Eating Disorders Self-Help and Recovery Tips

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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Anorexia-Bulimia Home Treatment Program

The best way to treat Anorexia Bulimia is at home with an individual program. This gives people a chance to control their behavior by themselves and not be dependent on a group or a therapist. The Positive Energy Treatment is the anorexia and bulimia selfhelp method discovered by Karen Phillips. This method is based on the belief that recovering from bulimia requires you to change your subconscious mind. You need to change negative feelings and thoughts into positive ones. You need to change a negative identity into a positive one.

AnorexiaBulimia Home Treatment Program Summary


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Subclinical Eating Disorders

The term subclinical eating disorder is frequently used to describe individuals, athletes and nonathletes, who have considerable eating pathology and body weight concerns, but do not show significant psychopathology or fail to meet all of the DSM-IV criteria for anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified 18,19 . Many athletes who report using pathogenic weight control methods (eg, laxatives, diet pills, and excessive exercise) do not technically meet the criteria for a clinical eating disorder 19 .

Clinical Eating Disorders

The clinical eating disorders include anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (Table 1) 16 . To be diagnosed with a clinical eating disorder, an individual must meet a standard set of criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) 16 . Clinical eating disorders are psychiatric conditions and go beyond simple body weight shape dissatisfaction and involve more than just abnormal eating patterns or pathogenic weight control behaviors. Individuals with clinical eating disorders often display severe feelings of insecurity and worthlessness, have trouble identifying and displaying emotions, and experience difficulty forming close relationships with others 17 . In addition, clinical eating disorders are often accompanied by comorbid psychological conditions, such as obsessive-compulsive disorder, depression, and anxiety disorder 17 . Clinical eating disorders Anorexia nervosa normal weight for...

Can Someone Be Both Anorexic and Bulimic

Often an individual will have disorder characteristics of both anorexia nervosa and bulimia, often called bulimiarexia. Both anorexia nervosa and bulimia are psychological disorders, which makes them somewhat difficult to treat. Typically treatment will include the efforts of an eating disorders counselor and a dietitian who specializes in eating disorders. Usually there is a root psychological issue that needs to be addressed. Today, many professionals are characterizing some patterns of overeating, leading to obesity, as an eating disorder as well. Here, food is used as a coping or comforting tool. Again, there are probably psychological issues at work here too.

Why Eating Disorders Happen

Eating disorders such as anorexia and bulimia commonly occur in people with low self-esteem they feel they are not good enough. They believe that thinness will make them into better and almost perfect people. The truth is that a thinner body does not make a person better, just smaller. There is simply less of the person to love. The individual is the same person, just obsessed, withdrawn, and tired. And when someone severely restricts food, he or she loses muscle, strength, and stamina. This is not the way to become a star athlete. The risk of developing an eating disorder seems to increase dramatically when an athlete with low self-esteem is physically beautiful, has traits of perfectionism, and tends to be hypercritical and anxious. Add to the scenario a mother who may have had (or still has) food and weight issues, and her daughter becomes a prime target for developing a fullblown eating disorder. Athletes with eating disorders are less available to their friends. After all, when a...

What Is Anorexia Nervosa

Teens become a lot more involved in their self-image. A distorted body image for a teen, or an adult, may result in an eating disorder such as anorexia nervosa. Anorexia nervosa is more common in teenage, white middle-class females who engage in chronic energy restriction to accommodate their fear of being fat. Even when their body weight is below ideal standards, they still consider themselves fat and continue the

Eating Disorders and Active People

Eating disorders among active people seem to be on the rise. The staff at health clubs commonly express concerns about some of their clients, as do coaches about their athletes, especially athletes in sports that emphasize weight, such as running, gymnastics, and wrestling. Research indicates that eating disorders are widespread among athletes in all sports. An estimated 15 to 30 percent of collegiate female athletes have some type of disordered eating pattern, be it anorexia, bulimia, laxative abuse, excessive exercise, crash diets, or other unhealthy weight-loss practices that place them at risk of developing a full-blown eating disorder (Beals and Manore 2002). Most people with eating disorders exercise compulsively, either to create a calorie deficit and be thinner or to burn off the calories consumed during a binge. I estimate that at least 40 to 50 percent of my clients are obsessed with food, and they represent only a minority of people who seek professional nutrition guidance....

Nutrition care of women with anorexia or bulimia nervosa during pregnancy

The first step in the nutrition management of the pregnant woman with AN or BN is identification of the eating disorder. Assuming that prenatal care is sought, many women with AN or BN do not disclose their conditions at any of their prenatal visits 42, 46, 49 . In addition, most obstetricians do not inquire about eating disorders in their patients. For example, only 18 of obstetricians in prenatal clinics questioned their pregnant patients about AN and BN 67 . The secrecy of these disorders and lack of inquiry lead to suboptimal care of these pregnant women.

Binge Eating Disorder A More Common Problem

Binge eating disorder (BED), different from occasional overindulging, is the uncontrollable eating of large amounts of food in a short time. Unlike bulimia, a person with BED usually doesn't purge, fast, abuse diuretics or laxatives, or overexercise. Estimates suggest that 2 percent of Americans (as many as 4 million) have this disorder many are obese or overweight. Although the cause of BED isn't clear, there's a link to depression and other negative emotions. Among the areas of research the effect of brain chemicals and metabolism, and whether depression is a cause or a result of binge eating disorder. Who's at Risk for Binge Eating Disorder Although many people with BED are overweight or obese (often severely obese), even normal-weight people have this disorder. More women than men deal with BED, but it's the most common eating disorder among men. Being overstuffed after an exceptional meal isn't necessarily a warning sign. Instead, people with binge eating disorder typically have...

Eating Disorders throughout History

Although eating disorders first came to widespread attention in the 1970s, self-starvation and other pathological eating practices are found throughout recorded history. Bulimia was widely known in both Greek and Roman societies and was recorded in France as early as the eighteenth century. Self-starvation for religious reasons became widespread in Europe during the Renaissance, as hundreds of women starved themselves, often to death, in hopes of attaining communion with Christ. During the nineteenth century, as corpulence stopped being viewed as a symbol of prosperity, self-starvation became common again. The incidence of eating disorders varies widely among cultures and time periods, suggesting that they can be encouraged or inhibited by social and economic factors. Eating disorders have most often been seen in affluent societies and are rarely reported during periods of famine, plague, and warfare. American Psychiatric Association (2001). Men Less Likely to Seek Help for Eating...

Anorexia and bulimia nervosa during pregnancy

AN and BN are typically manifested in the early postpubertal to young adult years 12 and continue throughout the reproductive years 13 . Amenorrhea is a diagnostic criteria for AN, suggesting that pregnancy is of little concern in a woman with this eating disorder. However, approximately 10 of women who sought treatment in an infertility clinic presented with AN or BN 14 . Moreover, 60 of women with oligomenorrhea had eating disorders 14 , indicating the desire for fertility despite any dysmenorrhea associated with AN or BN.

When Your Appetite Goes Haywire Eating Disorders

An eating disorder is a psychological illness that leads you to eat either too much or too little. Indulging in a hot fudge sundae once in a while is not an eating disorder. Neither is dieting for three weeks so that you can fit into last year's dress this New Year's Eve. The difference between normal indulgence and normal dieting to lose weight versus an eating disorder is that the first two are acceptable, healthy behavior while an eating disorder is a potentially life-threatening illness that requires immediate medical attention.

How to Help a Friend or Relative with an Eating Disorder

Combating an eating disorder is huge and generally involves a collaborative team of specialists, including a psychiatrist (or psychologist) to work through the psychological dynamics, a physician to monitor physical status, and a nutritionist (or dietitian) to reintroduce food as an ally not an enemy. Here are some things you can do if you suspect a friend or family member has an eating disorder The following organizations can provide information, literature, and qualified referrals for the treatment of eating disorders National Eating Disorders Association National Association of Anorexia Nervosa and Associated Disorders Eating Disorders Clinic Treatment is free for individuals who meet criteria for this research program. Eating Disorder Program Anorexia nervosa is a life-threatening eating disorder that involves self-induced starvation and refusal to maintain a normal healthy weight. Bulimia nervosa is a serious eating disorder that involves repeated episodes of rapidly consuming...

