WELCOME

A SEMINAR ON

Effects of Eating Disorders on Health

Presenter
Jaspreet Kaur
M.Sc.(Foods And Nutrition)
Reg.No. 04- HOMMA- 01229

Major Guide Minor Guide

Dr. V. H. Kanbi Dr. (Mrs.) S. Ahlawat
Associate Professor Professor and Head
Department of Food Science and Department of Ext. Edu. and
Nutrition Communication
SDAU, S.K.Nagar. SDAU, S.K.Nagar.
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 1. Introduction
2. NEED OF STUDY
3. CLASSIFICATION
.
4. AETIOLOGY

5. MOST PREVALENT EATING DISORDERS

Content 6. CASE STUDIES

7. ASSESSMENT

8. TREATMENT
9. CONCLUSION
.
10. Future Thrust

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 INTRODUCTION
 An eating disorder is when a person experiences severe disturbances
in eating behaviour, such as extreme reduction of food intake or
overeating, or feelings of intense distress or concern about body
weight or shape.
 Society, today promote the ideals of a slim body and models are often
taken as role models of success. conversely they may be
underweight to look perfect on televisions and magazines. In order to
look good they practice abnormal pattern of eating. Socioeconomic-
cultural changes and westernization could result of eating disorders in
India (Shroff and Thompson 2004).

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DEFINITION

Eating disorders are psychological illnesses

defined by abnormal eating habits that may
involve either insufficient or excessive food
intake to the detriment of an individual's physical
and mental health.

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 WHY WE SHOULD KNOW ABOUT EATING DISORDERS
 Eating disorders involves self-starvation and over eating. The body is
denied the essential nutrients which needs to function normally, so it is
forced to slow down all of its processes to consume energy and other
nutrient. This slowing down can have serious medical consequences
(Gupta, 2007).
 The prevalence of eating disorders in India is lower than that of
western countries but appears to be increasing significantly in the
country.
 Thus a study on eating disorders is felt needed realizing the increased
current prevalence, incidence of eating disorder, its complications and
increasing mortality in different age groups mainly in adolescent girls.
The study also fulfils the need to improve knowledge and attitude
regarding eating disorders to promote a disease free or healthy life.
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CLASSIFICATION OF EATING DISORDERS
Currently not
Currently recognized Other Prevalent Eating
recognized in medical Disorders
in medical manual
manual

Anorexia Nervosa (AN)

Bulimia Nervosa (BN) Compulsive Overeating,
Binge eating disorder (COE)
(BED) Diabulimia  Food Craving
Other Specified Orthorexia nervosa Pica
Eating Disorder Drunkorexia
(OSED) Pregorexia

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RARELY PREVALENT EATING DISORDERS

Pregorexia Orthorexia nervosa

Drunkorexia

Dibulimia 8
AETIOLOGY
Genetics Socio-cultural

PREDISPOSING FACTORS
Biological
Environment

Nutritional Deficiency
Stress
PRECIPITATING FACTORS Life transition Vulnerability
to ED Media
Family problems/
tension Low Self-esteem

PERPETUATING FACTORS Ongoing low self -esteem Ongoing stress

Ongoing family tension

EATING DISORDER

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Most prevalent Eating Disorder

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ANOREXIA NERVOSA

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 ANOREXIA NERVOSA
 The term anorexia nervosa was first formulated in 1873
by Sir William Gul. The term is Greek origin which
means : A lack of desire to eat.
 It is characterised by self-induced weight loss of at least
15% below the expected weight.

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SIGNS & SYMPTOMS OF ANOREXIA NERVOSA
A PERSON WITH ANOREXIA STARVE HER OR HIM SELF SO SHE
OR HE CAN BE SKINNY.

 Dramatic weight loss  Amenorrhea

 Constipation or Diarrhoea  Osteoporosis
 Electrolyte imbalance  Hyponatremia
 Cavities  Hypokalemia
 Cardiac arrest  Brain atrophy

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 Osteopenia

Leukopenia

Chilblains, also known as Perniosis.

