Eating Disorders

NF25: Intro to
Nutrition Science
Property of Jean Metter, MPH, RD
Not to be used without permission

1
p. 360
Ana Carolina Reston
6/4/85 – 11/15/06
Died age 21 of
anorexia nervosa
5’ 8” tall and 88
pounds at time of
death (BMI 13.4)
Cause of death: kidney
failure and
overwhelming infection 2
Luisel Ramos
4/12/84 – 8/2/06
Died age 22 of anorexia
nervosa
5’ 9” tall and 97 pounds
at time of death (BMI
14.5)
Cause of death: heart
failure
3
Eliana Ramos
12/23/88 – 2/13/07
Died age 18 of anorexia
nervosa
Sister of Luisel Ramos
who died of anorexia in
2006
Cause of death: heart
failure
4
Three Main Characteristics of
Disordered Eating
Eating habits or weight control
behaviors have become abnormal
Clinically significant impairments
of physical health or psychosocial
functioning have materialized
The disturbance is not caused by
other medical or psychiatric
conditions
5
p. 360
Eating Disorders (ED)
Three classifications:
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder

Most experts agree that eating

disorders have many causes.
However, excessive societal
pressure to be thin is at least partly
to blame. 6
Anorexia Nervosa (AN)
Anorexia = “without appetite”
Nervos = “of nervous origin”
Highest mortality rate of all
psychiatric disorders
Anorexia Nervosa: Extreme
restriction of energy intake relative
to requirements, leading to
dangerously low body weight and
disturbed perception of body weight
7
AN Diagnostic Criteria
Restrict Calories to the point of
developing too low body weight for
age, gender, and health
Intense fear of body fatness or
weight gain
Strive to prevent weight gain
although underweight

8
AN Diagnostic Criteria (cont’d)
Hold a false perception of body
weight or shape
Exaggerate the importance of
body weight or shape in their self
evaluation
Deny the danger of being severely
underweight

9
AN Physical Consequences
Anemia
Bone loss (causing osteoporosis
later in life)
Loss of brain function
Low blood pressure
Inability to stay warm
Weakened immune system
Organ damage
Death (usually from organ failure
10
Female Athlete Triad
Potentiallyfatal triad of medical
problems seen in female athletes:
Low energy availability (with or
without disordered eating)
Menstrual dysfunction
Low bone mineral density

11
From Table C9-1, p. 359
Female Athlete Triad
Energy Insufficiency

* Essential BF
for women __
%

Low Bone Density Menstrual Dysfunction

12
Fig. C9-2, p. 359
Bulimia Nervosa (BN)
Bulimia = “having a voracious
appetite”
Nervos = “of nervous origin”
More common than anorexia
Bulimia Nervosa: Recurring episodes
nervosa
of binge eating combined with a
morbid fear of
Less easily becoming fat, usually
recognized
followed by self-induced vomiting,
misuse of laxatives or diuretics ,
fasting, or excessive exercise.
13
BN Diagnostic Criteria
Frequent binge eating behavior
Compensation behaviors after
binges, such as vomiting or fasting
False perceptions of body weight
or shape; exaggerations of the
importance of body weight or
shape
Binge:inEating
self evaluation
a relatively large
amount of food in a relatively short
period of time, with loss of control
14
Binge-Eating Episodes are Associated
with Three or More of the Following:
Eating much more rapidly than
normal
Eating until feeling uncomfortably
full
Eating large amounts of food when
not feeling physically hungry
Eating alone because of being
embarrassed by how much one is
eating 15
 A typical binge consists of easy-to-
eat, low-fiber, smooth-textured, high-
Calorie foods. 16
Binge-Purge Cycle

17
Fig. C9-3, p. 362
BN Physical Consequences
Fluid and electrolyte imbalance
Abnormal heart rhythm
Heart muscle damage (leading to
heart failure)
Irritation and infection of the
pharynx, esophagus, and salivary
glands
Erosion of the teeth (causing
dental caries) 18
p. 362
Erosion of the Teeth in BN

19
Binge Eating Disorder (BED)
Also known as “compulsive
overeating”
~ half of people who restrict
eating to lose weight periodically
binge without purging
~ one third of obese people
Binge Eating Disorder: Criteria
regularly engage in binge eating are
similar to bulimia nervosa, excluding
purging or other compensatory
behaviors. 20
BED Diagnostic Criteria
Recurrent episodes of binge eating
Marked distress regarding binge
eating
Absence of regular compensatory
behaviors (such as self-induced
Eating Addiction??? The effects on
vomiting)
the brain of foods rich in sugars and
fats mimic those of euphoria-
producing drugs (such as opioids).
21
Risk Factors for Developing an
ED
Adolescence
~ 85% of EDs begin during
adolescence
Pressure to excel in a sport
Focus on achieving or maintaining
an “ideal” weight or body-fat
percentage
Participation in activities where
performance is judged on aesthetic
22
Treatment
Multidisciplinary approach
includes:
Psychiatrist Psychologist
Medical Doctor Dietitian
Focuses on:
Restoring normal body weight
Improving self-esteem and
attitude about body
Normalizing eating and
exercise behaviors 23
Muscle Dysmorphic Disorder
(MDD)
Also called “muscle dysmorphia”
Sometimes called “manorexia” or
“bigorexia”
Not a recognized eating disorder
Preoccupation with not being
sufficiently muscular or lean (when
this is not the case)
Psychological disorder marked by a
negative body image and an 24
Source: https://valentinbosioc.com/bigorexia-muscle-dysmorphia-disorder/ accessed 4/17/2020 25
MDD Characteristics
Dissatisfaction with body shape or
weight
Excessive exercising (beyond
requirements for health)
Being fanatical about weight and
diet
Justifying excessive behavior by
insisting it’s healthy
Overuse of supplements 26
Tips for Combating EDs
Never restrict food intakes to
below the amounts suggested for
adequacy by the USDA Eating
Patterns.
Eat regularly. People who eat
regularly throughout the day never
get so hungry that hunger dictates
their food choices.
If not at a healthy weight,
27
Table C9-2, p. 360
Tips for Combating EDs
(cont’d)
Allow a reasonable time to achieve
the goal. A reasonable rate for
losing excess fat is about 1% of
body weight per week.
Learn to recognize media image
biases and reject ultrathin
standards forEating
National beauty.Disorders
Association:
https://www.nationaleatingdisorders.
org/ 28
Table C9-2, p. 360