Anorexia and Bulimia What Are They

Anorexia nervosa is sometimes called the starvation sickness. Obsessed with food, weight, and thinness, people suffering from anorexia deny their hunger and refuse to eat even after extreme weight loss. As they consume too few calories for their basic needs, their bodies slowly waste away. By starving themselves, people with anorexia don't get the nutrients they need for normal bodily functions. Bulimia nervosa is marked by binge eating and purging (self-induced vomiting). The person gorges, usually on high-calorie foods, and then intentionally vomits or uses laxatives or diuretics. The consequences are serious dehydration, organ damage, internal bleeding from the stress of vomiting, tooth decay from acids in vomit, and in some cases, death. Many people with these eating disorders alternate between anorexia and bulimia. Reports indicate that 60 percent of people who have dieted extensively or starved themselves resort to bingeing, then purging to keep weight off. When does an eating...

Anorexia Nervosa The Relentless Pursuit of Thinness

Anorexia nervosa is a complex psychological disorder that literally involves self-starvation. People who suffer from this illness eat next to nothing, refuse to maintain a healthy body weight for their corresponding height, and frequently claim to feel fat even though they are obviously emaciated. Because anorexics are severely malnourished, they often experience symptoms of starvation brittle nails and hair dry skin extreme sensitivity to the cold anemia (low iron) lanugo (fine hair growth on body surface) loss of bone swollen joints and dangerously low blood pressure, heart rates, and potassium levels. If not caught and treated in time, victims of anorexia nervosa can literally diet themselves to death. The prevalence of anorexia nervosa is estimated at 0.1-0.6 percent of the general population 90 percent of the sufferers are women and roughly 6 percent are boys and young men. Although any personality can fall victim to this life-threatening illness, most anorexics tend to be...

Eating Disorders in Athletes

During the last two decades a substantial number of publications have been attributed to aspects of eating disorders such as anorexia and bulimia as well as to severe dieting practices among athletes involved in sports disciplines in which a low body weight is assumed to be essential for performance (365-373). Sundgot-Borgen and Corbin (370) reviewed the prevalence of eating disorders in elite female athletes by using questionnaires, interviews and clinical examination in 522 athletes from 35 sports and 448 non-athletic controls in the Norwegian population. A significant higher number of athletes (18 ) were found to suffer from eating disorders compared to controls (5 ). Especially affected are athletes competing in sports requiring a specific weight or body leanness, such as aesthetic, endurance or weight-class sports. Beals and Manore (380) reviewed the existing literature on the prevalence and consequences of subclinical eating disorders in female athletes. Dietary habits, sports...

Findings Related to Anorexia and Bulimia Nervosa

In those studies in which women with AN or BN were investigated together, risk and incidence of inappropriate weight gain 53-55 , hyperemesis gravidarum 56 , cesarean section 57 , preterm delivery 58 , LBW 56, 58, 59 , SGA 56, 58 , small head circumference or microcephaly 56 , short body length 59 , NTD 29 , and other birth defects 57 were high. In general, women who entered pregnancy in remission from their AN or BN had optimal maternal and fetal outcomes 50, 60 , while women with active eating disorders prior to conception and during pregnancy fared less well 24, 58 .

Eating Disorders

An eating disorder results in inadequate intakes of kcals and nutrients to replenish the energy used during daily activities. Two common types of eating disorders are Anorexia Nervosa and Bulimia Nervosa. Some behaviors people with eating disorders engage in are starvation, self-induced vomiting, excessive exercise, and the misuse of laxatives or diuretics. Both disorders are extremely damaging to the mind and body, and, if untreated, can lead to death. These disorders can have long-term health consequences by affecting the heart, liver, kidneys, and bone. In addition, these behaviors severely limit physical and mental performance.

Bulimia Nervosa

Bulimia uncontrolled episodes of eating (bingeing) usually followed by self-induced vomiting (purging) eating disorder behavioral disorder involving excess consumption, avoidance of consumption, self-induced vomiting, or other food-related aberrant behavior A clinical diagnosis of bulimia nervosa requires that the behavior occur at least two times a week for a minimum of three months. SEE ALSO Addiction, Food Anorexia Nervosa Binge Eating Body Image Eating Disorders Eating Disturbances. Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, which are followed by purging to prevent weight gain. During these incidents, unusually large portions of food are consumed in secret, followed by compensatory behaviors such as self-induced vomiting or diuretic and laxative abuse. Although the types of food chosen may vary, sweets and high-calorie foods are commonly favored. Bulimic episodes are typically accompanied by a sense of a loss of self-control and...

Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by an extreme reduction in food intake leading to potentially life-threatening weight loss. This syndrome is marked by an intense, irrational fear of weight gain or excess body fat, accompanied by a distorted perception of body weight and shape. The onset is usually in the middle to late teens and is rarely seen in females over age forty. Among women of menstruating age with this disorder, amenorrhea is common. A clinical diagnosis of anorexia nervosa necessitates body weight less than 85 percent of average for weight and height. Subtypes of this disorder include the binge eating purging type (bingeing and purging are present) or the restricting type (bingeing and purging are absent). see also Addiction, Food Body Image Bulimia Nervosa Eating Disorders Eating Disturbances. American Dietetic Association (1998). Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified...

What Is Bulimia

Bulimia is similar to anorexia nervosa in that individuals have a distorted self-image. However they will binge on food only to purge it shortly thereafter. It is not uncommon for a bulimic person to ingest several thousand calories of food in an hour or two. Usually the choice of food during this time includes snack chips, cookies, ice cream, pizza, candy, and other fast food. Self-induced vomiting and an engrossment in guilt shortly follow the eating binge. Bulimia is a self-perpetuating behavioral disorder, as the next food binge becomes a coping vehicle for guilt from the previous binge purge episode. Physical signs of bulimia may include a discoloration of teeth from frequent vomiting and also cuts to fingers and knuckles from frequent induction of vomiting.

Sharon M Nickols Richardson

Summary Anorexia nervosa (AN) and bulimia nervosa (BN) present high-risk situations during pregnancy. These conditions have been associated with poor energy and nutrient intakes, notably total energy folate vitamins B6, B12, and A calcium iron and zinc. Electrolyte imbalances are also of concern. Inadequate or excessive weight gain, spontaneous abortion, intrauterine growth restriction, preterm delivery, and low birth weight, among other adverse outcomes, have been reported in pregnant women with AN or BN and their offspring. Screening and assessment of women for these eating disorders during prenatal clinic visits is recommended. An interdisciplinary approach to care during pregnancy, the postpartum period, and beyond is critical to the successful management of AN or BN and optimal pregnancy outcomes. Keywords Anorexia nervosa, Binge eating, Bulimia nervosa, Compensatory behavior, Purging

Spectrum of Energy Availability

A given disorder category as opposed to the original version, which focused more on the extreme end point of each disorder category 3 . The category of disordered eating is meant to convey a continuum of abnormal eating behaviors, ranging from failing to meet the energy demands of exercise (ie, low energy availability) to the clinical eating disorders, anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified. Each one of the major categories contained within the spectrum of disordered eating is briefly described.

Bingeing purging and starving Unhealthy relationships to food

Some people relieve their anxiety not by eating but by refusing to eat or by regurgitating food after they've eaten it. The first kind of behavior is called anorexia nervosa the second, bulimia. Anorexia nervosa (voluntary starvation), the eating disorder that sidelined Mary-Kate Olsen in 2004, is virtually unknown in places where food is hard to come by. It seems to be an affliction of affluence, most likely to strike the young and well-to-do. It's nine times more common among women than among men. Many doctors who specialize in treating people with eating disorders suggest that anorexia nervosa may be an attempt to control one's life by rejecting a developing body. In other words, by starving themselves, anorexic girls avoid developing breasts and hips, and anorexic boys avoid developing the broad wedge-shape adult male body. By not growing wide, both hope to avoid growing up. Left untreated, anorexia nervosa can end in death by starvation. A second form of eating disorder is...