Optic neuropathy

Lanugo
Heart rate problems Slow
heart rate (bradicardia)

Tooth loss

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 CONTI....
 Preoccupation with food, recipes or cooking, may cook elaborate
dinners for others but not eat themselves.
 Cuts food into tiny pieces, refuses to eat around others.
 Hides or discards food.
 Perceives self to be overweight despite being told by others they are
too thin.
 Purging: uses laxatives, diet pills, ipecac syrup, or water pills; may
engage in self-induced vomiting.
 May run to the bathroom after eating in order to vomit and quickly
get rid of the calories.
 Becomes intolerant to cold.
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DIAGNOSTIC CRITERIA-ANOREXIA NERVOSA

 Refusal or inability to maintain body weight over a

minimum normal weight.
 Intense fear of gaining weight despite being underweight.
 Disturbance in perception of body shape.
 Absence of three consecutive menstrual cycles.

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 Isabelle Caro
The French model died in 2010 due to the complications of anorexia at the age of
28.

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Bulimia Nervosa

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 BULIMIA NERVOSA

 Bulimia Nervosa literally means ‘hunger of an ox for nervous

reasons’ .
 Bulimia is characterised by cycles of bingeing (eating a large
amount of food) and then experiencing guilt, fear, or stomach
pains, causing sufferers to purge. Those who suffer from the non-
purging type compensate for binges by exercising.
 A person with bulimia eats a lot of food in a short amount of time.
This is called binging. Binging can cause feelings of shame and
guilt. So, the person tries to "undo" the binge by getting rid of the
food by throwing it up.

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 SIGNS AND SYMPTOMS OF BULIMIA NERVOSA
 Chronic gastric reflux after eating
 Dehydration and hypokalemia caused by frequent vomiting
 Oral trauma, in which repetitive insertion of fingers or other
objects causes lacerations to the lining of the mouth or throat
 Gastroparesis or delayed emptying
 Constipation
 Infertility

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 CONTI....
 Inflammation of the esophagus
 Peptic ulcers
 Electrolyte imbalance, which can lead to cardiac arrest and even
death.
 Russell's sign :scarring of the knuckles from placing fingers
down the throat to induce vomiting.

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 DIAGNOSTIC CRITERIA-BULIMIA
 Minimum of 2 binge-eating episodes weekly for 3
months/recurrent binge eating.
 A feeling of lack of control over binge-eating behavior.
 Regular use of self-induced vomiting, laxatives, diuretics,
or vigorous exercise to prevent weight gain.
 Disturbance of body shape perception.

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BULIMIA IN MOVIES

Kate's Secret (1986)

Girl, Interrupted (1999)
Life is Sweet (1990)

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FAMOUS ATHLETES AND CELEBRITIES
WITH BULIMIA
 Nadia Comaneci (9x gold medalist gymnast)

 Victoria Beckham (Posh Spice)

 Kelly Clarkson (American Idol Winner)

 Princess Diana (Princess of Wales)

 Elton John (Musician)

BINGE EATING DISORDER(BED)

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 BINGE EATING DISORDER(BED)

Binge eating disorder is characterized by consuming large

quantities of food in a very short period of time until the
individual is uncomfortably full.
 Binge eating disorder is much like bulimia except the
individuals do not use any form of purging (i.e. vomiting,
laxatives, fasting, etc.) following a binge.

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 CONTI....
 Individuals usually feel out of control during a binge episode,
followed by feelings of guilt and shame.
 Many individuals who suffer with binge eating disorder use food as
a way to cope with or block out feelings and emotions they do not
want to feel.
 Individuals can also use food as a way to numb themselves, to cope
with daily life stressors, to provide comfort to themselves.
 Like all eating disorders, binge eating is a serious problem but can
be overcome through proper treatment.

