Transcript EDO

Part I – Eating Disorders:
General Trends/Issues
Early Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Prevalence/Patterns
Prevalence
Increases in prevalence over past 4 years; changing norms
regarding size and shape of women*
Historically confined to middle to upper SES
In college-age American women, 10 % or more have some
symptoms of an eating disorder
Estimated to occur in 0.5% to 3% of all teenagers
Among athletes and performers, range from 15% to 60%.
Gender & Age Differences
90-95% of affected individuals are female
Little is known about nature of disorder in males
Less frequently occurs before adolescence or after age 25
*Prorated Trend of Women’s Actual Body Weights
Compared with the Trend for Playboy Centerfolds & Miss
America Contestants
General Risk Factors
Self-Ideal Body Image Discordance
General sociocultural norms idealizing extremes of thinness
in women in Western cultures
This pressure may lead to development of intrusive and
pervasive perceptual biases regarding how fat they are
Lead women to believe that men prefer more slender shapes
than they in fact do
Related to decreases in self-esteem usually apparent during
mid-adolescence in girls
While women’s actual weight has been increasing over past
four decades, the weight of cultural beauty icons has
decreased at the same rate
Barbie Doll
Interesting Facts
In 1945 Ruth and Elliot Handler form Mattel. In
1957 Ruth conceives of a three dimensional adultlike doll. The body is based on German doll called
"Lilli" which is sold as a sex toy for men.
If Barbie was human sized, she would stand 5 foot
6 inches tall, weigh 110 pounds, and have a 39
inch bust, 18 inch waist and 33 inch hips.
General Risk Factors
Developmental Risk Factors
Continuum of “eating pathology” from pickiness and dieting to
clinical syndromes
Early eating habits: stability of problem eating in young children (e.g.,
pickiness, binging, pica (eating non-food items))
Drive for thinness: key motivational factor underlying dieting and body
image (e.g., “losing weight will make them like me more”)
Dieting: between grades 5-8, 1/3 students diet and 45% want to lose
weight
Biological Resistance to weight change
Bodies will resist, and try to compensate, for marked variation from
one’s “set point” (individual norm)
Physiological compensations include enhanced hunger drive and
slowing of metabolism at decreased caloric intake
Early Eating Disorders
Feeding Disorder of Infancy or Early Childhood
Sudden or marked deceleration of weight gain in an infant or
young child and a consequent slowing of emotional and social
development.
Relatively common (up to 1/3 of infants affected); more often
found in high-risk families, where abuse or neglect may be present
Outcome depends on timing and level of intervention
Failure to Thrive
Weight below 5th percentile for age, and/or deceleration in rate of
weight gain from birth to present of at least 2 standard deviations
Been associated with poor attachment, poverty, family
disorganization, limited social support
Outcome highly related to child’s home environment
Pica
Early Eating Disorders
Ingestion of inedible substances for period at least
1 month
Affects mostly very young kids and those with MR
Causes: poor stimulation and supervision in the
home; in some cases of MR also genetic/biological
factors
Severity often related to degree of environmental
deprivation and intellectual impairment
Most clinical interventions emphasize operant
conditioning
Shaping and reinforcement of appropriate eating
behavior
Anorexia Nervosa
Core Characteristics
Refusal to maintain body weight at or above a minimally
normal weight for age and height (less than 85%)
Intense fear of gaining weight of becoming fat, even though
under-weight
Disturbance in experience of body weight or shape by selfevaluation, or denial of seriousness of current low weight
Amenorrhea (absence of 3 consecutive menstrual cycles)
Two Types:
Restricting Type
Binge-Eating/Purging Type
Anorexia Nervosa
Associated Features
Comorbid Conditions
Depression
OCD & extreme self-control (in restricting types)
Substance abuse disorders (in binge-eating/purging type)
Personality disorders (esp. anxious-fearful)
Behavioral Patterns
Isolation from peers; social awkwardness
Severe dietary restriction, excessive exercise (RT)
Misuse of laxatives, diuretics, enemas, self-induced
vomiting (B-E/PT)
Anorexia Nervosa
Specific Risk Factors
Personality Characteristics
Emotionally reserved and cognitively inhibited
Preference for routine, order, and predictable environments; poor
adaptation
Show heightened conformity and deference to others
Avoid risk and react to stressful events with strong feelings of distress
Focus excessively on perfectionism
Maturity fears
Family Patterns
Mothers described as: excessively dominant, intrusive, overbearing,
and less affectionate, discouragement of autonomy
Fathers described as: emotionally absent
Families described as: limited tolerance of disharmonious affect or
tension, poor conflict resolution skills, preoccupation with desirability of
thinness, dieting, and good physical appearance
Anorexia Nervosa
Treatment Goals
Stabilize Patient
Restoring hormonal function and bone density
Maximize chances for full and lasting recovery
Treatment Components
Hospitalization
Renourish and reestablish weight to ensure survival
Psychological Treatment (Out/Inpatient)
Family therapy
Cognitive-behavioral therapy
Nutritional counseling
Anorexia Nervosa
Prognosis: Long-term Physical Effects
Heart disease
Most common medical cause of death in people with severe
anorexia.
Heart develops dangerous rhythms, blood flow is reduced and
blood pressure may drop, heart muscles starve, losing size
Cholesterol levels tend to rise
Electrolyte Imbalances
Anemia
Reproductive and Hormonal Abnormalities
Low levels of reproductive hormones& changes in thyroid
hormones
Neurological Problems
Nerve damage and seizures, disordered thinking, loss of
feeling, or other nerve problems in the hands or feet.