Disordered Eating Problems Signs and Help

An estimated eight million Americans suffer from disordered eating, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD). Between 5 and 20 percent will die from medical complications as a result. Eating disorders anorexia nervosa, bulimia, and binge eating disorder are actually distorted eating habits often related to emotional problems. Anorexia typically results in low body weight it's linked to menstrual irregularity, osteoporosis in women, and greater risk of early death in women and men. Bulimia may or may not be linked to low body weight. And binge eating disorder, probably the most common eating disorder, typically results in overweight and often in repeated weight gain and loss. All require qualified medical attention.

Very Low Calorie Plans

By definition, very low-calorie diet plans provide approximately 400-900 kcal daily. Clearly, the aforementioned discussion, coupled with the information provided in Part 1 of this book, demonstrates the inappropriate nature of such an approach to weight management during pregnancy. Even the most proficient registered dietitian could not design a nutritional care plan that provided all of the essential nutrients required for a normal, healthy pregnancy with so few calories. Pregnant women must be cautioned against undertaking any type of reduced calorie plan that compromises energy and nutrient intake to this extent. If such behaviors were to persist, the practitioner must consider further evaluation or referral for eating disordered behaviors (see Chap. 9, Anorexia Nervosa and Bulimia Nervosa during Pregnancy ).

Nutrition intervention

Nutrition education is a vital intervention component. Most women with eating disorders are well versed in nutrition facts and knowledge. However, they may be less aware of nutrition needs for healthy pregnancies. Discussion of micronutrient requirements and roles of these nutrients in fetal growth and development may redirect the mother's preoccupation with body weight and shape to fetal needs for intrauterine health. Other important nutrition education topics are listed in Table 9.6. Nutrition Education Topics during Pregnancy in Women with Anorexia Nervosa or Bulimia Nervosa

Obesity and Malnutrition

Eating disorders can result in malnutrition. Bulimia is a condition marked by periods of binge eating followed by purging. This differs from compulsive overeating, or binge eating, which occurs when an individual eats compulsively but does not purge and becomes overweight. Starvation, either from the lack of available food or from self-imposed starvation, as in anorexia nervosa, will also cause malnutrition.

Food and Nutrient Intakes of College Students

Anorexia nervosa refusal to maintain body weight at or above what is considered normal for height and age Eating disorders such as anorexia and bulimia are more prevalent among college females than among the general population. This is related to body image dissatisfaction females that are underweight, as measured by their body mass index (BMI), sometimes consider themselves to be overweight. The incidence of anorexia and bulimia may increase when there is excessive preoccupation with weight, academic achievement, body image, and eating, as well as during stressful periods, such as final exams.

Compulsive Overeating

People who compulsively overeat repeatedly consume excessive amounts of food, sometimes to the point of abdominal discomfort. However, unlike bulimics, they do not get rid of the food with any of the methods mentioned earlier. In fact, most people with this type of eating disorder are overweight from the constant bingeing and have a long history of weight fluctuations. Healing Connections, Inc. is a nonprofit organization that prevents eating disorders and body image disturbances through education. Healing Connections offers lectures and workshops to area schools and businesses, and also provides referrals for those looking for treatment. For more information, or to make a tax-deductible donation, please call 212-585-3450, or visit

Planning for postpartum care

Relapses in eating disorders often occur in the postpartum period 46-50, 55 . Moreover, the rate of PPD in women with eating disorders is high (see Chap. 19, Postpar-tum Depression and the Role of Nutritional Factors ). Changes in estrogen status and estrogen-beta-receptor function or other gene-nutrient interactions may be responsible for observed relapses. The registered dietitian should work closely with the patient toward the end of pregnancy to set realistic goals for dietary intake, weight loss, eating behaviors, and expectations during lactation.

Potential Nutrition Related Problems

Adolescents are at risk for obesity, obesity-related chronic diseases, and eating disorders. Eating Disorders. Adolescents tend to be very conscious of appearances and may feel pressure to be thin or to look a certain way. Fear of gaining weight may lead to overly restrictive eating habits. Some teens resort to self-induced vomiting or laxative use to control their weight. Both boys and girls are affected by eating disorders. Teens who suspect they have a problem with body image or eating habits should talk to a trusted adult.

Biliary calculus noun a gallstone technical

Binge eating noun uncontrolled eating, especially when caused by bulimia binge eating disorder noun a psychiatric disorder in which the person has a compulsion to overeat, but does not purge afterwards binge-purge syndrome noun any disorder in which bingeing is followed by purging, e.g. bulimia

Dietary Intake Assessment and Nutritional Status in Special Populations of Female Athletes

Female athletes may be more restrictive in their dietary intake than male athletes, placing them at greater risk for nutritional deficiencies and impaired performance and health. Beals and Manore 34 evaluated the diet and nutritional status of female athletes with subclinical eating disorders (n 24), compared with those of controls (n 24). The group with subclinical eating disorders had significantly lower energy intake than the control group (1989 kcal d versus 2300 kcal d P .004) however, energy expenditure did not differ between groups. Average micronutrient intake and iron, zinc, magnesium, vitamin B12, and folate status did not differ between groups (and were within normal limits). Athletes in both groups used vitamin-mineral supplements, which likely improved nutritional status.

The Fat Phohic Generation

It might sound funny, but it's no laughing matter to be completely preoccupied with fat. Certainly, a low-fat diet is an essential part of being healthy however, taking this concept to radical extremes can place serious restraints on social eating, let alone set you up for a serious eating disorder. If your reason is weight control, think again. Some fat is fine, and I promise you can maintain your ideal body weight (within reason, of course) and still allow yourself to enjoy foods with fat every once in a while.

Prevalence Of The Triad

Beals and Hill 7 examined the prevalence of disordered eating, menstrual dysfunction, and low BMD among 112 US collegiate athletes representing seven different sports. Disordered eating and menstrual dysfunction were assessed by a validated health, weight, dieting, eating disorder, and menstrual history questionnaire, and BMD was determined via DXA. Although only one athlete met the criteria for all three disorders of the triad (using a Z-score

Childrens Growing Bodies

Although dieting is standard among swimmers and participants in other sports that emphasize leanness (figure skaters, dancers, gymnasts, runners), the pressure to acquire the perfect body can lead to trouble if the dieter has a poor self-image and low self-esteem. All too often, diets are about feelings of being imperfect or inadequate rather than weight alone. Dieting increases the risk of developing a full-blown eating disorder.

Factors Affecting Nutrition and Oral Health

Oral health may be related to many nutritional factors other than sugar, including the number of times a day a person eats or drinks, the frequent ingestion of drinks with low acidity (such as fruit juices and both regular and diet soft drinks), whether a person is exposed to fluoride (through fluoridated water, fluoridated toothpaste, or fluoride supplements), and whether an eating disorder is present. Not only can the diet affect oral health, but also oral health can affect eating patterns. This is particularly true in individuals with very poor oral health, who may not be able to chew without pain or discomfort. Older, edentulous (having no teeth) patients who have had a stroke with the accompanying chewing and swallowing problems may be at significant nutritional risk, particularly if they are living alone and on a limited income. Finally, malnutrition (both undernutrition and overnu-trition) have specific effects on oral health.

Summary And Conclusions

The motivation for adopting a vegetarian diet may be important, as some women may become vegetarian in the process of developing an eating disorder, with attendant menstrual disturbances. Furthermore, high levels of cognitive dietary restraint are associated with subclinical menstrual disturbances. Accordingly, the subpopulation of women who become vegetarian for reasons related to body weight issues may be at increased risk.

