Eating Disorders: Not Just for Skinny People Anymore

1
Eating Disorders Not Just for Skinny People
Anymore

• Mary Ellen Olbrisch, Ph.D., ABPP
• Departments of Psychiatry and Surgery

2
I hope you enjoyed your lunch!

• A note about the slide design
• With apologies to Steve Auerbach, who (hopefully)
  was overruled on the broccoli and turnips option

3
Anorexia Nervosa

• Highly publicized problem
• Alarming to observers
• Well-known body image distortion, with disorder
  often precipitated by a belief that one is fat

4

• Incidence .5-1 of Caucasian adolescent females
• Incidence among males thought to be rising to as
  much as 10
• Highest mortality rate of any psychiatric
  disorder (6)
• Serious long-term health consequences

5

• Eating disorder usually includes severe food
  restriction, with food intake excluding most
  calories from protein and fat
• Extreme exercise as a means of compensation for
  the few calories that are consumed
• Efforts to deceive others in order to maintain
  the pathology and perceived benefits

6
Bulimia

• Also highly publicized but less visible because
  those with the disorder are often of normal
  weight
• Behavior is usually carried out in secret
• Alarming when observed, particularly purging
  behaviors, but often techniques are passed along
  through social networks

7

• Thought to affect at a minimum 10 of adolescent
  girls and young women
• Number of cases among boys and men thought to be
  low and may be less visible due to many fewer
  with purging and views as to acceptable food
  consumption for growing boys
• Can result in death and other serious long term
  health consequences

8

• Dynamics may be similar to those found in
  anorexia nervosa, especially the desire to
  maintain a socially acceptable body size
• Purging behaviors usually involve vomiting or
  laxative abuse but may also involve extreme
  compensatory exercise

9
There is HOPE!
10
OBESITY

• Increasing in the U.S. and throughout the world,
  including third world countries
• About 12 million Americans are thought to be
  morbidly obese (BMI gt 40)
• Physicians now consider it the countrys leading
  health problem

11

• Affects 1/3 of adults in the U.S.
• Nearly half of adults in the U.S. have a BMI gt 25
• Disproportionately affects minorities from the
  African-American, Native American and Hispanic
  populations

12

• Also highly publicized
• Not included in the psychiatric diagnostic
  nomenclature
• Considered not especially alarming, evoking more
  a sense of disgust directed to some degree at the
  behavior but to a larger extent at the resultant
  body

13
Very few instances where it is possible to
overcome negative stereotyping and social stigma
14
(No Transcript)
15
Increase in Obesity among children and associated
increase in serious health problems including
diabetes and NAFLD is considered alarming from a
public health perspective
16

• Increase in obesity at all ages and life stages
  is associated with morbidity and disability
• Enormous cost to society in lost work
  productivity, disability and medical costs

17
Also affecting our furry friends
18
Eating Behavior-What is Healthy?
19
(No Transcript)
20
(No Transcript)
21
Eating Behavior- What is Normal?
22
(No Transcript)
23
Eating DisordersIf normal isnt healthy, arent
eating disorders for practically EVERYONE?!
Should BMI define who has an eating disorder?
24
BMI and Eating Disorder

• Imbalance between energy consumption (calories)
  and energy expenditure
• Resultant abnormal body weight (BMI lt 19 or
  BMI gt 25
• Persons in these categories may be otherwise
  healthy
• Persons in these categories may be genetically
  programmed to maintain weights in these ranges
  without abnormal food consumption or energy
  expenditure
• Body weight tends to reach and fluctuate around a
  set point or settling point
• Persons in the normal weight range may eat in a
  manner that increases disease and mortality risk
  or that has resulted in morbidity

25
Candidate Eating Disorders among Persons of
Normal Weight and Persons with Obesity

• Disorders of food preference and nutrient balance
• Disorders of Control
• Binge Eating/Unrestrained Eating/Grazing/Mindless
  Eating
• Time of Eating Problems (Night Eating Syndrome)
• Emotional Eating
• Food-related Obsessions
• Compulsive Eating