Structural changes and abnormal activity during anorexic
states; some damage may be permanent.
Anorexia Nervosa
Prognosis
At this time, no treatment for anorexia is completely effective.
Many remain very thin and displayed characteristics of the disorder,
including perfectionism and drive for thinness, that keep them at
risk for recurrence of the eating disorder.
Recovery can take between 4 and nearly 7 years.
Comorbid disorders increase for poor outcome.
Risk of Death
Death rates ranging from 4% to 20%.
The risk for early death is twice as high in bulimic anorexics as
it is in the anorexic-restrictor types.
Increased suicide rates.
Bulimia Nervosa
Core Characteristics
Recurrent episodes of binge eating
Eating in a discrete period of time (i.e. 2hrs) an amount of food that
is definitely larger than most people would in similar circumstances
A sense of lack of control over eating during the episode
Recurrent inappropriate compensatory behavior to prevent weight gain,
such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or
medications, fasting, or excessive exercise
Both behaviors occur on average at least twice a week for 3 mos
Self-evaluation unduly influenced by body shape and weight
Two Types:
Purging Type
Non-purging type
Bulimia Nervosa
Associated Features
Comorbid Conditions
Anxiety disorders (esp. GAD)
Substance use disorders
Personality disorders (esp. Cluster B – emotional, dramatic,
emotional, erratic)
Behavioral Patterns
Purging types show greater physical and psychological
dysfunction
Preoccupation with efforts to conceal disorder and master impulse
to binge
Binge episodes usually involve intake of about 1000 calories
approx. 14 times per week
Bulimia Nervosa
Specific Risk Factors
Personality Characteristics
Long-standing pattern of excessive perfectionism
Negative self-evaluation
Maturity fears
Impulsivity
Family Patterns
High parental expectations
Other family members dieting
Higher criticism by family members about shape, weight,
or eating
Decreased allowance for autonomy
Bulimia Nervosa
Treatment
Antidepressants
Cognitive-Behavioral Therapy
Clearly superior to medication
Emphasis on normalizing eating patterns
Temporal regularity
Social eating
Focus on distorted cognitive patterns
Dichotomous thinking
Bulimia Nervosa
Prognosis
Less major health problems associated with bulimia,
where normal weight is maintained
In general, the outlook is better for bulimia than for
anorexia.
Mortality rate about 1% for those in treatment; 20%
have life-long patterns of disorder
Physical Effects
Teeth erosion, cavities, and gum problems
Loss of fluid and low potassium levels
Acute stomach distress, rupture of the esophagus, or
food pipe
Boys and Body Image
Growing awareness regarding the pressure men and boys are under to
appear muscular.
Many males are becoming insecure about their physical appearance as
advertising images raise the standard and idealize well-built men.
Alarming increase in obsessive weight training and the use of anabolic
steroids and dietary supplements that promise bigger muscles or more
stamina for lifting.
Number of boys affected is increasing and that many cases may not be
reported, since males are reluctant to acknowledge any illness primarily
associated with females.
Part II - Obesity:
An Epidemic
Current Treatments
A New Approach: BCT
Obesity Trends* Among U.S. Adults
BRFSS, 1985
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1986
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1987
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1988
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1989
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1990
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1991
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1992
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1993
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1994
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1995
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1996
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1997
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1998
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1999
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 2000
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 2001
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
A National Crisis
The rates of overweight and obese individuals
have been steadily climbing.
Rates of obesity alone have doubled in the last
decade.
1998, the World Health Organization labeled
Obesity “an Epidemic.”
65% of the population are now either
overweight or obese (2004).
The trend is continuing with no end in sight.
Who is Overweight or Obese?
Height-Weight Tables
>120% desirable weight
BMI (kg of body weight / height (in meters) squared)
Normal
< 25 kg/m2
Overweight
Class I Obesity
Class II Obesity
Class III Obesity
Percent Fat
25-30
30-34.99
35-39.99
>40
>25% males; >32% females
Waist Circumference
>40 in. males; >35 in. females
Physical & Emotional Burdens
Risk of major chronic diseases increases
with increases in BMI and central obesity:
Metabolic Syndrome
Cardiovascular Diseases
Type 2 Diabetes
Cancers
Osteoarthritis
Sleep Apnea
Gall bladder Disease
Psychological Disorders
Social and Employee Discrimination
The Financial Burden
$100 billion dollars spent annually on
obesity-related health care utilization.
$329.2 billion dollars spent in 2002 on CVDrelated illness.
$50 billion dollars spent annually on diet
related products.
The Ultimate Cost
Direct link between Obesity and Years of Life Lost
(Fontaine et
al, 2003)
Young adults with morbid obesity had a 22% reduction in
life span.
Ethnic differences in optimal BMI
23 to 25 for Caucasian (men and women)
23 to 30 was optimal for African American (men and women).
Obesity-related illness accounts for >280k deaths annually
(Manson, 2003)
Obesity mortality is positively correlated with CVD mortality
950,000 people die each year from cardiovascular disease (CDC, 2003)
Deaths in the Thousands
US Cardiovascular Disease Rates
520
Men
Women
500
480
460
440
420
400
79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0
Years
Cardiovascular disease mortality trends for males and females in the United States,
1979-2000. Reprinted from the American Heart Association.
Explanation
Biological
Psychological
Social
Engel, 1977, 1980; Schwartz, 1982