Have You Ever Wondered

Many teenage girls misguidedly link milk drinking to their fear of getting fat, including teens on fad diets or those with eating disorders. Yet those who watch calories can consume low-fat or fat-free dairy foods. Eight ounces of fat-free milk supplies fewer calories than 8 ounces of a soft drink or juice only 86 calories and almost no fat, yet fat-free milk has as much calcium as whole milk

Female Athlete Triad

Disordered eating is a medical term that includes a broad spectrum of eating disorders. Girls may feel pressured to lose a few pounds to increase performance. The intentions may be good at the start, but it can escalate to serious health problems. Heavy exercise and low calorie intake can cause a drop in estrogen (a hormone), which has a protective effect on bone. Low-

Diagnosis of Low Bone Mass and Osteoporosis in Athletes

DXA has been used as a diagnostic tool for the evaluation of bone health and particularly low BMD. BMD is normally distributed and is often expressed in standard deviation (SD) units relative to its T or Z distribution. The T distribution has a mean of zero, which corresponds to the mean of young healthy women. T-scores are used for the diagnosis of osteoporosis and osteopenia and to predict fracture risk in postmenopausal women 59 . Specifically, the World Health Organization has established cutoff scores for the diagnosis of osteoporosis and osteopenia for postmenopausal women 59 . In postmenopausal women, fracture risk nearly doubles for every SD below the young adult mean 62 . One more recent debate has been related to the fact that the same diagnostic strategies used for postmenopausal women (the distribution of T-scores and the comparison with the young adult mean) have been applied to premenopausal women, adolescents, and children. This seems problematic for three reasons (1)...

Interdisciplinary Care

Nutrition care is but one part of treatment for AN or BN. These complex disorders require multidisciplinary and integrated care, due to the multifactorial etiology and wide scope of signs and symptoms. The obstetrician, nurse practitioner, psychologist or psychiatrist, dietitian, dentist, social worker, family therapist, occupational therapist, pharmacist, certified exercise physiologist, and other allied health care professionals must openly and cohesively interact with one another and most importantly with the patient to provide effective treatment. Cognitive-behavioral therapy is used to modify anorexic and bulimic behaviors. Medications may be used in treatment, but a risk-benefit assessment for use during pregnancy should be completed (Table 9.7). An increased frequency of prenatal visits is warranted in these high-risk conditions. Monitoring of fetal heart rate and more frequent ultrasounds may shift the center of attention from the mother's AN or BN Selected Medications Used in...

Acceptable physical activity and exercise plans

In addition to adequate calorie and nutrient intake, and appropriate exercise and physical activity, various lifestyle factors should be considered when planning for appropriate weight gain during pregnancy. Occupation, leisure activities, stress level, and habitual dietary behaviors (i.e., eating out, eating cues, binge eating) are important considerations for weight management programs. Behavior modification strategies may need to be implemented for women who have problems with habitual unhealthy dietary behaviors (See Chap. 9, Anorexia Nervosa and Bulimia Nervosa during Pregnancy ). All of these factors should be taken into consideration in consultation with a registered dietitian and in collaboration with the supervising physician.

Can Osteoporosis Occur Earlier in Life

Although osteoporosis is most often diagnosed in postmenopausal women, it should be noted that signs of osteoporosis have been observed in younger women as well. Younger female athletes who are excessively lean can reduce or halt their estrogen production and establish the opportunity for bone loss. In addition, the positive effects of weight-bearing exercise are not apparent in excessively lean women. The positive effects of resistance training will not balance out the negative impact of reduced estrogen levels. Anorexia nervosa, which is most common in teenage and younger adult women, is characterized by abnormally low body weight. This state can also reduce estrogen production and invoke bone demineralization.

Where Would We Like To Be In The Not So Distant Future

In energy deficiency states we clearly need to advance further our understanding of the role of leptin (and other hormones) to improve and or correct the neuroendocrine abnormalities of women with hypothalamic amenorrhea and anorexia nervosa as well as those of obese subjects dieting to lose weight and or having had surgery for obesity. We also need conclusive evidence from randomized trials on whether leptin and or other treatment options could also improve the osteoporosis of subjects with anorexia nervosa or hypothalamic amenorrhea. Importantly, we need to learn whether the effect

Use in Prevention and Therapy

During increased physiologic stress, body requirements for BCAAs are greatly increased relative to other amino acids. Supplemental BCAAs are important in conserving body stores of protein in chronic illness, anorexia nervosa, very low-calorie diets, injury, surgery, burns, or infection.3 Anorexia. Appetite and food intake are increased when serotonin levels in the brain are low. By reducing brain uptake of tryptophan (the precursor of serotonin), BCAAs may increase appetite and food intake in disorders where appetite is lost (chronic infection, AIDS, cancer).

Can We Discern Hopeful Signs In The Middle Of The Current Difficulties Created By These Disease Stat

Several discoveries over the past 10 years have created opportunities for prevention and or treatment, including discoveries of new genes, molecules, and regulatory pathways. Central, in my opinion, may prove to be developments in the field encompassed by the question How does negative energy balance lead to neuroendocrine abnormalities Recent work, mainly from our laboratory, has demonstrated that levels of an adi-pocyte-secreted hormone, circulating levels of which reflect the amount of energy stored in fat, i.e. leptin, fall in response to negative energy balance and this fall can lead to the neuroendocrine dysfunction that has traditionally been associated with energy, and thus leptin, deficiency states, such as anorexia nervosa and exercise-induced or hypothalamic amenorrhea. Importantly, exogenous administration of leptin, in replacement doses, can correct these neuroendocrine abnormalities in these leptin deficiency states. These novel advances, discussed in the relevant...

Dietary Reference Intakes DRIs continued

Vitamin and mineral deficiencies do not develop overnight but over the course of months or years, such as can happen in a person with anorexia or someone who eats an inadequate vegetarian diet. Your body actually stores some vitamins in stockpiles (A, D, E, and K the fat-soluble vitamins) and others in smaller amounts (B and C the water-soluble vitamins). Most healthy people have enough vitamin C stored in the liver to last six weeks. One day of suboptimal eating will not result in a nutritionally depleted body.

Markers of Inflammation

Inflammation blunts appetite and increases protein catabolism, lipolysis, and REE. The effect of inflammation on REE is subtle, increasing by approximately 10-15 , but over time, this sustained increase may result in protein-energy deficits, especially when combined with anorexia, which is a common side effect of both CKD and inflammation. Chronic inflammation in CKD patients can be caused by infections, interactions between the blood and dialyzer, contaminants in the dialysate, concomitant conditions, or a combination of these factors. In addition, dialysis itself, even when biocompatible dialysis membranes are used, results in transient inflammatory response that persists for several hours following treatment (17). Thus, an understanding of inflammatory status is increasingly accepted as a key part of biochemical nutritional assessment. Other clinically useful markers are the proinflammatory cytokines tumor necrosis factor (TNF-a) and IL-6. Up-regulation of TNF-a and IL-6...

Gastrointestinal Peptides

The mechanism of action of ghrelin involves stimulation of hypothalamic neurons (97) and inhibition of gastric vagal afferent signals (98). Based on the foregoing, it is plausible that ghrelin or its analogues could be candidates for future therapy for primary anorexia as well as the anorexia and cachexia often seen in patients with HIV AIDS, systemic disorders, and malignant diseases. Conversely, ghrelin antagonism is an attractive idea for drug development for obesity and hyperphagic disorders.

Overweight Concern Wrestlers

A concern about some form of overweight is common in most sports events where certain weight categories are in place (Table 1). Wrestling, particularly, has been subject to a great number of studies that have dealt with body composition, eating habits and weight loss regimens. A number of these studies have focused on the impact that rapid weight loss may have on various physical performances parameters. Some excellent reviews and discussions can be found in references 382-386. Basically the following findings have been reported. The primary methods of weight loss are diet manipulation by using well balanced diets, fasting and reduction or elimination of fluid intake. Other measures are aerobics to reduce body fat, dehydration via thermal exposure (sauna, hammam) or exercising in nylon suits or multiple layer clothing. The use of diuretics, laxatives, colon cleaning procedures and very low caloric diet (VLCD) products has also been reported. Some reports mention that a low percentage...

Natural history and complications

Complications and medical morbidity include iatrogenic tests and interventions from the mis-diagnoses that were often applied to recurrent vomiting. Most are mislabeled as gastroenteritis, gastroesophageal reflux and food poisoning, and are treated in urgent care settings. Some with severe pain, bilious vomiting and intractability have undergone inappropriate laparotomy, appendectomy, cholecystectomy and Nissen fundoplica-tion. Others have been labeled with psychiatric disorders including bulimia and psychogenic vomiting, and have been hospitalized on psychiatric wards, and a few parents have been suspected of Munchausen-by-proxy.39

Are You Imagining the Wrong Body

Even lean athletes, men and women alike, are not immune from the epidemic of body dissatisfaction, despite their fitness. Many perceive themselves as having unacceptable bodies, and this perception can lead to the development of eating disorders. The best predictor of who will develop an eating disorder relates to who struggles most with body image.

