Chapter 9 – Eating Disorders And Obesity

Question 1

What does the term anorexia nervosa literally mean?

Answer 1

Lack of appetite induced by nervousness

Question 2

At the heart of this disorder is an intense fear of gaining weight or becoming fat, combined with a refusal to maintain even a minimally low bodyweight. There is a disturbance in the way in which ones body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low bodyweight. In postmenarcheal females, amenorrhea, The absence of at least three consecutive menstrual cycles.

Answer 2

Anorexia nervosa

Question 3

Disorders of food ingestion, regurgitation, or attitude that affect health and well-being, such as anorexia, bulimia, or binge eating

Answer 3

Eating disorders

Question 4

What are the two subtypes of anorexia nervosa?

Answer 4

The restricting type and the binge-eating/purging type

Question 5

In this type of anorexia nervosa, every effort is made to limit the quantity of food consumed. Caloric intake is tightly controlled and patients often try to avoid eating in the presence of other people. When they are at the table, they may eat excessively slowly, cut their food into very small pieces, or dispose of food secretly.

Answer 5

Restricting type

Question 6

In this type of anorexia nervosa, individuals either binge, purge, or binge and purge

Answer 6

Binge-eating/purging type

Question 7

And out-of-control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances

Answer 7

Binge

Question 8

Refers to the removal of food from the body by such means as self-induced vomiting or miss use of laxatives, diuretics, and enemas. Other compensatory behaviours that do not involve purging are excessive exercise or fasting.

Answer 8

Purge

Question 9

Frequent occurrence of binge-eating episodes accompanied by a sense of loss of control of over eating and recurrent inappropriate behaviour such as purging or excessive exercise to prevent weight gain

Answer 9

Boulimia nervosa

Question 10

Compare and contrast anorexia nervosa, binge-eating/purging subtype, and bulimia nervosa

Answer 10

The clinical picture of the binge-eating/purging type of anorexia nervosa has much in common with boulimia nervosa. The difference is weight. By definition, the person with anorexia nervosa is severely underweight. This is not true of the person with bulimia nervosa. Consequently, if the person who binges or purges also meets the criteria for anorexia nervosa, the diagnosis is anorexia nervosa binge-eating/purging type and not boulimia nervosa. Anorexia nervosa trumps the believe me at nervosa diagnosis because there is a far greater mortality rate associated with anorexia nervosa.

Question 11

A diagnostic category reserved for disorders of eating that do not meet criteria for any other specific eating disorder

Answer 11

Eating disorder not otherwise specified or EDNOS

Question 12

Distinct from non-purging bulimia nervosa, whereby bingeing is not accompanied by inappropriate compensatory behaviour to limit weight gain

Answer 12

Binge-eating disorder or BED

Characterized by eating in a discreet. Of time and amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. A sense of lack of control over eating during the episode.
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; feeling disgusted with oneself, depressed, or very guilty after overeating.
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least two days a week for six months

Question 13

Describe the age of onset, gender differences, and prevalence of eating disorders

Answer 13

Anorexia nervosa and boulimia do not occur in appreciable numbers before adolescence, however, children as young as seven have been known to develop eating disorders, especially anorexia.
Anorexia is most likely to develop in 15 to 19-year-olds. The age group at highest risk for bleeding is young women falling in the age range of 20 to 24.
Binge eating disorder are older than those with anorexia or boulimia and generally between 30 and 50 years of age.
Eating disorders do ochre in males, with binge eating disorder being relatively common, however, they are more likely to be found in women. There are three females for every male with an eating disorder.

The most common form of eating disorder in clinical samples is eating disorder not otherwise specified, at between five and 10% in community studies.
Binge eating disorder – lifetime prevalence around 3.5% in women and 2% in men. Higher in obese people in the range of 6.5 to 8%.
Bulimia – 1.5% for women and 0.5% for men
Anorexia – 0.9% in women and 0.3% in men.

The risk of developing anorexia seems to have increased during the 20th century. Lifetime rates of this disorder are higher in people born after 1945 then before this time and this is not fully explained by increased awareness of the disorder and better detection by clinicians. Also a rise in cases of boulimia from 1970 to 1993.

