chapter 18: eating disorders

Question 1

body image

Answer 1

• American media and societal preferences send strong messages that “thinner is better”
• dangerous messages for youth, adolescents, and young adults
• women are most at risk, but men are not exempt with so much emphasis on perfect physique
• young girls also especially vulnerable and may begin “dieting” at a young age

Question 2

causes of eating disorders

Answer 2

• negative self esteem
• depression
• internal struggles w/ autonomy, sexuality
• gender differences: women are built differently than men and have a different percentage of body fat
• genetics
• hypothalamus dysfunction (appetite center)
• improper dopamine levels
• cultural/ethnic differences may affect tendency toward body build and/or weight issues

Question 3

anorexia nervosa

Answer 3

• morbid fear of obesity causing anxiety and obsessive fear of losing control of food intake
• distorted body image of self as fat
• may or may not include purging
• self starvation and refusal to eat despite hunger
• excessive exercise after eating to use up calories

Question 4

treatment of anorexia nervosa

Answer 4

• acknowledge the disorder
• try to stop the weight loss, then promote slow weight gain (depending on height and weight/ 2-3 pounds per week)
• family support
• psychotherapy
• nutrition counseling
• rewards for weight gain sometimes are helpful as behavioral program
• antidepressants and anti anxiety meds

Question 5

anorexia complications

Answer 5

• serious medical disorder
• complications include electrolyte imbalances, heart failure, bone loss, hormone disruptions

Question 6

bulimia nervosa

Answer 6

• pattern of bingeing and purging
• may eat up o 8000 calories in 2 hours
• use of laxatives and emetics as part of purging
• many additional symptoms include loss of teeth enamel and hoarseness from chronic vomiting
• pattern of tension build up leading to consuming food and then guilt, disgust after purging
• more associated w/ depression
• more likely to be obese, normal weight, or fluctuating weight
• poor self image
• more associated w/ substance abuse
• separate diagnosis of binge eating disorder not associated w/ purging

Question 7

treatment of bulimia

Answer 7

• acknowledge the problem
• treat depression
• individual and group psychotherapy

Question 8

obesity

Answer 8

• obesity and morbid obesity are not considered eating disorders but the effects often lead to emotional distress
• morbid obesity: body weight greater than 100 pounds above “ideal” body weight

Question 9

contributing factors to obesity/morbid obesity

Answer 9

• genetic
• brain dysfunction: altered satiety center
• depression
• use of food for comfort after psychological traumas

Question 10

morbid obesity

Answer 10

• US preventative services task force has recommended that hcp identify people with BMI greater than 30 and refer them for weight loss counseling
• BMI is body mass index: a calculation of weight divided by the square of one’s height in adults to provide approximation of body fat

Question 11

treatment of morbid obesity

Answer 11

• nutrition counseling
• emotional support
• group approach helpful for some
• new medications: including Contrave, Saxenda, and Qsymia

Question 12

bariatric surgery

Answer 12

• several options, including laparoscopic and open abdominal surgery
• generally candidates must be 100 pounds overweight and have failed traditional weight-loss attempts, although those w/ comorbidities like diabetes may qualify at lower weights
• most programs employ nurses to counsel and work w/ the person both pre-operatively and postoperatively
• mental health issues often accompany this kind of surgery
• some surgeons require mental health testing of some sort preoperatively

Question 13

nursing interventions for eating disorders

Answer 13

• promote positive self concept and self acceptance
• promote healthy coping skills
• address feelings associated w/ food
• promote education for adequate nutrition
• promote appropriate amount of exercise
• focus on positive reinforcement of progress, not on the amount of weight the person is gaining or losing