Chapter 15- Eating Disorders Flashcards
what is the main problem in eating disorders in athletes ?
low energy availability (low diet- exercise expenditure)
what is normal eating ?
normal eating is flexible, it varies in response to your hunger, schedule, proximity to food, and feelings
what is the hunger-fullness scale? where should we be on it ?
famished, hungry, neutral, full, over-stuffed
we should always be between hungry and full
how do we feel when we are on either extremes of the hunger-fullness scale ?
when we are famished or over-stuffed : low energy, lethargic, etc
which foods promote satiety ?
protein and fiber
what is the success rate of diets ?
5%
is dieting normal adolescent behavior ?
NO
what is the connection between dieting and eating disorder ?
teens who diet are a lot more likely to develop an eating disorder
what is the connection between dieting and being overweight ?
dieting at a young age leads to being heavier later in life
when was the Ancel Keyes starvation study conducted and on who ?
in 1944-45 on conscientious objectors
wanted to study what would happen in concentration camps
what were the main findings of the Ancel Keyes starvation study ?
6 month semi starvation diet (lose 25% BW) leads to obsession w food, unusual eating habits (40 gums a day), binge eating, physical changes
what are 4 ways of purging ?
vomiting
misuse of laxatives
diuretics
diet pills
what does purging mean ?
ridding body of unwanted food
what was the main modification of the DSM 5
added other diseases than BN and AN
such as : binge eating disorder
nocturnal eating syndrome
avoidant/restrictive food intake disorder
etc
what is the lifetime risk of anorexia nervosa ?
- 9% for women
0. 3% for men
what is the lifetime risk of bulimia nervosa ?
- 5% women
0. 5% men
which is more prevalent: BN or AN ?
BN
what is the lifetime risk of binge eating disorder ?
3.5% women
2% men
what is the lifetime risk of OSFED ? (other specified feeding or eating disorder)
3-10%
what is the proportion of men and women who have eating disorders ? `
10% men
90% women
what percentage of ED start in adolescence ?
85%
how is body image a risk factor to ED ?
when body image becomes central to self-worth, incidence of ED increases
how does the prevalence of ED in athletes compare to ED in non-athletes ?
athletes suffer twice as much from eating disorders as non-athletes
what is the prevalence of ED in athletes ?
6-45% women
0-19% men
what are three categories of sports with higher rates of ED?
endurance
aesthetic
weight category
which are more likely to encourage ED: coaches or parents ?
coaches
does lower BW improve performance ?
no
what is the focus in sports which encourage ED ?
focus on the individual (gymnastics) and/or endurance (swimming)
what is the BMI at which you are more likely to have an ED ?
no such thing
what did the DSM-5 change in the diagnosis of anorexia nervosa ?
got rid of amenorrhea since men also have AN and menopausal women can have AN
what are the 3 diagnostic criteria (DSM5) for anorexia ?
restriction of intake leading to severely low BW (adults BMI <17=mild, <15= extreme)
intense fear of gaining weight
disturbed perception of body size/ shape
what are the two types of anorexia nervosa ?
restrictive
binge eating/purging
how long do the symptoms need to persist in AN to be diagnosed ?
3 months
what is the recovery key in AN ?
early recognition & treatment
what is a main symptom of anorexia due to macronutrient deficiency ?
hypothermia
what does low body temperature in anorexia manifest itself (4)
experience a lower body temp
lower BMR
lower RMR
LANUGO
what is lanugo ?
soft downy hair on face, back, and arms as a protective mechanism built into the body to help keep a person warm in starvation (anorexia)
lanugo is associated with which ED ?
anorexia
what mental health issue has the highest mortality rate
anorexia
what happens to the AN body after a few months?
cardiovascular issues: protein energy malnutrition similar to marasmus
leads to heart failure
what happens to the heart in AN
heart muscles become weak and thin due to protein breakdown
chambers decrease in size, blood pressure decreases, pulse decreases, leading to heart failure
what is the main cause of death in AN ?
heart failure due to electrolyte imbalance (esp Ca, Na, K, P) which are critical to maintain electric currents necessary for normal heart beat
which state increases risk of death in AN ?