Question 14

This word comes from the Greek word bous, which means ox, and limos which means hunger. It is meant to denote a hunger of such proportions that the person could eat an ox.

Answer 14

Bulimia

Question 15

Describe the medical complications of the various eating disorders

Answer 15

Anorexia has the highest mortality rate of any psychiatric disorder, more than 12 times higher than the mortality rate for females age 15 to 24 in the general US population. Most often die because of medical complications.

Malnutrition in anorexia – hair on Scott thins and becomes brittle as well as nails. Skin becomes very dry, and downy hair called lanugo starts to grow on the face, neck, arms, back, and legs. Develop a yellowish tinge to their skin, especially on the palms of their hands and bottoms of their feet. There undernourishment causes them to have a difficult time coping with cold temperatures. Have chronically low blood pressure and often feel tired, weak, dizzy, and faint. Thiamin or vitamin B1 deficiency may also be present which could account for some of the depression and cognitive changes. Increased risk for osteoporosis in later life. Die from heart arrhythmias or irregular heartbeats sometimes caused by major imbalances in key electrolytes such as potassium. Chronically low levels of potassium can also result in kidney damage and renal failure or severe enough to require dialysis.
Abuse of laxatives makes all these problems much worse because it leads to dehydration, electrolyte imbalances, and kidney disease as well as damage to the bowels and gastrointestinal tract.
Boulimia – much less lethal then anorexia but is still associated with the mortality rate that is approximately twice that founded people of comparable age in the general population. Purging can cause electrolyte imbalances, low potassium, puts the patient at risk for heart abnormalities. Damage to the heart muscle which may be due to using it the CAC syrup which causes vomiting. Patients develop calluses on their hands from sticking their fingers down there throats to make themselves sick and may tear their throat. Damage their teeth when they throw up repeatedly from the acid in their stomach. Mouth ulcers and dental cavities and small red dots around the eyes. Often have swollen parotid or salivary gland cause by repeated vomiting known as puffy cheeks or chipmunk cheeks.

After medical complications, the second most common cause of death for those with anorexia is suicide.

Question 16

It is quite common for someone who is diagnosed with one form of eating disorder to be later diagnosed with another eating disorder. This is called:

Answer 16

Diagnostic crossover.

Many of these changes reflect transitions from anorexia or boulimia to eating disorder not otherwise specified which happens when minor clinical improvement mean that the person no longer meets diagnostic criteria for the original diagnosis.
There are also bidirectional transitions between the two subtypes of anorexia.

Shifts from anorexia to boulimia also occur, but there were no cases of direct transition from the restricting type of anorexia directly into bulimia.

Only a minority of patients with bulimia transition into anorexia.

Are is no diagnostic crossover between binge eating disorder and anorexia

Question 17

Explain the comorbidity of eating disorders with other forms of psychopathologies

Answer 17

68% of patients with anorexia, 63% with bulimia, and 50% with binge eating disorder are also diagnosed with depression.

Abscess of-compulsive disorder is also found in patients with anorexia and bulimia. There is frequent cooccurrence of substance abuse disorders in the binge-purging subtype of anorexia as well as in bulimia. The restrictive type tends not to be associated with substance-abuse.

Personality disorders are also frequently diagnosed. The restrictive type are inclined toward the anxious-avoidant cluster. Those that involve binge/purge symptoms are associated with dramatic, emotional, or a erratic problems, especially borderline personality disorder.

People would BED have higher rates of personality disorders, anxiety disorders, mood disorders, and substance-use disorders.

Question 18

Describe eating disorders across cultures

Answer 18

Anorexia and boulimia our clinical problems in Japan, Hong Kong, Taiwan, Singapore, and Korea. Have also been documented in India and Africa. The prevalence in Iran is comparable to the US.

Being Caucasian appears to be associated with subclinical problems that may place individuals at higher risk for developing eating disorders. Such problems include body to satisfaction, dietary restraints, and a drive for thinness.

Asian women exhibit levels of pathological eating similar to those of white women, and African-Americans are less susceptible.

