Eating Problems Flashcards
What is a healthy diet?
Fruit and Veg:
a wide variety of fruit and veg should be eaten and preferably five or more servings should be eaten a day.
Bread, pasta, other cereals, and potatoes:
plenty of complex carbohydrate foods should be eaten, preferably those high in fibre
Meat, Fish, and alternatives:
moderate amounts of meat, fish and alternatives should be eaten and it is recommended that the low-fat varieties are chosen. Idelly two portions of fish should be eaten each week, one of which should be oily.
Milk and dairy products:
these should be eaten in moderation and the low-fat alternatives should be chosen where possible
Fatty and Sugary Foods:
food such as crisps, sweets and sugary drinks should only be eaten infrequently and in small amounts and lower sugar ones should be chosen where possible.
other recommendations for healthy eating include eating more beans and pulses, less red and processed meat, and fruit juices and smoothies should be limited to 150ml a day. women should take in a total of 2000kcal and men should take in a total of 2,500kcal (including food and drink), a moderate intake of alcohol (max. of 3-4units per day for men, 2-3 units for women), the consumption of fluoridated water where possible, a limited salt intake of 6g per day, eating unsaturated fats from olive oil and oily fish rather than saturated fats from butter and margarine, and consuming complex carbohydrates (e.g. bread and pasta) rather than simple carbohydrates (e.g. sugar). it is also recommended that men aged between 19 and 59 require 2,550kcal per day and that simlarily aged women require 1.920 kcal per day although this depends upon body size and degree of physical activity.
the impact of diet on health
can lead to eating disorders which could result in:
- heart irregularities
- heart attacks
- stunted growth
- osteoporosis
- reproduction
can also lead to obesity which could result in:
- diabetes
- heart disease
- and some forms of cancer
Diet and treating illness:
obesity - encouraged to stop smoking, increase physical activity and adopt a healthy diet.
Dietry interventions can improve glucose metabolism, self-management, losing weight, eating more healthily
who eats a healthy diet?
a healthy diet should be high in fruit and veg, high in complex carbohydrates and low in fat and sugary foods and links have been found between diet and the onset of illnesses and their effective management. However, research indicates that many people across the world do not eat according to these recommendations.
Children:
In the western world, there is an emphasis on reducing food intake and the avoidance of becoming overweight.
However, in the developing world undereating remains the problem which results in physical and cognitive problems and poor resistance to illness due to lower intakes of both energy and micronutrients.
WHO indicates that 174 million children under the age of 5 in the developing world are malnourished and show low weight for age and that 230 million are stunted in their growth. WHO also estimates that 54% of childhood mortality is caused by malnutrition, particularly related to a deficit of protein and energy consumption. such malnutrition is the highest South Asia which is estimated to be 5 times higher than in the western hemisphere, followed by Africa, then Latin America.
Adults:
In a large-scale study carried out between 1989-90 and 1991-2, the examination of eating behaviour of 16,000 male and female students aged between 18 and 21 from 21 European countries took place. The results suggest:
-basic healthy eating practices was low
- women reported more healthy eating practices than men
- cultural variability of eating fibre, red meat, fruit and salt
The Elderly:
many elderly people report diets that are deficient in vitamins, too low in energy and have poor nutrient content.
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Uk large scale survey completed:
- average daily intake of fruit and veg was higher in women, with differences showing lower intakes in the youngest and oldest groups
A cognitive model of eating behaviour
Distraction:
research indicates that watching TV, listening to a story, listening to music, playing a computer game, engaging in a word counting task, eating on the go, and social interaction increases food intake.
Memory:
memory also plays a big factor; distraction interrupts episodic memory formation and prevents the encoding of a meal. studies also show that reminding someone of recent meals makes the memories of these meals more apparent which in turn suppresses subsequent food intake. studies also show that lacking in memory of meals or having impaired memory such as amnesia can increase food intake.
studies have also explored the ways in which the food environment can trigger overeating by making it harder to monitor how much is being consumed. For example, research illustrates how overeating can be triggered by the ambience of the room, container size, plate size, variety of food and perceived time of day. Research also indicates that not only does the food environment encourage automatic decisions to eat without any conscious processing, but that people deny that the environment has an impact on their food intake.
