NUT202: Fundamentals of Human Nutrition

Chapter 6: Eating Disorders

 Learning Outcomes
1.Review the different types of eating disorders

2.Discuss how to identify

3.Describe interventions to manage eating

disorders
 Part 1:
Definition & Risk Factors
 Eating Disorder

https://youtu.be/nJMtReAg1DI
 Eating Disorder ?

• Pattern of extreme emotions, attitudes, and behaviors

surrounding weight and food issues
• Associated with food restriction, binge eating, purging, and
fluctuations in weight
• Associated with emotional and cognitive changes that affects the
way a person perceives and experiences his or her body
Eating Disorders
• Serious but treatable mental illnesses.The earlier an ED is
diagnosed and effective treatment begun, the greater the chances of
recovery

• Can affect people of every age, sex, gender, race, ethnicity,

and socioeconomic group. More common during adolescence and
early adulthood

• Often co-occur with other disorders (depression, anxiety,

substance abuse, etc.)
 Common Eating Disorders
• Anorexia Nervosa
Starvation, weight loss, disturbed body image, amenorrhea

• Bulimia Nervosa
Binge/purge episodes, disturbed body image

• Binge Eating Disorder

Frequent binge episodes, disturbed body image or self esteem
DSM V: Diagnostic and Statistical Manual of Mental Disorders
(Galmiche;Déchelotte et al., 2019)
Eating Disorders Prevalence- US
Eating Disorder Women Men
Anorexia Nervosa 1.4% 0.12%
Binge Eating 0.46 0.08
Binge Eating Disorder 1.25 0.42%

Eating disorder prevalence ranges from 0.3% to 2.3% in

adolescent females and 0.3% to 1.3% in adolescent males.

(Feltner;Peat et al., 2022; Force, 2022)

Eating Disorders Prevalence- Lebanon
A study aiming to assess the profile of individuals with ED was conducted in
2013 and published in 2017
Results revealed:
• Bulimia Nervosa was the common prevalent ED (~46%), followed by AN
(39%) and Binge Eating (14%)
• Profile of typical ED individual attending to ED clinics: single female young
adult of middle to high socio-economic status with severe ED symptoms
• Common symptoms: amenorrhea, multiple purging behaviors and
depression

(Zeeni;Safieddine et al., 2017)

Risk factors for ED
Biological Factors
• Heredity
• Having a first-degree relative (parent or sibling) with an ED
increases one’s risk of developing an ED
• Having a close relative with a mental health condition (i.e.
anxiety, depression, addiction) increases the chances of
developing an ED
• Female gender-increases the risk of developing an ED
• History of dieting and other weight-control methods-
associated with the later development of binge eating
Social Factors
• Cultural pressure that glorifies “thinness” and places value on
obtaining the “perfect body” (media, social media…)
• Narrow definitions of beauty that include only women and men of
specific body weights and shapes
• Cultural norms that value people on the basis of physical
appearance and not inner qualities and strength
• Weight-based teasing or bullying
• Non-heterosexual and cis-gender individuals -higher risk of ED due to
stigma, discrimination, and body image distress
• Smaller social networks- loneliness and isolation
https://www.nationaleatingdisorders.org/learn/general-information/risk-factors
 Distorted Body Images in the Media

