervosa
  • Requires a multidisciplinary approach
  • Low risk clients may benefit from
  • Family counseling
  • Cognitive therapy
  • Behavior modification
  • Nutrition guidance
  • High risk clients may also need
  • Other forms of psychotherapy
  • Supplemental formulas to provide energy and
    nutrients
  • Drugs are commonly prescribed, but their
    usefulness is limited

78
Eating Disorders
  • Few anorexics seek treatment on their own
  • Denial makes treatment difficult
  • Many relapse into abnormal eating behaviors
  • Anorexia nervosa has a high mortality rates among
    psychiatric disorders

79
Eating Disorders
  • Bulimia Nervosa
  • More common then anorexia nervosa
  • People often suffer in secret and may deny the
    existence of a problem
  • More men suffer from bulimia nervosa than from
    anorexia nervosa
  • However, more common in women

80
Eating Disorders
  • Binge Eating and Purging
  • Food is not consumed for its nutritional value
  • Eating is accelerated by hunger from previous
    caloric restriction
  • Nearly 1,000 extra calories are consumed at a
    time
  • There may be several binges in a day
  • Typical binge foods
  • Easy-to-eat foods
  • Low-fiber
  • Smooth-texture
  • High-fat
  • High-carbohydrate

81
Eating Disorders
  • After the binge
  • Hands may be scraped raw against the teeth during
    induced vomiting
  • Swollen neck glands and reddened eyes from
    straining to vomit
  • Bloating, fatigue, headache, nausea, pain
  • Vomiting causes
  • Irritation and infection of the pharynx,
    esophagus, salivary glands
  • Erosion of the teeth and dental caries
  • The esophagus or stomach may rupture or tear
  • Overuse of emetics (cause vomiting) can lead to
    death by heart failure

82
Eating Disorders
  • Bulimia Nervosa Physical and Psychological
    Problems
  • Fluid and electrolyte imbalances are caused by
    vomiting or diarrhea
  • They can cause abnormal heart rhythms and injury
    to the kidneys, UTIs can lead to kidney failure
  • Unlike anorexics, bulimics are aware that their
    behavior is abnormal, and they are ashamed of it
  • Bulimics are less likely to be in denial and more
    likely to recover

83
Eating Disorders
  • Treatment of Bulimia Nervosa
  • To regain control over food and establish regular
    eating patterns requires adherence to a
    structured eating plan
  • Regular exercise may be of benefit
  • Restrictive dieting is forbidden
  • Steady maintenance of weight
  • Prevention of relapse into cyclic gains and
    losses
  • Learning to consistently eat enough food to
    satisfy hunger needs
  • 50 of females recover completely after 5 - 10
    years with or without treatment
  • Antidepressant medication may be of benefit

84
Eating Disorders
  • Binge Eating Disorder
  • Up to 50 of all people who restrict eating to
    lose weight periodically binge without purging
  • Obesity itself does not constitute an eating
    disorder
  • Binge eating behavior responds more readily to
    treatment than other disorders
  • Successful treatment improves physical health,
    mental health, and the chances of breaking the
    cycle of rapid weight losses and gains

85
Eating Disorders
  • Eating Disorders in Society
  • Eating disorders have many causes
  • Sociocultural
  • Known only in developed nations
  • Become more prevalent as wealth increases and
    food becomes plentiful
  • Psychological
  • Heredity
  • Probably neurochemical unbalance
  • Society sets unrealistic ideals for body
    weight-Especially for women
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