Language:
studies have also shown a role for language on food intake and in the main this has explored the impact of food labels. For example, Provencher et al.. (2009) reported that participants consumed 35% more cookies when they were described as containing ‘healthy’ ingredients compared to ‘unhealthy’ ingredients.
Eating behaviour is influenced by cognition in the broader sense and research has highlighted a role for distraction, memory and language.
a developmental model of eating behaviour
this model emphasises the importance of learning and experience and focuses on the development of food preferences in childhood. An early pioneer of this research was Davis (1928) who generated a theory of ‘the wisdom of the body’ that emphasised the body’s innate food preferences and Davis concluded that children have an innate regulatory mechanism and are able to select a healthy diet. However, they can only do so if healthy food is available, children’s food preferences change over time and are modified by experience.
Birch (1989) interpreted Davis’s findings to emphasise the role of learning and described a developmental systems perspective.
Exposure:
neophobia involves the child showing fear and avoidance of novel foodstuffs. simple exposure can help children prefer healthy foods. For example, Birch and Marlin (1982) gave 2yr old children novel foods over a six week period. one food was shown 20 times, one 10 times, one 5 times while one remained novel. the results showed a direct relationship between exposure and food preferences and indicated that a minimum of about 8 to 10 exposures was necessary before preferences began to shift significantly. this relationship was also shown in other studies.
Social Learning:
social learning describes the impact of observing peoples behaviour on one’s own behaviour and it sometimes is referred to as ‘modelling’ or ‘observational learning’. this has been explored in terms of peers, parents and the media.
Associative Learning:
this refers to the impact of contingent factors on behaviour. for example, food can be paired with specific places, times of day, people or other foods and drinks which can change what and when people eat. at times these contingent factors can be considered reinforcers in line with operant conditioning. In particular, food has been paired with a reward, used as the reward and paired with psychological consequences. Research has also explored the relationship between control and food.
Food and Physiological Consequences:
studies have also explored the association between food cues and physiological responses to food intake. there is a wealth of literature illustrating the acquisition of food aversions following negative gastrointestinal consequences. For example, an aversion to shellfish can be triggered after one case of stomach upset following the consumption of mussels.
Research has also explored pairing food cues with the sense of satiety which follows their consumption. one early study of infants showed that by about 40 days of age infants adjusted their consumption of milk depending upon the calorific density of the drink they were given. Similarily, children can adjust their food intake according to the flavour of foods if certain flavours have been consistently paired with a given calorific density.
a weight concern model of eating behaviour
The Meaning of Food and Weight
Food is associated with many meanings such as a treat, a celebration, the forbidden fruit, a family get-together, being a good mother and being a good child. Furthermore, once eaten, food can change the body’s weight and shape, which is also associated with meanings such as attractiveness, control and success. as a result of these meanings, many women, in particular, show weight concern in the form of body dissatisfaction, which often results in dieting. This in turn changes eating behaviour.
Body Dissatisfaction
- distorted body size estimation: a perception that the body is larger than it really is. Research has shown that individuals with clinically defined eating disorders show greater perceptual distortion than non-clinical subjects. However, the research has also shown that the vast majority of women, with or without an eating disorder, think that they are fatter than they actually are.
- discrepancy between ideal vs. perceived reality:
the research has tended to use whole-body silhouette pictures of varying sizes whereby the subject is asked to state which one is closest to how they look now and which one best illustrates how they would like to look. it has consistently been shown that most girls and women would like to be thinner than they are and most males would like to be either the same or larger. - negative feelings about the body: this has been assessed using questionnaires and the body dissatisfaction subscale. body dissatisfaction can be conceptualised as either a discrepancy between individuals perception of their body size and their real body size, a discrepancy between their perception of their actual size and their ideal size, or simply as feelings of discontent with the body’s size and shape. those with eating disorders, dieters and women show a greater body dissatisfaction.
- causes of body dissatisfaction: concerning media, there are representations of thin women in the media and the concept of the ‘ideal body shape’ which cause body dissatisfaction. Social comparison theory suggests the reason for this is due to women internalising these ideals and making favourable upward comparisons to these images. Therefore, if this is prevented, body dissatisfaction may then not transpire. interventions have been designed for this purpose to manipulate and be critical of the pictures shown in media. Concerning family studies have highlighted that mothers who are dissatisfied with their bodies communicate this to their daughters, which results in the daughters own body dissatisfaction. Although, this cannot be predicted as not the case for every mother and daughter relationships. Burch (1974) also suggests that anorexia may be a result of a child’s struggle to develop her own self-identity within a mother-daughter dynamic that limits the daughters autonomy.