https://sharronhinchliff.com/2013/11/04/photoshop-in-action-remoulding-the-female-body/
 Psychological Factors
• Low Self-Esteem
• Body image dissatisfaction
• Perfectionism- setting unrealistically high expectations for oneself
• Personal history of an anxiety disorder
• Response to change (puberty, sexuality issues)
• Response to stress (athletes, dancers, models)
 Part 2:
Characteristics & Treatment
Distorted Body Image
https://m.youtube.com/watch?v=h4IYCXp9Vrg
ANOREXIA NERVOSA
• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• Preoccupation with weight, food, calories, fat grams, and dieting.
Makes frequent comments about feeling “fat.’
• Resists or is unable to maintain a body weight appropriate for their
age, height, and build
• Maintains an excessive, rigid exercise regime – despite weather,
fatigue, illness, or injury
www.nationaleatingdisorders.org
 Anorexia Nervosa
• Person refuses to eat enough food to maintain
acceptable weight
• Deny extreme hunger
• Restrict the number of calories and types of food they eat
• Some also exercise compulsively, purge via vomiting and
laxatives misuse, and/or binge eat
• 10% of cases eventually die
• 25% of individuals with AN are male
• Higher risk of death- often diagnosed later since many
people assume males do not have EDs
https://www.nationaleatingdisorders.org/anorexia-nervosa
 AN: Warning Signs
• Dramatic weight loss
• Intense fear of weight gain or being “fat”
• Repeated weighing of themselves
• Refusal to eat certain foods or food groups
• Denies feeling hungry
• Cooking meals for others without eating
• Excessive, rigid exercise regimen
• Excuses to avoid situations involving food
• Withdrawal from social life
 AN: Physical Signs
• Nutritional deficiencies
• Feeling cold all the time
• Rough, dry, scaly, and cold skin
• Loss of hair
• Constipation
• Lanugo: downy hair that trap air to counteract heat
loss
• Depression
• Loss of menstrual periods
• Loss of bone mass and high risk of osteoporosis
www.aafp.org
 BULIMIA NERVOSA
• Evidence of binge eating, including disappearance of large amounts of food in short periods of
time or lots of empty wrappers and containers indicating consumption of large amounts of food

• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or
smells of vomiting, presence of wrappers or packages of laxatives or diuretics

• Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of
mouthwash, mints, and gum

• Has calluses on the back of the hands and knuckles from self- induced vomiting

• Dental problems, such as enamel erosion, cavities, discoloration of teeth from vomiting,

and tooth sensitivity

www.nationaleatingdisorders.org
 Bulimia Nervosa

•Binge eating followed by different means to purge

•Associated with low self-esteem, depression and family problems

•Unlike Anorexia Nervosa

•Turn to food (not away from) in critical situations
•Usually at or above normal weight
•Eat food very fast (anorexic may take 1 hour to finish a muffin after
cutting it into tiny pieces)
•People recognize their behavior as abnormal
 BN: Diagnosis
• Diagnosis: Binge and purge at least 2x per week for 3 months
• Binge triggers: stress, boredom, loneliness, excessive dieting
• Binges: Means ~ 3000 Kcal
• Purging:
• Vomiting: 33-75% of the calories are still absorbed
• Other: laxatives, enemas (90% of food absorbed), intensive exercise
• Triggers a feeling of guilt and a vicious cycle
BN: Physical Signs
• Repeated exposure of teeth to acid in vomit
→demineralization and tooth decay
• Drop in blood potassium (vomiting or use of diuretics)
• Salivary glands swelling (infection from persistent
vomiting)
• Stomach ulcers and tears in oesophagus
• Constipation (frequent laxatives)
• Bruised or callused knuckles, bloodshot eyes, light
bruising under eyes
Bulimia Nervosa
Signs of AN
& BN
 BINGE EATING DISORDER
• Secret recurring episodes of binge eating (eating in a discrete period of time an amount of
food that is much larger than most individuals would eat under similar circumstances); feels
lack of control over ability to stop eating

• Feelings of disgust, depression, or guilt after overeating, and/or feelings of low self-esteem

• Steals or hoards food in strange places

• Creates lifestyle schedules or rituals to make time for binge sessions

• Evidence of binge eating, including the disappearance of large amounts of food in a short
time period or a lot of empty wrappers and containers indicating consumption of large
amounts of food

www.nationaleatingdisorders.org
Binge Eating Disorder
• Characterized primarily by periods of uncontrolled, impulsive, or
continuous eating beyond the point of feeling comfortably full

• No inappropriate compensatory behaviors after a binge

• People with BED may struggle with anxiety, depression, and

loneliness, which can contribute to their unhealthy episodes of
binge eating

• Body weight may vary from normal to mild, moderate, or severe

obesity
BED: Warning Signs

• Eating large quantities of food in short periods of time

• Feeling “out of control” during binges
• Feeling ashamed or disgust by the behavior
• Eating alone
• Eating food rapidly without really tasting it
• Noticeable fluctuations in weight, both up and down
• Often associated with history of depression
BED
 EDNOS

https://www.youtube.com/watch?v=4yCiMfmbUWg&feature=youtu.be
OTHERWISE SPECIFIED FEEDING OR EATING
DISORDER (OSFED)
• OSFED encompasses a wide variety of eating disordered behaviors, any or all of the

following symptoms may be present in people with OSFED.