A select number of the clinical features of diagnosed forms of eating disorders may also very according to culture. 50% of anorexia patients in Hong Kong are not excessively concerned about fatness but a fear of stomach bloating. Anorexia patients in Britain but who had South Asian ethnic origins also were less likely than patient with English origins to show evidence of fat phobia.
Women in Ghana who had anorexia were also not concerned about their weight but emphasize religious ideas of self-control and denial of hunger. Japanese women reported low levels of perfectionism and less of a drive for thinness then American women.

Anorexia is not a disorder that occurs simply because of exposure to western ideals, in contrast, believe me it does seem to be a culture bound syndromes and seems to occur in people of had some exposure to western ideals about fitness and you have access to large amounts of food and can purge in private

Question 19

Describe the biological, socio-cultural, individual, and family risk and causal factors associated with eating disorders

Answer 19

Biological:

Genetics – eating disorders have been shown to run in families and the relatives of patients with eating disorders are more likely to suffer from a variety of other disorders as well.
Twin studies suggest that both anorexia and boulimia are heritable. Evidence that a gene on chromosome 1 May be linked to susceptibility to the restrictive type of anorexia, and a chromosome 10 gene may be linked to boulimia.
Link to genes that are involved in the regulation of serotonin.

Brain abnormalities- The hypothalamus plays an important role in eating and there is evidence that abnormalities in this area play a central role in eating disorders.

Set points – there is a well-established tendency for our bodies to resist market variation from some sort of biologically determined set point or wait that our bodies try to defend. Hunger is a physiological opposition designed to prevent us from moving far from our set point.

Serotonin – implicated in obsessionality, mood disorders, and impulsivity and also modulates appetite and feeding behavior. Because many patients with eating disorders respond well to treatment with antidepressants which target serotonin, some researchers have concluded that eating disorders involve a disruption in the system. Serotonin is made from Anna sensual amino acid called tryptophan which can only be obtained from food, people with anorexia have low levels of a major metabolite of serotonin maybe because they are eating so little food. These metabolites are normal and people with bulimia, but after recovery these groups have higher levels than control women do and also have higher levels than when they were in the ill state. It has been suggested that resuming normal eating makes it possible to detect abnormalities in the serotonin system that might be involved in risk for eating disorders.

Socio-cultural factors:

Young women are bombarded with images of unrealistically thin models in magazines, ads, and on the television. Social pressures towards fitness may be particularly powerful and higher socioeconomic backgrounds. Fitness became deeply rooted as a cultural ideal in the 1960s.

Family influences:

More than one third of patients with anorexia reported that family disfunction was a factor that contributed to the development of their eating disorder. They perceive their families as more rigid, less cohesive, and as having poor communication.
Many of the parents of patients with eating disorders have long-standing preoccupations regarding the desirability of thinness, dieting, and good physical appearance and also have perfectionistic tendencies. When it comes to bulimia, both white and ethnic minority adolescents with boulimia perceive their families to be less cohesive.

Individual risk factors:

Gender – more frequently found in women than in men and the greatest risk is during adolescence. Binge eating is more likely to be found in males as well as in females.
Internalizing the thin ideal – the extent to which people internalize this ideal is associated with a range of problems that are thought to be risk factors for eating disorders which include body to satisfaction, dieting, and negative affect.
Perfectionism – an important risk factor for eating disorders because these people may be much more likely to subscribe to the thin ideal and relentlessly pursue the perfect body. Perfectionism helps maintain bulimic pathology through the rigid adherence to dieting that then drives the bench/purge cycle.
Negative body image- reception will biases lead girls and women to believe that men prefer more slender shapes then they do, and women feel evaluated by other women believing that there female peers have even more stringent standards of weight and shape than they do themselves.
Dieting – nearly all eating disorders begin with the normal dieting that is routine in our culture.
Negative emotionality – negative affect or feeling bad is a causal risk factor for body to satisfaction because when we feel bad, we tend to become very self-critical and may focus on our limitations and shortcomings well magnifying our flaws and defects. This seems to be especially true of individuals with eating disorders who tends to show distorted ways of thinking and processing information received from the environment.
Childhood sexual abuse

Question 20

Key structure at the base of the brain; important in emotion and motivation

Answer 20

Hypothalamus

Question 21

The tendency of our bodies to resist efforts to bring about a marked change in weight

Answer 21

Set point

Question 22

A neurotransmitter from the indolamine class that is synthesized from the amino acid tryptophan. Also referred to as 5 – HT, this neurotransmitter is thought to be involved in a wide range of psychopathological conditions.