Klaus KA Witte and Andrew L Clark

Relationship Between Vit And Copper

Magnesium deficiency is associated with an increase in the rate of ventricular ectopic beats, both in the presence of left ventricular dysfunction11 and normal cardiac function.12 In rats, magnesium deficiency can increase the rate of adrenaline-induced ventricular tachycardia.13 Hypomagnesemia may potentiate the contractile response of smooth muscle to oxidizing agents, thereby accelerating atherosclero-sis.14 In animal studies, hypomagnesemia leads to hypertension, heart failure, and myocardial fibrosis.15-17 More than 30 of patients with CHF are magnesium-deficient,19 which is associated with a worse prognosis in CHF.19-21 The deficiency is a particular problem in patients with heart failure and atrial fibrillation it can precipitate digoxin toxicity.22,23 Hypomagnesemic heart failure is described in anorexia nervosa and correction of the electrolyte imbalance leads to improvement in left ventricular function.24 Muscular magnesium deficiency, which often follows prolonged serum...

Prevalence of Low Energy Availability and Disordered Eating in Athletes

Current estimates of the prevalence of disordered eating, including pathogenic weight control behaviors and subclinical and clinical eating disorders, range from less than 1 to 62 in female athletes 2,21,22 and 0 to 57 in male athletes 21,22 . These wide-ranging estimates are due to differences in screening instruments and assessment tools (eg, self-report questionnaires versus in-depth interviews), definitions of ''eating disorders'' employed (eg, few have used the DSM-IV criteria), and athletic populations studied (eg, collegiate versus high school athletes, elite athletes versus recreational athletes versus physically active people). Only four studies have used large (N 400) heterogeneous samples of athletes and employed validated measures of disordered eating (Table 2) 23-26 . The remainder employed inadequate sample sizes, examined single sports, or used inappropriate measures of disordered eating, all of which can bias prevalence estimates. EDI and in-depth interview developed...

Etiology and pathophysiology

Echogenicity Pancreas Ultrasound

Hereditary Metabolic Systemic -Antitrypsin deficiency Anorexia nervosa Autoimmune disease Brain tumor Bulimia In the pediatric population, the classic signs of acute pancreatitis include nausea, vomiting, anorexia and abdominal pain. The pain is classically located in the epigastrium, with radiation to the back. However, the pain could also be located in the periumbilical region, right upper quadrant or lower chest.46,47 Eating usually exacerbates the abdominal discomfort and emesis, which may progress to biliousness. In the review of systems, the physician should inquire about rashes, diarrhea, joint pain and other signs of vasculitis. A family history of pancreatitis should raise suspicion for hereditary and metabolic diseases (see Table 21.1). Anorexia nervosa (salivary amylase elevation only) Bulimia (salivary amylase elevation only)

Dr Michael Schacter

In the case of some people who suffer from eating disorders, they may be suffering from a zinc deficiency. A few years ago, Alex Schauss presented a paper about a number of patients who were suffering from anorexia nervosa. He found that they were zinc-deficient by using a simple test called a zinc taste test. The person takes some zinc sulfate solution in their mouth, and if they describe it as having a bad taste, they usually have sufficient levels of zinc. On the other hand, if they can't taste the solution or if it tastes just like water, then they may have a zinc deficiency, even if their blood levels look fine. Their tissue levels may still be low. Schauss found he had trouble correcting those zinc abnormalities using zinc tablets or capsules, and needed to use liquid zinc because that seemed to be absorbed. the system with the zinc liquid for a short period of time, frequently the condition will improve. While I haven't seen many patients in the last couple of years with...

Collagenous gastritis

Collagenous gastritis is an extremely rare disorder of unknown etiology, To date, fewer than ten cases have been reported in the literature. The condition is characterized by deposition of a subepithelial collagen band greater than 10 im in thickness. The disorder was originally described by Colletti and Trainer in a 15-year-old girl with refractory H. pylori-negative chronic gastritis.55 It has been reported either as an isolated entity or with synchronous collagenous colitis, collagenous duodenitis, lymphocytic colitis or celiac disease. Clinical features, such as epigastric pain, vomiting, anorexia, postprandial fullness and weight loss are reported. Endoscopic findings include diffuse nodularity, patchy or diffuse erythema, erosions and frank ulcers with hemorrhage. The diagnosis relies on mucosal histology, usually of the fundus and corpus, sharing discontinuous subepithelial collagen deposition with entrapped capillaries and fibroblasts, in association with mild glandular...

Hunger and satiety shortterm control of feeding

Lateral Hypothalamus Hunger

As shown in Figure 1.3, there are hunger and satiety centres in the brain, which stimulate us to begin eating (the hunger centres in the lateral hypothalamus) and to to stop eating when hunger has been satisfied (the satiety centres in the ventromedial hypothalamus). A great deal is known about the role of these brain centres in controlling food intake, and there are a number of drugs which modify responses to hunger and satiety. Such drugs can be used to reduce appetite in the treatment of obesity (section 6.3.3) or to stimulate it in people with loss of appetite or anorexia.

Etiology of Disordered Eating in Athletes

Most eating disorder experts agree that there is no single ''cause'' of eating disorders among athletes, but rather that the etiology is multifactorial and encompasses a complex interaction between sociocultural, demographic, environmental, biologic, psychological, and behavioral factors 28 . Controversy currently exists whether athletes are at a greater risk for developing eating disorders than their nonathletic counterparts some research suggests that the prevalence of disordered eating is greater among athletes 25,26,29 , whereas other research does not 30,31 . The current controversy notwithstanding, evidence does suggest that certain inherent pressures in the sport setting may trigger the development of an eating disorder in psychologically vulnerable athletes. Sundgot-Borgen 32 examined the etiology of disordered eating behaviors in 522 elite Norwegian female athletes and found that an early start of sport-specific training and dieting at an early age were frequently associated...

Adrianne Bendich phd facn Series Editor

Calcium in Human Health, edited by Connie M. Weaver and Robert P. Heaney, 2006 Preventive Nutrition The Comprehensive Guide for Health Professionals, Third Edition, edited by Adrianne Bendich and Richard J. Deckelbaum, 2005 The Management of Eating Disorders and Obesity, Second Edition, edited by David J. Goldstein, 2005 Nutrition and Oral Medicine, edited by Nutrition, edited by Adrianne Bendich and Richard J. Deckelbaum, 2000 The Management of Eating Disorders and Obesity, edited by David J. Goldstein, 1999

Biochemical assessment of nutritional status

Biochemical assessment offers the advantages of being readily available in most clinical settings, it is objective, and it requires only minimal patient cooperation. CKD and dialysis procedures each can influence nutritional status, limiting nutrient intake due to anorexia, dietary restrictions, socioeconomic constraints, or impaired gastrointestinal (GI) motility. In addition, CKD also exerts an indirect effect on nutritional status by increasing requirements and impairing the body's ability to down-regulate resting energy expenditure (REE) and protein turnover. Biochemical testing provides important insights into adequacy of protein and energy intake, the presence of inflammatory or oxidative stress, and nutritional adequacy over time.

Summary of Biochemical Assessment

Secondary effects of other comorbidities results in hypermetabolism and inefficient utilization of nutrients. With this form of malnutrition, simple nutritional repletion without measures to correct the underlying comorbidities and inflammation is ineffective. Because there are interactions between inflammation, anorexia, and poor nutrient intake, a multifaceted intervention strategy that optimizes dialysis delivery, energy and protein intake, corrects concomitant conditions (e.g., acidosis, anemia, uremia, medication side effects, economic concerns, dental health, etc.), and addresses inflammation and elevated proinflammatory cytokines is needed. Biochemical assessment is an instrumental part in differentially diagnosing the etiology of protein deficits in people with CKD.