• Frequent episodes of consuming very large amount of food followed by behaviors to

prevent weight gain, such as self-induced vomiting

• Evidence of binge eating, including disappearance of large amounts of food in short periods

of time or lots of empty wrappers and containers indicating consumption of large amounts of

food

www.nationaleatingdisorders.org
OTHERWISE SPECIFIED FEEDING OR EATING
DISORDER (OSFED)

• Self-esteem overly related to body image

• Dieting behavior (reducing the amount or types of foods consumed)

• Expresses a need to “burn off” calories taken in

• Evidence of purging behaviors, including frequent trips to the

bathroom after meals, signs and/or smells of vomiting, presence of

wrappers or packages of laxatives or diuretics

www.nationaleatingdisorders.org
 Other Specified Feeding &
Eating Disorders (OSFED)
• Previously known as Eating Disorders Not Otherwise Specified (EDNOS)
• EDs that do not “fit” typical criteria for AN, BN, BED diagnosis
• Examples:
• Chronic dieting
• Orthorexia
• Bigorexia/muscle dysmorphia
• Night eating syndrome
• Pica - ingestion of nonnutritive substances (clay, sand, stones, hair,
laundry starch, plastic, chalk…)
 PICA
• The persistent eating, over a period of at least one month, of
substances that are not food and do not provide nutritional value

• Typical substances ingested tend to vary with age and availability.

They may include paper, soap, cloth, hair, string, wool, soil, chalk,
talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch,
or ice

www.nationaleatingdisorders.org
 Orthorexia Nervosa

Pathological obsession for “pure” foods free of herbicides, pesticides and other
artificial substances… with:

1. Impairment of physical health due to nutritional imbalances, e.g. developing

malnutrition due to unbalanced diet

2. Severe distress or impairment of, social, academic or vocational functioning due

to obsessional thoughts and behaviors focusing on patient's beliefs about
“healthy” eating
ORTHOREXIA

• Cutting out an increasing number of food groups (all sugar, all carbs, all dairy,
all meat, all animal products)

• An increase in concern about the health of ingredients; an inability to eat

anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’

• Spending hours per day thinking about what food might be served at
upcoming events

• Body image concerns may or may not be present

www.nationaleatingdisorders.org
 ED TREATMENT

➢Psychotherapy (individual/family therapy, CBT)

➢Support groups (share experiences..)
➢Nutritional support (educate, set healthy goals, restore
hunger/satiety, supplementation…)
➢Medication (antidepressants…)
➢Hospitalization (severe physical/behavioral problems)
 PREVENTION IS THE KEY !

1.Creating awareness (advertising, seminars, school projects, ED associations…)

2. Being healthy ourselves (focus on health, well being and personality rather
than shape or size)

3. Encouraging a friend/family member to get help (But not forcing them!)

Eating disorder?
Eating disorder?
Eating disorder?
 References
Feltner, C., Peat, C., Reddy, S., Riley, S., Berkman, N., Middleton, J. C., . . . Jonas, D. E.
(2022). Screening for eating disorders in adolescents and adults: evidence report and
systematic review for the US Preventive Services Task Force. JAMA, 327(11), 1068-1082.
Force, U. P. S. T. (2022). Screening for Eating Disorders in Adolescents and Adults: US
Preventive Services Task Force Recommendation Statement. JAMA, 327(11), 1061-1067.
doi:10.1001/jama.2022.1806
Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating
disorders over the 2000–2018 period: a systematic literature review. The American Journal of
Clinical Nutrition, 109(5), 1402-1413.
Smith, A. M., Collene, A., & Spees, C. (2018). Wardlaw's Contemporary Nutrition: A functional
Approach (5 ed.): McGraw Hill Education.
Zeeni, N., Safieddine, H., & Doumit, R. (2017). Eating Disorders in Lebanon: Directions for
Public Health Action. Community Mental Health Journal, 53(1), 117-125. doi:10.1007/s10597-
015-9917-x