Answer 22

Serotonin

Question 23

The need to get things exactly right. A personality trait that may increase risk for the development of eating disorders, perhaps because these people may be more likely to idealize thinness

Answer 23

Perfectionism

Question 24

The experience of an emotional state characterized by negative emotions. Such negative emotions might include anger, anxiety, irritability, and sadness.

Answer 24

Negative affect

Question 25

Explain the various methods used for treating anorexia nervosa

Answer 25

The most immediate concern is to restore their way to a level that is no longer life-threatening and in severe cases, this requires hospitalization and extreme measures such as intravenous feeding followed by rigourous control of the patients caloric intake

Medications: antidepressants are sometimes used although there is no evidence that they are especially effective. Treatment with an antipsychotic medication called olanzapine May be beneficial for treating the distorted beliefs about body shape and size and one side effects is weight gain.

Family therapy: considered to be the treatment of choice for adolescents. The best studied approach which blames neither the parents nor the child is known as the Maudsley model which involves 10 to 20 sessions spaced over 6 to 12 months in three phases. During the refeeding phase, the therapist works with the parents and supports their efforts to help their child to eat healthily once more. Family meals are observed by the therapist, and efforts are made to guide the parents as a functioning support team for their child’s recovery. After the patient starts to gain weight, the negotiations for a new pattern of relationships phase begins, and family issues and problems begin to be addressed. Later in the termination phase, the focus is on the development of more healthy relationships between the patient and her parents. Randomized controlled trial’s have shown that patients treated with family therapy for one year do better than patients who are assigned to a control treatment. And five years after treatment 75 to 90% show full recovery.

Cognitive-behavioral therapy: involves changing behaviour and maladaptive styles of thinking. Shown to be very effective in treating bulimia nervosa and because anorexia shares many features with bulimia, CBT is often used with anorexia patients as well. The recommended length of treatment is 1 to 2 years with a major focus on modifying distorted beliefs concerning weight and food, as well as distorted beliefs about the self that may have contributed to the disorder.
Over one year, women receive either 50 sessions of CVT or nutritional counseling, and only 17% of patients who received CBT showed full recovery and none of the women in the nutritional counselling group was fully well. Highlights the current limitations of CBT for this group of patients, as well as the pressing me for new treatment developments particularly for older patients with more long-standing problem.

Question 26

Explain the various methods used for treating bulimia nervosa

Answer 26

Medications: comment to be treated with antidepressant medication after he became clear that many patients also suffer from mood disorders. In contrast to patients with anorexia, patients taking antidepressants do better than patients were given inert, placebo medications. Antidepressants seem to decrease the frequency of binges as well as improve patient’s mood and preoccupation with shape and weight.

Cognitive-behavioral therapy: the leading treatment for bulimia. Multiple controlled studies reveal CBT to be superior to other treatments, and combining CBT and medication produces only a modest increment of effectiveness over that attainable with CVT alone. The behavioural component focusses on normalizing eating patterns including meal planning, nutritional education, and ending bingeing and purging cycles by teaching the person to eat small amounts of food more regularly. The cognitive element is aimed at changing the cognitions and behaviours that initiate or perpetuate a binge cycle. This is accomplished by challenging the dysfunctional thought patterns typically present such as the “all or nothing” dichotomous thinking. This treatment clearly helps to reduce the severity of symptoms but patience with the disorder are rarely entirely well at the end of treatment. Bingeing and purging is eliminated in around 30 to 50% of cases and weight and shape concerns may remain.
In an effort to improve treatment efficacy, new approaches such as dialectical behaviour therapy are now being explored with some success as well as using more individualized cognitive-behavioral therapy approaches that are specifically tailored to the needs of the patient as opposed to a more standardized treatment format.