Stomal Stenosis Stricture

Dietary indiscretions and vomiting associated with bulimia are ruled out, a stomal stricture at the gastrojejunal anastomosis should be considered. The reported prevalence of stricture ranges from 2.8 percent-7 percent.14,15 The presenting complaint is vomiting and postprandial pain in the gastric pouch (Table 8.3). A barium swallow often detects narrowing at the gastrojejunal anastomosis, and a referral to a gastroenterologist for endoscopic dilatation should be made. Marginal ulcers at the anastomosis should be searched for. A decision to insert a nasojejunal feeding tube at the time of endoscopy should be considered depending on the degree and rate of weight loss. Clearly, a significant number of individuals go into obesity surgery with preexisting eating-disordered behavior. To maintain the weight loss that typically follows surgery, they have to change their eating patterns dramatically. General normalization of eating behavior has been reported characterized by fewer meals, less...

The Problem Of Underweight

A person is considered underweight if he or she has a BMI below 18.5. Although anyone who has seriously dieted may think an underweight person is problemfree, this is hardly the case. Underweight persons who have trouble gaining weight have very real concerns. Just as some people cannot seem to lose weight, other people have trouble putting on a few extra pounds. The cause could be genetics, metabolism, or environment. However, some thin people, if they were to gain weight, would feel uncomfortable. Anyone who is underweight due to wasting diseases such as cancer or eating disorders also has a problem malnutrition.

Micronutrients and postpartum depression Iron

Vitamin B12 is necessary for the maintenance of myelin, which insulates nerves and affects neurotransmission 79 . Although dietary B12 deficiencies are rare due to efficient recycling, strict vegetarians and individuals with decreased appetite anorexia should consider supplementing their diet. Neurological symptoms associated with deficiency include numbness and tingling, abnormalities in gait, memory loss, and disorientation. Vitamin B12 is found almost exclusively in animal products. Fortified cereal and grain products provide an alternative for those individuals who do not consume animal products. Although vitamin B12 is important to CNS functions, no associations have been reported for vitamin B12 and depression 90 or postpartum depression 88 .

The Reproductive Years

At the other extreme, cycle disturbances also occur in association with obesity. Almost 50 years ago, before anorexia nervosa became common, a higher prevalence of obesity was observed among amenorrheic women.32 More-recent literature suggests that anovulatory cycles are more common among obese women,33,34 and that weight loss in these individuals results in improved ovulation and ability to become pregnant.35 Whether levels of cognitive dietary restraint differ between vegetarians and omnivores may depend on the motivation for vegetarianism. Some women with high levels of cognitive dietary restraint may adopt a vegetarian diet as a means of limiting food intake. Supportive evidence is provided by studies of women with anorexia nervosa, a condition characterized by very high levels of restraint. Among consecutive cases in two patient series, 45 and 54 were vegetarian.57,58 And in a survey of 158 In contrast, in a study of carefully selected vegetarians and omnivores (the inclusion...

Nutrient needs of the pregnant adolescent

The overall issue of weight gain may be problematic for teens responding to the skinny image presented in pervasive media. Croll in Guidelines for Adolescent Nutrition Services 30 presents an entire chapter dedicated to body image issues and tools to assist teens to establish a healthy appreciation for their unique appearance. She suggests that routine patient counseling should include assessment for body image concerns, and if present, teens should be provided with appropriate resources to address these issues. In her book, Croll provides specific questions to use in assessing body image, and suggests several strategies and tools to use with teens and their parents on body distortion, dieting, and media literacy. The same source 30 also has a chapter by Alton on eating disorders and offers diagnostic criteria and treatment information for these psychiatric syndromes with disturbed body images.

The Pubertal Transition And Menarche

Female monkeys will initiate ovulatory menstrual cycles.4 Similarly, exogenous GnRH administration to young women with anorexia nervosa and delayed puberty will also induce the onset of pubertal changes and menarche.5 The causes of the increased activity of the GnRH pulse generator at the onset of puberty are not, however, known with cer-tainty.3

Protein Energy Nutritional Status

Serum cholesterol also is depressed with chronic inflammation. The relationship between mortality and serum cholesterol is usually U shaped, with lowest mortality occurring with serum cholesterol levels of about 200-220 mg dL in most trials and increasing for higher or lower values. A relationship between CRP and serum cholesterol has been reported, with patients at both high and low extremes of the serum cholesterol distribution having higher CRP levels (13). Low levels of cholesterol and elevated CRP suggest the presence of inflammatory stress and anorexia, whereas elevated levels of both may be more reflective of cardiovascular disease (CVD).

Eating with Enjoyment and in a Relaxed Atmosphere

Exhausting talks, discussions, and distractions (TV, radio, reading) burden stomach and spleen, which are especially sensitive to emotional tensions such as brooding, worries, anger, and fear. Negative emotions block and weaken the qi of digestive organs, resulting in loss of appetite, bloating, regurgitation, and stomach pain. It turned my stomach It ruined my appetite The news made me choke on my food are popular ways of describing this all too common situation. Continuous exposure of the stomach spleen network to emotional stress can cause serious eating disorders and digestive problems such as obesity, bulimia, anorexia, or gastric ulcers.

Essential Fatty Acid Requirements

EFAD development has been described in several human diseases, including cystic fibrosis (154), acrodermatitis enteropathica (149), peripheral vascular disease (PVD) (155), and multiple sclerosis (156). Enteral supplementation of vegetable oils high in C18 2n-6 has been demonstrated to improve EFAD in patients with cystic fibrosis (154). Children with cystic fibrosis may require 7 to 10 of energy as C18 2n-6 to prevent reduced weight gain and growth, and infants with cystic fibrosis may require formula with a C18 2n-6 content above 12 of total calories (154, 1.57). Subjects with anorexia nervosa may have EFAD exhibited by plasma PL profiles showing lowered n-6 and n-3 PUFA concentrations (158). Low total plasma PUFA concentrations, particularly those of 20- and 22-carbon n-3 PUFA, have been noted in patients with acquired immune deficiency syndrome (AIDS) (159). Development of EFAD as measured by the triene tetraene ratio has been demonstrated in elderly patients with PVD (160), in...

Anorexigenic Neuropeptides

The integrated physiology of the interactions of these opposing neuropeptides is evident from their weight-related alterations. Following weight loss, the deceasing levels of insulin and leptin lead to activation of NPY AgRP neurons and inhibition of POMC neurons (23). These counterregulatory changes induce accelerated food intake and accumulation of fat. Defects along the melanocortin signaling pathway, such as those seen in transgenic mice with targeted disruption of the MC4 receptor (knock-outs), result in hyperphagic and massive obesity (24). Recently, fairly widespread functional mutations of the human MC4 receptor have been demonstrated in patients with severe childhood obesity (25) and also linked to binge-eating disorder (26). It should be noted, however, that the majority of obese patients have no demonstrable mutations in MC4, yet such persons may possibly benefit from future therapies targeting activation of MC4 pathways. Indeed, intransal administration of a melanocortin...

Low Weight Concern Dancers

Anorexia and bulimia are common eating disorders in high performance orientated dance companies, especially among dancers having a natural higher body weight compared with those who have a natural ectomorph body type (376-379). Practical tips on how to help the athlete with bulimia can be found in Clark (387). Susan Campbell Sandri (375) reviewed the aspects of body composition and related nutritional problems in dancers. She discusses the basic problem of a culture clash between dancers and nutrition authorities because dancers need safe methods of achieving ultra-lean physique while the recommendations of most nutritionists do not fit with dancers' requirements. If a possible eating disorder is expected, start by making a thorough assessment of the dancer's behaviour and attitudes towards food, including interviews with persons that are of significant impact on the daily life of the dancer. Dancers seem to be more frightened about overweight than about the health impairing effects...

North American Society for Pediatric Gastroenterology Hepatology and Nutrition Naspghan

Nutrition and the Metabolic Syndrome A Twenty-First-Century Epidemic of Obesity and Eating Disorders Negative energy balance, either due to lack of availability of appropriate nutrition leading to starvation in underdeveloped nations, or due to voluntary (dieting for weight loss) or involuntary caloric restriction (anorexia nervosa, exercise-induced or hypotha-lamic amenorrhea) in developed nations, is also of increasing prevalence. Immune dysfunction as well as certain well-defined neuroendocrine abnormalities leading to important adverse health consequences such as osteoporosis and infertility are the end result of energy deprivation. Research efforts to identify missing links between energy deficiency and these pathophysiological abnormalities have also been intensified over the past several years. In the area of epidemiology of obesity, the good news is that increasing rates of obesity appear to be reaching a plateau either because public health campaigns and interventions have...