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SIGNS & SYMPTOMS
Significant weight gain
Digestive problems
Breathlessness
Periodically does not exercise control over consumption of
food.
Eats an unusually large amount of food at one time, far
more than an average person would eat in the same amount
of time.
Eats much more quickly during binge episodes than during
normal eating episodes.
Eats until physically uncomfortable and nauseated due to
the amount of food just consumed. 28
 CONTI....
• Eats large amounts of food even when not really hungry.

• Usually eats alone during binge eating episodes, in order to

avoid discovery of the disorder.

• Often eats alone during periods of normal eating, owing to

feelings of embarrassment about food.

• Feels disgusted, depressed, or guilty after binge eating.

• Rapid weight gain, and/or sudden onset of obesity.

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Food Craving

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 FOOD CRAVING
 Food Craving is an intense desire to consume a specific
food and is different from normal hunger. It may or may
not be related to specific hunger.

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 CRAVING SPECIFIC IN MALE & FEMALE
 Male typically crave protein, fat and sodium : Roast beef,
burgers, fries, steak, pizza and chips etc.
 Female are more likely to crave sweet, high-carbohydrate and
high-fat foods : Chocolate, cookies, ice cream, pasta, and bread
etc.

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MOST CRAVED FOODS

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 CRAVING RELATED DEFICIENCIES
Craving Related deficiency Eat this
Chocolate & Magnesium Nuts ,whole grain, Legumes, fruits
Cold drinks
Sweet Carbon Fresh fruits
Phosphorus Fish, egg, Dairy Products, Legumes, whole
grain
Sulphur Cruciferous vegetables
Coffee & Tea NaCl Fruits and Salads
Iron Meat, Lotus stem, leafy vegetables

Burned food Carbon Fresh fruit

Chewing ice Iron Meat, Lotus stem, leafy vegetables

Oily snacks, calcium Milk products, Legumes, Seasum, Ragi

fatty food 34
35
Pica

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 PICA
 Comes from the Latin word magpie - a bird which eat anything.

 An eating disorder in which non-nutritional objects are eaten.

 Characterized by a compulsive craving for eating, chewing or

licking non-food items or foods containing no nutrition.

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 MOST PREVALENT IN
 Children ages 1-6
 Pregnant women
 Certain cultures
 Mentally deficient

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 POSSIBLE CAUSES
 Nutrient deficiencies- especially iron and zinc
 Stress
 OCD- Obsessive Compulsive Disorder
 Developmental disorders
 Mental disorders

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SUBTYPES
Subtypes are characterized by the substance eaten
 Amylophagia (consumption of starch)

 Coprophagy (consumption of feces)

 Geophagy (consumption of soil, clay, or chalk)
 Hyalophagia (consumption of glass)
 Lithophagia (consumption of pebbles or rocks)
 Mucophagia (consumption of mucus)
 Pagophagia (consumption of ice)
 Trichophagia (consumption of hair or wool)
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 CONTI...
 Urophagia (consumption of urine)

 Xylophagia (consumption of wood or paper)

 Consumption of paint.

 Self-cannibalism (rare condition where body parts may be

consumed)
 Odowa (soft stones eaten by pregnant women in Kenya)

Consumption of dust or sand has been reported among iron-

deficient patients.

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EFFECTS OF PICA

In children: In adults :
 Malnutrition  Infertility
 Severe stomach ache  Increase blood pressure
 Muscle weakness  Nerve disorders
 Brain damage  Muscle/joint pain

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 CASE STUDIES RELATED TO PICA
Sample size & Prevalence References
characteristic of
population

500 (school age children) 6% Bhandari and Agarwala

(1996)

246(learning disabled 10.1% Tewari et al., (1995)

adults)

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COMPLICATIONS of Eating Disorders

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 Changes in the production of specific hormone-releasing factors

Reduced production of TSH Increased production of ACTH Reduced production of FSH and LH

THYROID GLAND

Reduced production of thyroxine,

resulting in slowed heart rate, low blood
pressure, poor thermal response
and cold extremities
ADRENAL CORTEX

Increased production of cortisol as a

normal stress response, resulting in release
of protein from muscle and muscle wasting

GONADS

Reduced production of oestrogen

and progesterone in females,
resulting in loss of ovulation
and menstruation
Reduced production of testosterone
in males resulting in impotence
Trotter (1997) Endocrine effects of eating disorder 45
 CONTI….
 Skeletal
  oestrogen and  cortisol levels are largely implicated
 If menstruation interrupted for a prolonged period of time, bone loss results.
  risk of fractures and osteoporosis.