Dieting
Research indicates that feeling critical of how you look consistently relates to dieting which in turn influences eating behaviour. Restrained eating (undereating) aims to reduce food intake and several studies have found that at times this aim is successful. At other times these attempts may be ineffective but at least they do not do harm. Several studies have also suggested that higher levels of restrained eating are also related to increased food intake (overeating). the characteristic of overeating in restrained eaters has been called ‘disinhibition’, ‘counter regulation’ or ‘the what the hell effect’, which illustrates overeating in response to a high calorie preload.
Causes of overeating:
- giving in - characterised by a ‘motivational collapse’ and a cognitive shift towards a passive state
- rebellion
- mood modification - overeating allows the individual to mask negative moods with temporarily heightened mood caused by eating.
- denial - suppressing thoughts
- relapse - parallels exist such as the overeating of the dieter
- self-licensing - when people decide to ‘let themselves off’ and indulge in moments of lowered self-control.
The role of control
For example, control is challenged by a high risk situation, undermined by lowered mood or cognitive shifts and problems with control are exacerbated by internal attributions - a rebound effect against denial.
Dieting and Weight Loss
Keys et al. (1950) suggested that overeating is not the only possible consequence of restricting food intake. 36 healthy non-dieting men received a controlled daily food intake of approx. half their normal intake for 12 weeks, and consequently lost 25% of their original body weight. They developed a preoccupation with food, often resulting in hoarding and stealing it. they showed an inability to concentrate and mood changes, with depression and apathy being common. at the 12th week, participants were free and were reported to have a loss of control sometimes resulting in binge eating. these results suggest dieting can cause overeating.
the restraint theory therefore suggests:
- dieters aim to eat less as a means to lose weight and change their body shape. at times this aim is achieved, therefore dieters sometimes show undereating. sometimes they eat the same as non-dieters.
- dieters, however, also show episodes of overeating, particularly in response to triggers such as high calorie loads, axniety or smoking abstinence.
- this overeating can be understood in terms of shifts in cognitive set, mood modification, a response to denial, a lapse or changes in self-control. Increasing or promoting dieting can result in an increased preoccupation with food, increased depression and, paradoxically, increased eating behaviour.
thinking critically about eating behaviour
outlines the problems with the cognitive, developmental, and weight concern model. in addition to this, some general problems with eating research.
The characteristics and main diagnostic criteria of the three main eating disorders.
Anoxeria Nervosa
include a refusal to maintain a minimal body weight, a pathological fear of gaining weight and a distorted body image in which sufferers continue to insist they are overweight. Weight may be controlled by excessive physical activity and/or purging. Patients may also engage in abnormal behaviour such as hiding food and moving food around the plate to make it seem less.
Lifetime prevalence rates are around 0.4 per cent. onest typically between 14 and 19yrs old and prevalence is much higher in girls than boys (10:1). There are high rates of comorbidity between anorexia nervosa and other psychiatric disorders such as major depression and OCD.
DSM-5 stresses objective levels for judging the severity of the symptoms based on body mass index (BMI), a ‘normal’ BMI is 18.5, so anything lower than this could trigger the possibility of a diagnosis of anoxeria nervosa if other criteria are met.
DSM-5 distinguishes two types of anoxeria nervosa:
- restricted type AN in which starvation is not associated with concurrent purging (e.g. self-inducing vomiting or use of laxatives)
-binge-eating/purging type AN where the sufferer regularly engages in purging activities to help control weight gain.
Physical symptoms and side effects; extreme thinness, rapid weight loss which may be hidden by baggy clothes, growth of fine hair, dry skin, tiredness, hypothermia, dizziness, damage to heart (leading to irregular heart beats, slow heart beat), kidney and gastrointestinal symptoms, and damage to the musculoskeletal system.