Challenges Of Lifestyle Change In The Management Of Obesity

For some people, food is often used to relieve stress or adapt to difficult situations. When these behaviors become maladaptive, eating disorders might result. Not surprisingly, obese people have a higher prevalence of two distinct eating disorders binge-eating syndrome and night-eating syndrome. Binge eating is a feeling of loss of control while consuming an amount of food that is larger than most people would eat. Binge eating is twice as prevalent in obese patients than nonobese patients.23 Moreover, relative to obese patients who do not binge eat, binge eaters have higher BMIs, as well as higher rates of comorbid depression and anxiety.24 Among bariatric-surgery patients, the prevalence of preoperative binge eating ranges from 13 percent to 49 percent.25 Night-eating syndrome, first recognized by Stunkard in 1955, is defined by ingestion of 50 percent of the daily caloric intake after the evening meal, awakening at least once a night for three nights a week to eat, and morning...

Informed Choices About Eating

People who suffer from anorexia nervosa will be malnourished, which will affect most of their body functions, including their ability to grow, heal cuts or bruises, and fight infections. They may have trouble sleeping, be chronically fatigued, and moody. Eventually, they will lose bone mass to the extent that they will have osteoporosis. If they survive and the condition continues, patients will exhibit early aging. About 6 of anorexia patients die, mostly from heart problems caused by low potassium levels.

Monitoring and evaluation

At each prenatal visit, eating disorders screening may be conducted (see Table 9.4) along with measurement and documentation of parameters or outcomes related to nutrition interventions and diagnoses. Body weight and rate of weight gain should be tracked and evaluated. Adjustments in energy intake should be based on appropriateness of weight changes. Eating behaviors and dietary intake should be examined at each prenatal visit to assess the adequacy of dietary composition and patterns of intake. Changes in purging and nonpurging behaviors should be noted and addressed. Fingersticks to check hematocrit and glucose may be useful in the monitoring of iron status and hypoglycemia or hyperglycemia. In women with established eating disorders, urinalysis may detect starvation or dehydration as noted by urinary ketones, elevated specific gravity, and alkaline urine. Vital signs will show any change in general health status. Glucose tolerance testing should be conducted in the 24th to 28th...

Cross References

See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors. Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Follic Acid Physiology, Dietary Sources, and...

Binge Eating

Binge eating disorder (BED), also known as compulsive overeating, has been designated as a psychiatric disorder requiring further study by the eating disorder behavioral disorder involving excess consumption, avoidance of consumption, self-induced vomiting, or other food-related aberrant behavior American Psychiatric Association. Like bulimics, individuals suffering from binge eating disorder indulge in regular episodes of gorging, but unlike bulimics, they do not purge afterward. Binges are accompanied by a similar sense of guilt, embarrassment, and loss of self-control seen among bulimics. Because of the tremendous number of calories consumed, many people with BED are overweight or obese, and as a result they are more prone to complications such as high blood pressure, diabetes, high cholesterol, and heart disease. A clinical diagnosis of BED requires bingeing at least two times a week for a period of six months or longer. see also Addiction, Food Bulimia Nervosa Eating Disorders...

Additional resources

Katz MG, Vollenhoven B (2000) The reproductive endocrine consequences of anorexia nervosa. Br J Obstet Gynaecol 107 707-713 Mitchell-Gieleghem A, Mittelstaedt ME, Bulik CM (2002) Eating disorders and childbearing concealment and consequences. Birth 29 182-191 Spear BA, Myers ES (2001) Position of the American Dietetic Association nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS). J Am Diet Assoc 101 810-819 Anorexia Nervosa and Related Eating Disorders, Inc. National Association of Anorexia Nervosa and Associated Disorders National Eating Disorders Association


Individuals are usually considered to be ready to terminate therapy once they have achieved a healthy body weight and can eat all foods free of guilt or anxiety. For a complete recovery, extensive treatment may be required from six months to two years, and for as long as three to five years in cases where other psychiatric conditions are present. For some, eating disorders will be a lifelong struggle, with stressful or traumatic events triggering relapses that may require occasional check-in therapy to restore healthful eating patterns. Of individuals with anorexia nervosa, 50 percent will have favorable outcomes, 30 percent will have intermediate results, and 20 percent will have poor outcomes. The prognosis for bulimics is slightly less favorable, with 45 percent achieving favorable outcomes, 18 percent having intermediate results, and 21 percent with poor results. Among both anorexics and bulimics, 5.6 percent will die of complications related to their illness. Those who receive...

Treatment Modalities

Outpatient therapy provided by practitioners specializing in eating disorders is appropriate for highly motivated patients within 20 percent of their normal body weight and whose illness is mild or just developing. Treatment consists of cognitive-behavioral therapy, intensive nutritional counseling, support-group referrals, and medical monitoring. At the outset of treatment, a contract is established, outlining an anticipated rate of weight gain (usually between 0.5 and 2 pounds per week), target goal weight, and consequences if weight gain is not achieved. Vitamin and mineral supplementation and the use of liquid supplements to facilitate weight gain may also be indicated. Idealized images of thinness can cause body dissatisfaction, which may lead to eating disorders. Such disorders may also be encouraged by professions that require a certain body type, such as modeling or gymnastics. Photograph by George De Sota. AP Wide World Photos. Reproduced by permission....

Risk Factors

Environmental, social, biological, and psychological factors all contribute to eating-disorder risk. Early childhood environment and parenting may have a substantial impact. Many sufferers report dysfunctional family histories, with parents who were either emotionally absent or overly involved in their upbringing. As a result, these children may not tolerate stress well, they may have low self-esteem, and they may have difficulty in interpersonal relationships. Children who have been abused either physically, sexually, or psychologically are also highly vulnerable to eating disorders, particularly bulimia. Those raised by eating-disordered parents may be at heightened risk due to repeated exposure to maladaptive food-related behaviors. Professions, activities, and dietary regimens that emphasize food or thinness may also encourage eating disorders. For example, athletes, ballet dancers, models, actors, diabetics, vegetarians, and food industry and nutrition professionals may have...

What to Do

If you suspect a friend or a family member has anorexia, bulimia, or binge eating disorder, don't wait until a severe weight problem or a serious medical problem proves you are right. There's plenty you can do before that happens Act to get help. Speak to the person about your concern. Enlist assistance from family and friends. Talk to medical professionals, a social worker, or the school nurse or counselor if the person is a student. Call your local mental health association. A registered dietitian also can give you an expert perspective on eating disorders. See chapter 24, Well Informed to locate a registered dietitian in your area. For people with BED, a weight-loss diet alone may not be successful. Losing weight and keeping it off may be harder (for physical and emotional reasons) than for people without an eating disorder. Normal-weight people with binge eating disorder shouldn't be on a weight-loss diet. Expect resistance. A person with anorexia usually doesn't believe that he...


Originally considered to be a disease targeting affluent white women and adolescents, eating disorders are now prevalent among both males and females, affecting people of all ages and from many ethnic and cultural groups. As many as 70 million people worldwide are estimated to suffer from these conditions, with one in five women displaying pathological eating patterns. Most eating-disorder research focuses on females, who represent 90 percent of all cases. The additional 10 percent are males, a group that is often underdiagnosed due a widespread misperception that this disease only affects females. This belief also makes males less likely to seek treatment, frequently resulting in poor recovery. Among males, body image is a driving factor in the development of eating problems. Gender identity may also play a role in the evolution of eating disorders, with homosexual males more prone to this disorder than the overall male population.

Changes in behaviors

A relapse in eating disorder symptoms in women who were previously in remission may occur during pregnancy 56 . In active AN or BN, body dissatisfaction and low body esteem may worsen during pregnancy 61 in addition to an increased frequency of restricting, binge eating-purging, and nonpurging behaviors 36, 44, 46, 51, 58 . Conversely, AN or BN symptoms and behaviors improved during pregnancy in women receiving treatment 45, 46, 53, 54 and not currently receiving treatment 47, 49, 55, 61-63 . Yet, postpartum resumption of AN and BN behaviors occurred with some regularity 45, 46, 48, 49, 54, 55, 62, 63 . Postpartum depression (PPD) requires assessment in women with AN or BN as this mood disorder is tightly linked to eating disorders 64, 65 . While most studies report an increased incidence of PPD in women with AN or BN 24, 57, 64, 65 , one study reported fewer symptoms of depression in women with treated BN who delivered infants compared to women with treated BN who had not given birth...


