Lecture 15: Diets and Eating Disorders

Will Brown02/28/2012

What is a Diet?

• What do you think people mean when they say, “I am going on a diet”?

• A diet comprises everything that you eat• A “Diet” usually refers to an attempt to

change eat patterns for the purposes of losing weight

• Why is the underlying reason to lose weight?• What are the motivations behind a “Diet”?

Diet Reality

• Roughly 45 million Americans will go on diets over the course of the year

• 85% will fail• In 2009 a study was published in Annuls of

Internal Medicine said that most commercial diet plans do not have data to back up their claims of helping people lose weight– The one exception was Weight Watchers

Why don’t we succeed?

Fad Diet• What is a “Fad Diet”?

– Diet that becomes popular very quickly and may fall out of favor very quickly– Important to note that “Fad” does not mean failure

• Recommendations that promise a quick fix • Dire warnings of dangers from a single product or regimen • Claims that sound too good to be true • Simplistic conclusions drawn from a complex study • Recommendations based on a single study • Dramatic statements that are refuted by reputable scientific organizations • Lists of "good" and "bad" foods • Recommendations made to help sell a product • Recommendations based on studies published without review by other researchers • Recommendations from studies that ignore differences among individuals or groups • Eliminated one or more of the five food groups

Fad Diets: Categories

• Extreme diets• Low Carb diets• Low fat/high carb• Food combining• Liquid diets• Diet pills• http://www.faddiet.com/

Extreme Diets

• HCG Diet– Eat 500 calories while taking a growth hormone– No longer approved by the FDA

• Cabbage soup diet– Eat cabbage soup every time you feel hungry– Claims of losing 10 pounds a week; a near

physiological impossibility– Extreme flatulence is a side effect

Low Carb

• Grapefruit diet; a.k.a. the Hollywood diet– Eat half a grapefruit with every meal– Grapefruit can interfere with medications

• Atkins diet• Carb addict diet• Zone diet

Why don’t these work?

• They are unrealistic– It is not possible to eat in those ways or long term

• They are to restrictive– They deny to much from what a body needs

• They do not address underlying causes – They address weight and weight only– Most weight issues are lifestyle related not just

food

What happens when diets lead to disorders?

Eating Disorders: Causes• Root cause for each person is different• Not just physical but psychological as well• What kind of images are we subjected to?

– To “skinny”– To “fat”

• What kind of messages are sent?– Fad Diets– Fashion and Magazines

• What does food represent?– Currency– Power– Bribe– Comfort

Eating Disorders

• Severe changes in eating patterns linked to physiological changes.

• The main four – Anorexia nervosa– Bulimia nervosa– Binge eating– Female athlete triad

• Affect about 5 million Americans – Women more than men; 5:1 ratio

Eating Disorders: Anorexia Nervosa and Bulimia Nervosa

• Affects ~5% of women• Nervosa refers to the belief that one is disgusted with

themselves• Anorexia – “Loss of appetite” but is a denial of appetite– Affects 1:200 adolescent girls typically blame themselves for

age related weight gain– Men account for 10% of cases; mainly athletes that require

weight loss• Bulimia – binge eating followed by attempts to purge

by vomiting and laxatives

Anorexia

• First described in 1689• Patients suffer from extreme fear of being fat or obese• Although it is an “eating disorder” it is more psychological

in nature• Only 25% recover, after ~6 years, but most go on to suffer

other eating disorders as well• Numerous reasons why anorexia begins

– Affects primarily Caucasian females from middle to upper socioeconomic backgrounds• Conflict within family structure is common• Also, power and control issues are common

Anorexia

• Early patterns– Extreme dieting; diet because single focus– Odd eating behavior• Cutting peas in half• Making but not eating a large meal• Compulsive exercise

• As disease progresses, safe and unsafe food lists develop

• Internally, these behaviors are seen as rational

Anorexia

• Physical effects– Body weight less then 85% of expected weight

• BMI <17.5

– Low body temp intolerance to cold– Slowed metabolic rate– Decreased heart rate– Anemia– Rough, cold, dry, skin– Low WBC– Loss of hair– Etc. Etc. Etc.

• All are attempts of the body to hold onto what weight it can

Anorexia: Treatment

• For success, requires a team of experts and most importantly a strong support structure

• Nutrition Therapy– Goal is to increase oral food intake– Switches to stopping weight loss then gaining

weight• Psychological treatment – Once dietary needs

are met treatment switches to underlying causes

Bulimia Nervosa

• Categorized by binge eating and purging by vomiting or laxatives

• Most common in college ages, some high school students are at risk

• Usually successful females – different from anorexia in that bulimics are typically above average weight

• Rather than turning away from food, food is a coping mechanism in critical situations

• Bulimics acknowledge they have a problem– Many report childhood abuse– Many are impulsive in other areas of life

Bulimia: Typical Behavior• Harder to diagnose – patients must binge and purge twice weekly for 3

months• Eating large amounts of food in a short time followed by periods of

strict food consumption– Most binge eating occurs at night– No set time frame for cycles– Binges typically last ½ - 2 hours

• Common foods include those high in carbohydrates and convenience foods– Problem is that 33-75% of calories can still be absorbed leading to more

weight gain– If laxatives are used because of the fact that they act in the LI after absorption

occurs• Excessive exercise

Bulimia

• Health issues– Demineralization of teeth– Low blood potassium resulting in heart problems– Swollen salivary glands– Stomach and esophageal tears and ulcers– Constipation from laxative use– Certain vomit inducing agents are toxic; ipecac

• Debilitating disease that can lead to death due to suicide, low blood potassium, or infection

Bulimia: Treatment

• Similar to anorexia requires a team of professionals• Most do not start treatment underweight so psychological

treatment by begin before food therapy• Food therapy starts with reducing amount of food consumed in

a binge– Leads to less damage to esophagus

• Psychotherapy aims to reduce all-or-nothing thinking– Medication can also be used to combat the depression associated

with bulimia• Nutritional counseling to re-establish proper food habits• Overall goal is to not stop binge/purge cycles but to reset good

eating habits

Other eating disorders

• Binge eating – binge cycles not accompanied by purges– Generally not diagnosed– Severe dieting increases likelihood of developing binge

eating disorder– 40% are male– Perceive hunger when not hungry– Depression is common

• Night eating syndrome• Female athelete triad

An Ounce of Prevention…

• The best treatment is prevention• Change outlooks and perception as to what is

“acceptable”• Learn principles of good nutrition– Begin this earlier in life

• Supportive environments• Etc. Etc. Etc…