Bulimia Nervosa
also associated with distorted perceptions of body shape an attempts to control weight (fear of weight gain). involves recurrent episodes of binge eating followed by periods of purging or fasting. Purging is most likely to be inducing vomiting but laxatives and diuretics may also be used. Patients are unlikely to be severely underweight.
bulimia is characterised by high levels of self-disgust, low self-esteem, feelings of inadequacy, and high levels of depression. Experience a lack of a sense of control over overeating binge which is likely to lead to shame and attempts to keep the behaviour secret.
usually seen in ages 16-20yr olds. 90% of those suffering bulimia are women, and 75% of those women were in remission 20yrs after being diagnosed. the lifetime prevalence rate for bulimia among women is between 1 and 3 per cent.
bulimia is often comorbid with major depression, borderline personality disorders, and substance abuse.
Binge-Eating Disorder (BED)
recurrent episodes of binge eating without the purging or fasting that is associated with bulimia nervosa.
Is associated with high levels of major depression, impaired work and social functioning, shame, low-self esteem, and dissatisfaction with body shape.
can be triggered by interpersonal stress, dieting, negative body image, and boredom.
the lifetime prevalence of binge-eating disorder in the general population is around 3% and has a peak onset age 16-20yrs.
Usually have a long history of dieting. Dieting behaviour is restrained eating.
Dieting involves putting cognitive controls around eating behaviour rather than relying on somatic info about hunger and satiety to guide eating behaviours. When cognitive control is broken dieters may binge.
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other eating disorders (OSFED) in the DSM 5 include:
Pica - the persistent eating of non-nutritive, non-food substances on a persistent basis. these might include paper, soap, cloth, hair, ash, clay, starch, ice, wool, soil, talcum powder, paint, gum, pebbles, coal and so on.
Rumination Disorder - repeated regurgitation of food
Avoidant/restrictive food intake Disorder - avoidant or restrictions of food intake resulting in failure to meet requirements for nutrition or insufficient energy intake. this eating disturbance may manifest as a lack of interest in food, avoidance based on the sensory characteristics of food, or concerns about the aversive consequences of eating.
The cultural and demographic distribution of eating disorders, and evaluate why this information is important in understanding eating disorders.
some of the origins of eating disorders lie in the values and ideals defined by cultures.
the presence of weight concerns or body dissatisfaction does not appear to be a universal motivating factor for food refusal in anorexia.
eating disordered are less prevalent in ethnic minorities in the USA, but their incidence is increasing as these minorities are exposed to the dominant thin ideal espoused by American culture.
there is this idealisation of female weight, size and body shape by the western media. this results in female thinness becoming an important social value that is associated with social acceptance and social rewards. changes in socio factors may influence the frequency and prevalence of eating disorders.
there is little evidence for examples of bulimia in individuals who have not had exposure to Western ideals. Exposure to Western body-image ideals is not a necessary condition for anoxeria; examples of the self-starvation typical of anorexia nervosa can be found in cultures where Western ideals are nonexistent.
The Aetology of Eating Disorders
A number of psychological and cognitive processes may be important common factors in the acquisition and maintenance of all eating disorders.
These psychological factors include the defining of self-worth in terms of control over eating, low self-esteem, clinical perfectionism, interpersonal problems and intolerance of negative moods such as depression. these are all dispositional factors to exert a possible causal influence on the development of an eating disorder.
Many of these psychological factors may be influenced by exposure to media ideals of body shape, peer attitudes to controlled eating, and familial factors - such as intra-family conflict or dysfunctional mother-daughter interactions. a dysfunctional family structure may reinforce a child’s disordered eating. mothers have a specific influence in developing eating disorders by producing eating problems in their offspring and criticising their child’s appearance.
media-portraying extreme body shape ideals has been shown to increase body dissatisfaction in young adolescent females, and to increase their tendency to either diet or purge after overeating. Body dissatisfaction and dieting are two important vulnerability factors for eating disorders.
The tripartite model argues that the effect of influences from media, parents, and peers is mediated by internalisation of social ideals and social comparison, leading to body dissatisfaction, disordered eating and negative affect.
Traumatic life events also appear to be risk factors for eating disorders, and childhood sexual abuse has been one specific form in which trauma has been researched in relation to eating disorders.
there is an inheritent component to eating disorders that may account for up to 50% of the variance in factors causing these disorders, although this is modest and twin studies have tended to emphasise that unique environmental experiences are equally important as genes in the etiology of eating disorders.
Finally, eating disorder symptoms have been found to be associated with a number of brain mechanisms and reward pathways, including opioid, seratonin and dopamine pathways:
- Maintaining a low body weight may be reinforced by the endogenous opioids that the body releases during starvation to reduce pain sensation.