Cravings for carbohydrate-rich foods cause many bulimics and binge eaters to center their binges around desserts and high-starch foods. Many individuals suffering from disordered eating commonly avoid foods low in carbohydrate and high in fat, and instead seek out excessive sugar, routinely using large quantities to sweeten foods and beverages. This may stem from a physiological and evolutionary need for ample carbohydrate to ensure proper neurological function. Large quantities of carbohydrate eaten in a short time frame are capable of altering neurotransmitter synthesis, producing a calming effect on the brain, and thus may be the impetus for such cravings in certain eating disorders and disturbances.


Undernutrition in children with a neurological handicap is mostly caused by a decreased appetite or intake. Increased requirements or increased losses are not reported. Eating problems or difficulties in chewing, swallowing disturbances, absent swallowing reflex, no co-ordination of oral and esophageal phases and choking of food into the nose are implicated. Also, rumination, hyper-sensitivity in the mouth area, food refusal or aversion contribute to eating disorders. Nutrition is further influenced negatively by changes in taste, dry mouth, epigastric pain, nausea, sedation and hypersalivation. Specifically, anti-epileptics cause gingival hyperplasia and anorexia antidepressants such as lithium increase thirst and appetite mental stimulants such as Ritalin decrease appetite antacids might cause constipation and aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) cause pyrosis and nausea and may lead to ulcerations in the gastrointestinal tract. In the Institutional Tokyo Study...


Clinicians may pose several questions to their patients to identify preexisting or newly developed AN or BN (Table 9.4). Once such screening suggests the coexistence of pregnancy and an eating disorder, medical nutrition therapy (MNT) can be applied. As part of MNT, a full nutritional assessment involves systematic collection and evaluation of anthropomet-ric, biochemical, clinical, and dietary intake data. In addition, functional and behavioral status may be evaluated based on responses to screening questions (Table 9.4). An easily obtained parameter of adequate dietary intake and fetal growth is maternal body weight. Body weight should be measured at each prenatal visit, recognizing that this assessment may make a woman with AN or BN uncomfortable. Some women may even refuse to have body weight measured. In those women who may increase eating disorder behaviors with body weight gain 46, 48, 50 , nondisclosure of weight changes may be appropriate. Alternatively, in women who relax...

Excessive Exercising

Also known as activity disorder, excessive exercising is an extreme method of weight control. Individuals suffering from this syndrome are compelled to exercise for prolonged periods on a daily basis and to indulge in constant activity to burn excess calories. Eventually they experience a loss of control over the desire to exercise, in the same way that a person with an eating disorder cannot control behaviors relative to eating. Excessive exercisers suffer from the same obsession with body weight and shape as anorexics and bulimics, and exercise eventually becomes necessary not only for weight control, but also for mood stabilization and self-definition. Utterly powerless to restrain their urge to exercise, they will pursue daily activity in spite of injury or exhaustion, or in places and settings that are completely inappropriate. They are usually accomplished individuals, both professionally and academically, and they may appear to be vigorously fit and healthy. Despite their...

Eating too much

Although many recent studies document an alarming worldwide increase in obesity, particularly among young children, not everyone who is larger or heavier than the current American ideal has an eating disorder. Human bodies come in many different sizes, and some healthy people are just naturally larger or heavier than others. An eating disorder may be present, though, when


Adolescence is a time of growing up both physically and socially. During these years, the nutrition choices people make will affect not only their current health, but their future health as well. see also Eating Disorders Eating Disturbances School-Aged Children, Diet of. Bode, Janet (1999). Food Fight A Guide to Eating Disorders for Preteens and Their Parents. New York Aladdin Paperbacks.

Addiction Food

Food addiction is a nonmedical term that refers to a compulsion to eat spe cific foods, usually those that are high in sugar or starch. Although this term is used to describe intense cravings to seek out specific foods, these foods are not, in and of themselves, physically addictive in the way a drug might be. Instead, the need to pursue and consume these foods may be representative of a psychological disturbance, extreme anxiety, or emotional distress. see also Eating Disorders Eating Disturbances. Cassell, Dana, and Gleaves, David (2000). The Encyclopedia of Eating Disorders, 2nd edition. New York Facts on File.

Eating Disturbances

An eating disturbance shares many similar characteristics with eating disorders, but is less severe in scope. As a result, many abnormal dietary patterns and behaviors, such as binge eating, excessive exercising, weight cycling, and chronic dieting may involve many of the same attitudes and impulses as eating disorders, though they do not meet the clinical criteria for diagnosis. Eating disturbances usually develop during adolescence and early adulthood. While they occur in both males and females, they are far more prevalent among females. They are characterized by distorted eating patterns and usually occur in individuals of normal weight who have a history of dieting and a strong desire to become thin. As with eating disorders, body perception and self-esteem are closely intertwined. Many cases may start out innocently, with only small dietary changes such as eating smaller or larger portions of food, and eventually progress beyond the individual's control. For some, eating may...


The decreased levels of female hormones during amenorrhea can lead to calcium loss from the bones and increase the likelihood of developing osteoporosis later in life. Osteoporosis is a major cause of bone fractures in the elderly. Bone density throughout the adult lifespan is greatly impacted by the amount of bone formed prior to the early thirties. Therefore, amenorrhea and eating disorders in young adults can negatively affect bone health for life. Prior to menopause, a healthy diet (including adequate calcium intakes) and the performance of weight bearing activities are the two factors that have the greatest positive influence on bone health (see Chapters 3, 4, 5, and 7).


The term fasting refers to voluntarily or involuntarily going without food. A person may fast voluntarily because of an eating disorder, as a dietary practice related to religious proscriptions, or for health reasons, such as weight loss or internal cleansing. There are, however, no nutritional benefits to fasting.

Nutrition and Health

Deckelbaum, 2005 The Management of Eating Disorders and Obesity, Second Edition, edited by David J. Goldstein, 2005 Nutrition and Oral Medicine, edited by Riva Touger-Decker, David A. Sirois, and Connie C. Mobley, 2005 The Management of Eating Disorders and Obesity, edited by David J. Goldstein, 1999 Vitamin D Physiology, Molecular Biology, and Clinical Applications, edited by Michael F. Holick, 1999 Preventive Nutrition The Comprehensive Guide for Health Professionals, edited by Adrianne Bendich and Richard J. Deckelbaum, 1997


While more adolescents become overweight, the media and peer pressure demand that girls look thinner and boys get bulkier. These societal pressures lead many teens to engage in disordered eating behaviors, such as extreme dieting. Consequently, many suffer from some form of eating disorder. Teens face a dilemma in a society that values youthfulness and thinness but encourages a lifestyle of sedentary convenience. Such a lifestyle includes a decrease in physical activity, and therefore energy expenditure, as well as fast foods full of fat and high in calories, making it difficult for adolescents to escape a sentence of obesity and ill health. eating disorder behavioral disorder involving excess consumption, avoidance of consumption, self-induced vomiting, or other food-related aberrant behavior

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Drewnowski et al. (41) examined the hypothesis that the influence of opiate antagonists on taste preferences and food consumption would be greater amongst binge eaters. Bingeing is typically associated with food cravings. They compared patients with a diagnosis of bulimia nervosa with a group without this history. Snack foods were presented and divided into four categories depending on whether they contained high or low levels of sugar or fat. The high-sugar high-fat category contained chocolate bars and chocolate-containing cookies and candies. The infusion of naloxone, rather than saline, significantly reduced the total energy intake of binge eaters. The reduction in intake was most marked for the high-sugar high-fat foods such as those containing chocolate. The obvious explanation is that such foods are highly palatable and that the pleasure associated with eating such foods is mediated via opioid mechanisms. Thus drugs such as naloxone, that block the action of endogenous opioids,...

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