Question 27

Explain the various methods used for treating binge-eating disorder

Answer 27

Due to the high level of comorbidity between binge eating and depression, antidepressant medications are sometimes used to treat this disorder. Other categories of medications, such as appetite suppressant and anticonvulsant medications, have also been a focus of interest. Sibutramine, A medication that inhibits the reuptake of serotonin and norepinephrine, has been shown to reduce the frequency of binges and to be associated with more weight loss than a placebo medication in one clinical trial.

In one study IPT, CBT in the form of a self-help book guided by a therapist, and behavioural weight-loss treatment that involve exercise and moderate restriction of calories were compared. At the end of six months of treatment, there were no significant differences between the groups with regards to remission, however at to your follow up, people who had received either IPT or guided CBT we’re doing better than those in the behavioural weight-loss group. The dropout rate was much lower for people in the IPT group then it was in the guided CBT for behavioural weight-loss groups. These findings suggest that for racial and ethnic minorities with BED, interpersonal psychotherapy might be a particularly suitable treatment approach.

Question 28

The condition of having elevated fat mass is in the body. Defined as having a body mass index of 30 or higher. A state of excessive, chronic fat storage.

Answer 28

Obesity

Question 29

Identify risk and causal factors of obesity

Answer 29

The role of genes: genetic make up plays an important role in determining how predispose we are to be coming obese in the modern environment of increased food availability. Some of the genes that may, in our ancestral past, had been advantageous and help us survive in times of famine may predispose those who carry them to readily gain weight when food is plentiful. Thinness seems to run in families and there are genes associated with fitness and leanness found in certain animals, and a genetic mutation has been discovered that is specifically associated with binge eating.

Hormones involved in appetite and weight regulation: our bodies regulate the daily quantity of food consumed and balance this with our energy output over the longer-term with a precision of more than 99.5%. One key element of this homeostatic system is a hormone called Lefton which is produced by fat cells, and asked to reduce our intake of food. Increased body fat leads to increased levels of leptin, which leads to decreased food intake. When body fat levels decrease, leptin production decreases and food intake is stimulated. Rare genetic mutations that result in an inability to produce leptin cause people to have an insatiable appetite and result in morbid obesity. Unfortunately, when Lefton is given to overweight individuals, in the majority of cases it has little effect. People who are overweight generally have high levels of leptin in their bloodstream. The problem is that they are resistant to its effects. In fact, it has been suggested that obesity may result from a persons being resistant to leptin.
Grehlin is a powerful appetite stimulator that is produced by the stomach that under normal. Under normal circumstances, this hormone’s levels rise before a meal and fall after we had eaten. When it is injected into human volunteers, it makes them very hungry. People with a rare condition called Prader-Willi syndrome chromosomal abnormality’s that create many problems, out of which is very high levels of Grellin. Suffers are extremely obese and often die before age 30 from obesity-related causes.

Socio-cultural influences: a diathesis-stress perspective is most appropriate. Some of us, by virtue of our genetic make up and personality, are likely to experience more weight-related problems from living in a culture that provides ready access to high-fat, high sugar foods, encourages overconsumption, and makes it easy to avoid exercise.
A major culprit is time pressure.
The food industry is also highly skilled at getting us to maximize our food intake and the culture of supersize and temps us to buy more than we might choose to buy otherwise simply because it costs only a little bit more.
There is also an issue of accessibility, foods with low nutritional value are less expensive and also much easier to find then foods with high nutritional value.
Food advertising seems to trigger the kind of automatic and unconscious eating that is not related to being hungry.

Family influences: in some families, a high-fat, high calorie diet or an over emphasis on food may lead to obesity in many or all family members, including the family pet. In other families, eating becomes a habitual means of alleviating emotional distress or showing love. Children whose mothers smoked during pregnancy or whose mothers gained a lot of weight during the pregnancy are also at a higher risk of being overweight at age 3.
People who are obese have markedly more adipose cells then people of normal weight. When obese people lose weight, the size of the cells is reduced but not their number. It is possible that over feeding infants and young children causes them to develop more adipose cells and may thus predispose them to weight problems in adulthood.
There is some evidence that obesity might be socially contagious. If someone close to us becomes obese, the chance that we are cells will later become obese can increase by as much as 57%.