 Refeeding syndrome
 Hypokalemia
 Hyponatremia
 Hypophosphatemia
 Hypomagnesemia
 Hyperglycaemia, nausea and vomiting, diarrhoea, possible cardiopulmonary
failure….. death

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 GIT
 Salivary gland hypertrophy
 Occasionally pancreatitis
 Oesophagitis
 Gastric dilatation – poses risk of gastric rupture
 Loss of bowel control
 Constipation
 Steatorrhoea

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Pulmonary
 Aspiration pneumonia
 Recurrent chest infections

Dental
 Erosion of dental enamel
 Projection of fillings above the surface of the teeth

 Chronic Diseases
 Obesity

 CVD (include: dyslipidaemia and HT)

 Diabetes
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 CASE
CASE STUDIES

STUDIES
 Result Source

Affect up to 24 million Americans and 70 Renfrew Centre Foundation for

million individuals worldwide. Eating Disorders, (2002)

20% of people suffering from anorexia will Renfrew Centre Foundation for
prematurely die from complications related Eating Disorders, (2002)
to their eating disorder, including suicide
and heart problems.

High prevalence of eating disorders among ADA, (2001)

athletes, models, dancers and performers.

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Effect Subject Resource

38.6% engaged in NSSI 70 female patients with EDs Claes et al ., (2004)

(non-suicidal self-injury).

A number of micronutrient 100 Anorexic Patient Hadigan et al ., (2000)

deficiencies have been
identified.
Suicide attempts 1000 people Bulik et al ., (2008)
approaching approximately (Anorexia Nervosa )
17%.
Disturbed eating attitudes 120 adolescent girls from Upadhyah et al., (2014)
and behaviours were Crosthwaite Girl’s College,
present in 26.6% of Allahabad, UP.
adolescents girls and they
had earlier menarche and 51
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lower BMI.
Result Place Subject Resouce

32 were diagnosed as Bangalore, 74 patient with Prabha et al., (2011)

anorexia nervosa (AN), 12 as India eating disorders
bulimia nervosa (BN) and 30
as eating disorders not
otherwise specified
(EDNOS).

Particularly among urban girls Sikkim, 577 adolescent Mishara and

from families with a higher India girls about Mukhopadhyay, (2010)
economic status are about two eating and
times more likely to report weight concerns
dissatisfaction with their body
weight and these girls are five
times more likely to report the
need for dieting. 52

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 SOME STUDIES RELATED TO CAUSES OF EATING DISORDERS

Result Reference
Prevalence of anorexia nervosa has shown an increase in Chadda et al., (1987)
India. Socio-cultural variables like familial interaction
patterns, parental attitude towards weight control,
desirability for slimness, and thinness have a deciding
role. Stress of any kind can act as a precipitating factor.
Many religions, including Judaism, Christianity, Collins et al ., (1993)
Hinduism, Buddhism and Islam, include some dietary
exclusion or periods of fasting as part of religious
observance.
Abnormal serotonin metabolism may play a greater role Murphy et al., (2001)
in individuals with Bulimia nervosa.
A portion of the vulnerability to develop eating disorders Patel et al., (2002)
can be inherited. 53
CASE STUDIES RELATED TO WESTERNISATION INFLUENCED
Westernisation Place No. of subject Source
influenced case (Pt. with ED)

54 Patients with AN South 100 Norrois (1979)

Africa

5 case United Arab 80 Abou-Saleh et al., (1998)

5 cases India 60 Gandhi et al., (1991)

3 cases India 33 Chandra et al., (1995)

