Eating Disorders and Obesity

Question 1

Anorexia Nervosa

Answer 1

=lack of appetite (refusal to eat) caused by nervousness
A. restriction of energy intake leading to significantly low body weight
B. intense fear of gaining weight/becoming fat and persistent behavior that interferes with weight gain
C. disturbance in the way in which one’s body weight or shape is experienced, undue influence of body shape on self evaluation, or denied of the seriousness of the current low body weight

Question 2

Types of Anorexia

Answer 2

=Restricting
=Binge eating/purging
-if you are significantly underweight, even if you binge and purge

Question 3

Binge Eating

Answer 3

=within a discrete period, amount of food that is consumed is definitely larger than most would eat during a similar period of time under similar circumstances
=sense of lack of control over eating during the episode
=often carried out in secret
-leave you with guilt and anxiety

Question 4

Purges

Answer 4

=attempts to compensate for or undo the caloric effects
= vomiting
=laxatives, diuretics, enemas
=might also involve extreme exercise

Question 5

Thoughts of an Anorexic

Answer 5

=denial 
=ambivalence - hide weight loss 
=preoccupation with food 
=distorted thinking 
- perfectionism - unrealistically high standards

Question 6

Prevalence of Anorexia

Answer 6

=typical onset: 15-19
=us lifetime prevalence: .9% women, .3% men
-least common eating disorder
=aesthetic sports
-ballet dancers specifically
-and other sports where evaluation is subjective according to a judge
=about 50% will recover
-other 50% struggle on and off or die from starvation or suicide

Question 7

Clinical Picture of Anorexia: the typical case

Answer 7

=a normal to slightly overweight female has been on a diet

• escalation to anorexia nervosa may follow a stressful event
• separation of parents, move or life transition, experience of personal failure

Question 8

Effects of Anorexia

Answer 8

=cognitive and brain
-can’t think right, fear of gaining weight, sad, moody, irritable, bad memory
-changes in brain chemistry
=hair thins and gets brittle, grows on other parts of body to keep warm
=heart – light headed, pass out easily
=dry skin and brittle nails, bruise easily
=periods will stop
=permanent bone loss

Question 9

Mortality of Anorexia

Answer 9

=very high compared to other disorders
=some suicide, a lot with physical effects of starvation
-about a quarter commit suicide
-more than 12 times higher mortality rate than for normal females aged 15-24

Question 10

Initial Goal of Treatment for Anorexia

Answer 10

=initial goal is to restore weight and recover from malnourishment

• competition among patients to resist weight gain, who can be the best anorexic
• may need to resort to force feeding – this does not set stage for good trusting relationship with therapist, but sometimes needs to be done
• can’t use psychotherapy if you can’t think straight because you are starving

Question 11

Anorexia

1. Medications
2. psychotherapy

Answer 11

1. antidepressants – not especially effective
   olanzapine – antipsychotic, established efficacy, weight gain
2. cbt – not especially effective
   -family therapy – established efficacy

Question 12

Bulimia Nervosa

Answer 12

A. recurrent episodes of binge eating
B. recurrent inappropriate compensatory behavior to prevent weight gain
- eg vomiting, laxatives, diuretics, enemas, fasting, excessive exercise
C. A and B both occur on average at least once a week for 3 months
D. self evaluation unduly influenced by body shape and weight

Question 13

Binge Purge Cycle

Answer 13

Strict dieting → tension and cravings → binge eating → purging to avoid weight gain → shame and disgust → back to strict dieting

Question 14

Prevalence of Bulimia

Answer 14

=highest risk: 20-24
=us lifetime prevalence: 1.5% women, .5% men
=about 70% will recover

Question 15

Effects of Bulimia

Answer 15

=not as bad as anorexia, but still bad
=dehydration and electrolyte imbalance – irregular heart beat and failure
=brain: depression, fear of gaining weight, anxiety, dizziness
=throat and esophagus tears and pain
=stomach ulcers

Question 16

Mortality of Bulimia

Answer 16

=about twice the normal population
=elevated suicide risk
-about 25% attempt

Question 17

Treatment for Bulimia

Answer 17

=antidepressant medication
=CBT
-training better eating habits
-smaller, more regular meals