Stress and comfort food: foods that are high in fat or carbohydrates are the foods that can so most of us when we are feeling troubled. Obese individuals have been shown to be conditioned to more cues both internal and extra no, then others of normal weight. Anxiety, anger, boredom, and depression may lead to over eating. Eating in response to such cues is then reinforced because the taste of good food is pleasurable and because individuals emotional tension is reduced.

Pathways to obesity: obesity results from a combination of genetic, environmental, and socio-cultural influences but another important step may be binge eating. Binge eating is a predictor of later obesity. Also, being heavy often leads to dieting, which may lead to binge eating when will power Wayne’s. There is also a pattern of binge eating in response to negative emotions that make a bad situation worse

Question 30

Discuss treatment methods for obesity

Answer 30

Lifestyle modifications: a clinical approach that ideally involves a low calorie diet, exercise, and some form of behavioural intervention. Using meal-replacement products, continuing a relationship with a treatment provider, and maintaining a high level of physical activity I’ll help improve efforts at long-term weight control.
Weight watchers is the only commercial weight loss program with demonstrated efficacy in a randomized controlled trial. Crash diets and extreme treatments to bring about dramatic weight loss are now considered to be outmoded and ineffective approaches. Although they lead to weight loss in the short-term, the weight-loss is not maintained.
Calories matter more than focussing on the proportion of fat, protein, or carbohydrates. People should focus on just eating less.
For those who are obese, losing weight and maintaining the weight-loss present a truly formidable challenge as your body tries to defend a set point weight, and as energy expenditure decreases significantly following weight-loss.

Medications: fall into two main categories, one group reduces eating by suppressing appetite, typically by increasing the availability of neurotransmitters. A second group works by preventing some of the nutrients in food from being absorbed.
Two medications for use in conjunction with a reduced calorie diet are sibutramine which inhibits the reuptake of serotonin and norepinephrine and to a lesser extent dopamine. Orlistat works by reducing the amount of fat in the diet that can be absorbed once it enters the gut. Both medications provide modest clinical benefits and lead to more weight loss than placebo but in some cases the differences are not especially impressive.

Bariatric surgery: bariatric or gastric bypass surgery is the most effective long-term treatment for people who are morbidly obese’s. Several different techniques can be used to reduce the storage capacity of the stomach and, sometimes to shorten the length of the intestine nine so that less food can be absorbed. Binge eating becomes virtually impossible because the stomach can now only hold about a shot glass of food. Weight-loss is quite dramatic after bariatric surgery and tends to result in substantial weight loss. Levels of the appetite hormones Grellin are also suppressed. However, some patients manage to find ways to continue to binge eat after surgery and tend to regain their weight over and 18th month period.

Question 31

Describe the importance of prevention in obesity

Answer 31

To be prevented, it must first be recognized. Childhood obesity in one study was predicted by having an obese parent, skipping breakfast, habitual over eating, and not being physically active. Because we know that childhood obesity predicts adult obesity, parental education is very important.

Losing weight is difficult because it is a battle against a biological mechanisms designed to keep us at our current weight. This highlights the importance of not gain weight in the first place.

Cutting back by 100 cal per day or walk an extra mile each day is a good way to prevent weight gain in adulthood. This can be accomplished through:

• Eat 3 fewer bites of food when you eat a meal.
• take the stairs, combine a meeting with a walk, or park a little farther from your destination. A mile of walking is only 2000 to 2500 extra steps which can be added in small increments throughout the day.
• sleep more. An adult who sleeps only 5 to 6 hours a night games more weight overtime then those who sleeps 7 to 8 hours a night.

Question 32

These disorders are characterized by a severe disturbance in eating behavior.

Answer 32

Eating disorders

Question 33

An estimation of total body fat calculated as body weight in kilogrammes divided by height squared

Answer 33

Body mass index

Question 34

A hormone that is produced by the stomach that stimulates appetite

Answer 34

Grehlin

Question 35

A hormone produced by fat cells that acts to reduce food intake

Answer 35

Leptin