- the neurotransmitters serotonin and dopamine may be involved in eating disorders by affecting satiety and pleasurable consequences of eating.
But it is still unclear whether these neurobiological processes are causes of eating disorder symptoms or are themselves consequences of those symptoms.
The Treatment of Eating Disorders
eating disorders are often hard to treat because of the denial by sufferers that they have a disorder, the medical implications of the symptoms, and comorbidity with other psychological disorders.
Anorexia Nervosa:
- drugs should not be primary treatment
- CBT, interpersonal psychotherapy, focal dynamic therapy, or family interventions
Bulimia Nervosa:
- antidepressants or/and self-help programme
- SSRI’s
- dietry counselling should not be primary treatment
- self-help programme
- CBT or interpersonal psychotherapy
Bing-eating Disorder:
- SSRI’s
- CBT
there is evidence that self-help groups, alternative delivery systems and school-based programmes may be helpful in lowering the prevalence of eating disorders.
- Alternative delivery systems: allow access to services for sufferers who might not receive other forms of treatment.
the major depression that is often comorbid with eating disorders can be treated pharmacologically with antidepressants such as fluoxetine.
one of the most common treatments for eating disorders is family therapy, in which the families role in developing and maintaining an eating disordered individual is explored.
- family systems theory: the sufferer may be embedded in a dysfunctional family structure that actively promotes psychopathology.
- Maudsley approach: family based, staged therapy for eating disorders. focuses on how the family can help and solve the problems they are facing, challenge the eating disorder symptoms, and develops family relations and activities once recovery from eating disorder has occurred.
CBT is often an effective treatment for bulimia and attempts to deal with the symptoms of bulimia, the dysfunctional cognitions associated with disorders eating, and provide prevention against relapse.
Many people will recover without specialist intervention. Some will need some specialist support. Some patients will need intensive inpatient treatment and recovery may be relative.
Evolutionary perspectives on eating
- Eating is the way that animals have evolved to absorb the nutrition needed to fuel life.
- Earliest humans were hunter gatherers- food sources could not be relied on.
- Human physiology evolved to lay down body fat when food was available which provided energy when food was scarce.
- Today we have a plentiful and readily available supply of food but our bodies are still programmed to store fat.
- The evolution of taste probably evolved to help us to identify safe and unsafe foods and we may well have developed a particular liking for fatty, salty and sugary foods which are important to health ( in moderation).
- It is possible that the enjoyment we get from the taste of food also motivated the hard work of gathering food.
Whats prompts you to start eating?
Key: is it always hunger that prompts you to start eating? (e.g. routine)
Hunger can be explained through the Set point theory:
We eat because our body tells us it needs refuelling.
•The theory assumes that:
1.after a meal our energy stores are close to their set point
2.following the meal energy resources are used in activities of daily living and energy stores decrease.
3.When energy stores are sufficiently below the set-point we experience hunger and are motivated to find a meal.
•Once we have eaten enough to return to our set point we experience satiety, the motivation to stop eating.
•Can you think of any problems with this theory?:
-does this account for my eating (when I start and stop)
An alternative explanation is the positive incentive perspective:
•Assumes that we are not normally driven by energy deficits to eat but by the pleasure of eating.
•Hunger is driven by all the factors that contribute to the pleasure we gain from eating including:
Food factors - the taste of food available; memory of previous pleasure from eating the food
Biological factors - blood glucose levels; food present in the digestive system.
Psychosocial - how long since last meal; are other people present and what are they doing; location.
(most likely) an interaction between these different factors.
What is hunger?
- Hunger is an unpleasant and very real physical experience.
- But it is not the result of the body’s energy stores running low rather, it is the body preparing it self for another meal.
- Eating stresses the body and what you experience is the body making itself ready for the meal to minimise physiological stress.
- You typically experience hunger before a meal, not because your body is running low on energy, but because you tend to eat to a fairly regular schedule which you body is aware of and thus starts preparing itself.
What triggers you to stop eating?
•We may stop eating when we feel full but feeling full does not indicate that we have eaten the appropriate amount to meet our nutritional needs. If we feel full then we are literally full and may well have eaten too much.
•In fact a range of non-physiological factors seem to guide how much we eat including:
- Portion size
- Social situation
- How much we are enjoying the food.