Question 18

Binge Eating Disorder

Answer 18

1. Recurrent episodes of binge eating

2. binges associated with three or more. binges associated with 2 or more months

Question 19

Age for Binge Eating Disorder

Answer 19

=ages 30-50 years

=us lifetime prevalence: 1.35% women, 21% men

Question 20

Treatment for binge eating disorder

Answer 20

=antidepressant
=ipt
=cpt

Question 21

Comorbidities

Answer 21

=can switch between an anorexia diagnosis of bing-purge subtype and a bulimia diagnosis
=depression , anxiety

Question 22

Subthreshold symptoms

Answer 22

=in high school and middle school girls and boys. Many admitted to having some bulimia

Question 23

Groups

Answer 23

=61% of female college students report some form of disordered eating
=ED rates higher than among sorority sisters
=ED rates higher among competitive athletes

Question 24

Eating Disorders over time

Answer 24

=13% increase in female
=37% increase in male
-either increase in disorder or increase in willingness to get treatment

Question 25

Eating Disorders in Males

Answer 25

=10 to 15% of people with anorexia or bulimia are male
=less likely to seek treatment (perception of EDs as “women’s diseases”
=more common in gay males
-want to be attractive to men and men put more emphasis on looks than women do
=sports
-wrestling, diving
=the media and body image in men

Question 26

Eating Disorders and Culture

Answer 26

=ED are worldwide but
-in US, being white is a risk factor
-in US, being black is a protective factor
=AN is not culture bound
-but reasons for food restriction may vary by culture
=BN is culture bound
-western ideals about thinness
-can’t binge without lots of food available and most people want privacy of modern bathroom to purge

Question 27

Causal Factors: biology and genetics

Answer 27

• about as highly heritable as BD or schizophrenia
• abnormalities in frontal and temporal cortex
• serotonin overactivity

Question 28

Causal Factors: sociocultural

Answer 28

=-despite genetics, highly unlikely that you will develop an ED without cultural influence
=how ideal of female body image has changed over time
-fat in Renaissance
-Marilyn Monroe- size 12
-nowadays - underweight
=greater gap in time from cultural ideal and what women actually look like
-we are getting fatter and models are getting thinner
-viewing underweight model has a direct effect on our self esteem and body perception

Question 29

Example of Fiji

Answer 29

=before TV, ideal was robust, women wanted to be strong to work
=after TV, women started dieting and losing weight

Question 30

Impact of Viewing Ultrathin models

Answer 30

=in adult females leads to decreased body satisfaction and self esteem
=conflicting messages - an article about losing weight in the same magazine with an article on baking brownies

Question 31

What to do about media?

Answer 31

=viewing normal weight models has been shown to undo these effects
=dove commercials

Question 32

Other Risk Factors

Answer 32

• family dysfunction
• sexual orientation in men
• internalizing the thin ideal
• perfectionism for anorexia
• body dissatisfaction and negative body image
• dieting
• negative mood
• childhood sexual abuse

Question 33

Obesity

Answer 33

=about 2/3 of Americans weigh more than they should

=slightly but significantly more prevalent among minority groups

Question 34

Health Risks of Obesity

Answer 34

• high cholesterol
• hypertension
• heart disease
• arthritis
• diabetes
• cancer
• reduced life expectancy: 5-20 years

Question 35

Thinness/obesity runs in families

Answer 35

=genetic makeup matters

• study with 12 pairs of identical twin males
• 1000 calories/day above need for 100 days
• results: positive correlation in the amount of weight they gained and where they tended to gain it. Weight gain was influenced genetically, same for both twins. If A wasn’t going to gain a lot, B wasn’t. If A gained a lot, B did too.

Question 36

Foods high in salt, sugar, and fat may trigger addiction

Answer 36

Table 9.6

Question 37

Time pressure

Answer 37

super rushed world, hard to take the time to shop for and prepare healthy food
-hard to slow down eating and stop when you’re full

Question 38

Sociocultural factors for obesity

Answer 38

-Advertising does a very good job of making unhealthy food look good, taste good, easier and cheaper to buy

Question 39

Evolutionary Factors

Answer 39

=thrifty gene hypothesis
=availability and type of food for our ancestors (and in some cultures today)
-food used to be less available and less calorie dense
=availability and type of food in western culture today
-grocery store, lots of food that is highly caloric

Question 40

Family Influences

Answer 40

=household diet 
=food as a way to manage emotions or show love 
-comfort food 
=pregnancy factors 
=overfeeding in childhood 
=obesity as a socially contagious