exercise
explain the GI problems in AN
deteriorated GI tract, slowed absorption, slowed production of digestive enzymes by pancreas, atrophy of lining of GI
why would some athletes that are AN experience an increase in performance ?
euphoria
it is short lived
starvation is a physiological stressor and releases NE and E which will evoke a feeling of euphoria and increase VO2max
how does AN affect endurance ?
deteriorates as liver and muscle glycogen deplete + reduction of strength and power from loss of muscle mass
what is a common symptom of AN in sports ?
dehydration which decreases plasma volume and the ability to thermoregulate
what is the RED-S?
screens for relative energy deficiency in sport (better than the athlete triad)
how does the DSM-5 define bulimia nervosa
cycles of binge eating and inappropriate compensatory behaviors once a week for at least three months
lack of control over binges, followed by purging (vomiting, exercise, laxative, strict dieting)
BMI >18.5
what is Binge Eating Disorder ?
binging for 1x/week at least for three months
no compensatory behaviors (no purging)
what proportion of men and women does binge eating disorder affect ?
60% women
40% men
what are 4 health risks in binge eating disorder ?
acute gastric dilation
post-binge pancreatitis
cardiac risks (htn, cvd, dm, edema)
weight gain
does purging help lose weight ?
no, only half of what is consumed is rid of
what is a skin problem that shows signs of self induced vomiting:
Russell’s sign
what are the two methods for self induced vomiting ?
ipecac: a vomiting pill but usually only used for poisoning; it is cardiotoxic and can lead to heart problems
or fingers down throat
what happens to glands in self induced vomiting ?
parotid glands are enlarged with elevated amylase
what are metabolic complications of self induced vomiting ?
hypokalemia, hypochloremia
alkalosis
dehydration
what can be a consequence of laxative abuse (4)
electrolyte imbalance (dehydration) constipation/diarrhea loss of colon function due to laxative dependence rapid weight gain when discontinued
what are two consequences of diuretic use
electrolyte imbalance and dehydraiton
kidney damage
what are 2 side effects of diet pills
elevated BP
anxiety
what kind of energy are ED ppl prone to
stress fractures
how does bulimia affect performance in sports
weak muscles, lower electrolytes and potassium means more fatigue
dehydration: less thermoregulation
slower recovery from workouts due to lack of vitamins and minerals
osteoporosis
what is anorexia athletica ?
excessive workouts + restriction
what is the main risk factor for anorexia athletica ?
pressure to improve performance by diet or exercise
what is orthorexia nervosa ?
dysfunctional eating patterns, obsessed with eating healthy pure diet
(not a diagnosed eating disorder)
what is diabulemia ?
when ppl with type I diabetes skip or reduce insulin to lose weight (1/3 women with type I)
nauseated from elevated blood sugars (ketoacidosis), which will make them vomit, weight loss
side effects of diabulemia ?
nephropathy, CVD, electrolyte imbalance, dehydration, death
what is nocturnal eating syndrome ? what are the DSM criteria
excessive intake of food at night with distress about it and guilt, with the excess eating not explained by social norms, sleep cycle, etc
need to fit 3/5 symptoms:
lack of morning hunger, urges to eat in evening/night, belief that one must eat in order to fall back to sleep at night, depressed mood, difficulty sleeping
which adults are more at risk of nocturnal eating syndrome ?
obese people and those seeking bariatric surgery
what is muscle dysmorphia? how is it classified ?
classified as obsessive compulsive
compulsive exercise, inflexible dieting regimens, anabolic steroid abuse, obsessive thoughts of muscles
what is nocturnal eating syndrome classified as ?
OSFED (DSM 5)
prevalence of muscle dysmorphia ?
1/3 men
what is the best way to treat an ED ?
multidisciplinary treatment
most ED patients are outpatient or inpatient ?
outpatient
when is an ED an inpatient ?
when they cant improve as outpatient, concern for safety
what is refeeding syndrome ?
when you aggressively refeed an ED person, shifts electrolytes from serum, which can lead to thiamin, P, Mg, K deficiency
what should be a golden rule when refeeding an ED person?
feed conservatively, monitor electrolytes
what is avoidant/restrictive food intake disorder ?
avoidance of food, failure to meet energy needs, but no body image issues (usually kids)