7 cases reported – 1 case Malaysia 71 Ong et al., (1982)

with no formal
education from lowest
social class 54 54
 CASE STUDIES RELATED TO PREVALENCE OF EATING
DISORDER BY GENDER

Country Year Sample size and Incidence Resource

type

Australia 2008 1,943 adolescents 1.0% male 6.4% Patton et al., (2008)
(ages 15–17) female

Brazil 2004 1,807 students 0.8% male 1.3% Vilela et al., (2004)
(ages 7–19) female

USA 1992 799 college 0.4% male 5.1% Heatherton (1995)

students female

Norway 1995 19,067 0.7% male 7.3% Gotestam et al.,

psychiatric female (1995)
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patients
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 57
National Australian Eating Disorders Collaboration ,(2012)
ASSESSMENT & TREATMENT

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 ASSESSMENT
 Full physical examination & appropriate medical investigations is
required for proper treatment.
 Assess patients height & weight
 If any of the following features are present in patient then treatment is
indicated:
 Wt < 70% of that expected Or BMI < 15
 Acute rapid weight loss
 Marked dehydration
 Electrolyte imbalance
 Convulsions
 Uncontrolled vomiting
 GIT bleeding
 Acute pancreatitis
 Self - injurious behaviour
 Severe depression, suicide risk
 Intolerable family situation
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TREATMENT
Treatment varies according to type and severity of eating disorder and usually
more than one treatment option is utilized.
NUTRITIONAL INTERVENTION

 Goals of Nutrition Intervention

 To normalise the relationship with food.
 To gain an understanding of nutrient needs for growth, development, tissue
maintenance, wt control, appropriate body weight.
 To provide an increased/ adequate energy intake (macronutrient) to promote
weight gain (initially 800-1200kcal/d and gradually increased to achieve goal
weight gain of 0.5 to 1 kg/ wk) OR weight stabilisation.
 Introduction of fear foods

 Adequate vit & min intake (Ca, Mg, K, Zn, Fe, B-vits)
 Promote energy expenditure in BED. 60
 FORMULATION OF NUTRITIONAL PLAN
 Nutrient Requirements:
 Energy
 Must observe energy intake with regard to weight gain
 Must be aware that refeeding in AN increases
 Be aware of individual response may be a period of abnormal
energy requirements for weight gain and maintenance
 Restrictors have greater energy requirements than BN’s and BED.
 Protein
 1.2 - 1.5g/ kg IBW
 Vitamins
 B-complex
 Vit D
 Vit E
 Vit A and B-carotene 61
 CONTI.....
 Minerals
 Calcium
 Zinc
 Iron

Zinc: supplementation has been shown in various studies to be

beneficial in the treatment of AN even in patients not
suffering from zinc deficiency, by helping to increase weight
gain.
Ideally use low-dose multivit-mineral .

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 COGNITIVE BEHAVIOURAL THERAPY
 Cognitive behavioural therapy (CBT) : which
postulates that an individual's feelings and behaviours
are caused by their own thoughts instead of external
stimuli such as other people, situations or events, the
idea is to change how a person thinks and reacts to a
situation even if the situation itself does not change.
 Teach the patient to recognize the cognitions around
eating and to confront the maladaptive cognitions.
Introduce “forbidden foods” and regular diet and help
the him/her confront irrational cognitions about these.
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CONCLUSION
 Eating disorders are unhealthy diet practices that
can easily get in of hand and are difficult habits to
break.
 Eating disorders are serious clinical problems that
require professional treatment by doctors,
therapists, and nutritionists.

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 FUTURE THRUST
 Future studies are needed to explore the risk of autoimmune diseases and
immunological mechanisms in individuals with eating disorders and their
family members.
 It is imperative that practices which increases the risk of eating disorders
are minimized as they appear to inadvertently increase the risk of
depression in athletes and other performers.
 Further research needs to formulate comprehensive and holistic theoretical
framework .
 Future research should examine gene–environment interactions for dieting.
 Efforts are needed to raise awareness of the clinical implications of
different types of eating disorders for all age groups so that their
appropriate screening and treatments can seek out.

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