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We're going to take a few minutes to look
at eating disorders.
This is a somewhat interesting topic to a lot of folks.
And they also learn about it in a psychology class
or they might learn about it in a sports nutrition
class, something like that.
It's also covered in nutrition.
And there's kind of a disconnect there
because when we look at eating disorders
like anorexia nervosa, it's actually
a psychiatric diagnosis.
So it's about mental health more than about nutrition.
Food is just use as a weapon in that disease to some extent.
So let's look at this.
We'll look at the prevalence first.
So the latest statistics are showing us
that about 5 million people in the US
have some kind of eating disorder.
And there are several different kinds
that we're going to cover.
The most familiar are probably anorexia nervosa and bulimia
nervosa.
And then we have a binge eating disorder.
There are also several other types as well.
And we're seeing these being diagnosed
with very, very young children.
Most of them started in adolescents.
And that should make some sense to you
that it's a time when people are experiencing
a lot of changes in their body.
And there's a lot of uncertainty,
social identity, family dynamics.
It's actually quite complex.
And kind of the understanding of how these originate
is still emerging.
We know that there are certain characteristics
that families have.
So there's a lot of pressure to be
very successful, greed-driven type A personalities.
Stuff like that kind of figures into it.
But we're also understanding that the media plays a role.
So if you open up any women's magazine,
you're going to see these incredibly beautiful,
airbrushed women.
And maybe you don't even think they're that beautiful.
But we have is ideal for women that is really unobtainable.
Women can't do this.
Not everybody is meant to be a size 0, or a size 2, or 4,
or even a size 10.
And I often tell people that Marilyn Monroe, who is just
the epitome of sex to many men, I
mean she's just gorgeous and confident
and all these other things, she was a size 16.
And so that's not considered small.
And you a very, very rarely see that size woman
portrayed as this image.
And really there needs to be some understanding about that.
We also know that it's about control.
So one way to kind of control what's
going on in a life that feels out of control
is through food and what we put into our bodies.
And it's that ability to turn those painful emotions
kind of inward, where some people feel--
I want to say some kind of a payoff.
It helps them to feel a sense of control.
So when we look at societies that
are struggling with eating disorders,
we know that it's a sociocultural phenomena.
And it's only really seen in developed nations.
So in countries where there's not enough food,
they don't have eating disorders.
They don't have that luxury.
And I don't mean to say that anybody
wants to ever have an eating disorder.
But what I'm saying is that those people
are struggling for survival.
So their relationship with food is very, very different
than how we use food.
Earlier I had said that food can be an addiction.
Again, we don't see that happening
in other countries in the same way.
I was talking with someone from Zambia
in kind of Southern, Eastern Africa.
And we were talking about body image.
And he was telling me that when they see a person that's
larger, it's actually a sign of wealth and leisure
and an opportunity to actually have extra resources.
So, again, keep in mind this is in developed countries.
And that as food becomes more plentiful in a society,
the risk of eating disorders goes up.
We know that there's a psychological component.
There's also a hereditary component in some families.
So you see this kind of trajectory in families.
But it's also that environment, that household environment.
And there's also a lot of research
looking at body chemicals and how this kind of fits into it
and maybe that there's a chemical imbalance.
But again, I just want to say that it's
society's unrealistic expectations
for body weight that seems to be one
of the big, big factors that a lot of people mention,
and especially for women.
But again, we should keep in mind
that eating disorders also affect men.
And there was a lot of interest in looking
at the connection between eating disorders and homosexuality.
And I just want to say right now that there's no connection.
That that is not some link that's
been established in any of the literature.
So we want to be really clear about that.
There are some people that are also
at risk kind of based on their lifestyle around athletics.
So we have something I just want to mention
called the female triad.
And think about the different kinds
of athletic events or a lifestyles
that it might be tied into eating disorders, anything
that is weight driven.
So it could be gymnastics, it could be swimming,
it could be driving.
It can be wrestling.
So this is also for men too.
Those are the folks they we're kind of
concerned about because they're trying
to maintain a certain weight and they
tend to have a little bit greater risk
for eating disorders.
And then in girls, as their body weight drops,
they lose their period so they can have a amenorrhea.
And this is defined as missing three consecutive cycles.
So it's something to definitely pay attention to.
Sometimes women will say, whoo, hoo, I'm not having my period.
This is great.
It's not to be desired really because it really sets you up
for different kinds of hormonal imbalance.
Then we have osteoporosis.
And we've talked about that.
That it's lo bone mineralization.
And this is actually one of the significant consequences
of eating disorders, that people end up
with very, very fragile bones.
So we want to be aware of this, and especially coaches.
So there's a lot of training from organizations like NCAA,
making sure the track athletes are really, really aware of how
to eat healthy and that these coaches can
spot eating disorders.
Also in other kinds of sports at the collegiate level.
But high school coaches also need to be aware of this.
So let's take a look at anorexia nervosa.
And I want to kind of differentiate
between anorexia and anorexia nervosa.
When we say anorexia nervosa, we're
talking about a psychological diagnosis.
When we talk about anorexia, it's
someone who's just not eating.
That can because they are going through a cancer treatment
or whatever it is.
So it doesn't mean the person has an eating disorder per se.
It's more likely to be seen in upper class
families or middle class families.
And we see guys are about 5% to 10% of cases.
And again, very often tied to athletics.
And the causative agent here is really unknown.
It tends to vary depending on the individual
and what those triggers have been for them.
The consequences here-- and I have quite a few
of these I just want to mention.
But really with anorexia nervosa itself, starvation.
The person is slowly tapering off their energy intake
to the point where they might be getting maybe 50 calories a day
or even less.
So they're just systematically starving their body.
So all of the things that we saw in Chapter 6
when we looked at protein malnutrition and energy
malnutrition are also going to be
part of this particular situation as well.
So the brain loses its ability to really function properly.
So people that are going through this, they can't think clearly.
So they can't even be kind of objective
about where their body status is.
We also see that nerve activity is really corrupted.
People can't sleep.
digestion becomes kind of co-opted
because there's no food.
So the body stops making enzymes.
It stops maintaining that digestive lining,
all kinds of things happen.
And then when people do eat, digestion
is really problematic.
And it can often be very, very painful, kind
of this refeeding of folks.
And often results in diarrhea or constipation or something
like this.
We also have a lot of other kind of things
we want to look at, anemia, your immune response, blood lipids.
So the amount of circulating triglycerides is really skewed.
Vitamins are thrown off.
That should make sense, low blood proteins.
So the person-- I mentioned anemia.
But are their blood cell count is going to be way off.
There all kinds of skin things that happen.
Some people will develop very, very dry, rough, cracked skin.
You can also develop a fine layer
of like kind of downy hair.
It's your body's way to try and keep you warm because your body
temperature is suboptimal, these folks who are really, really
cold.
So if you have a friend who has a lower body weight
than they probably should be for health,
you'll notice that they feel cold generally speaking.
And that's also a result of the anemia.
So we mentioned the fine body hair as well.
So we look at treatment, I mentioned
that this is a psychiatric disorder.
So it's having a team of folks to help.
So you usually have a physician or a pediatrician,
depending on the age of the patient.
You have a social worker for the family.
You have a nutritionist.
You have all of these people there
to help, the psychologist or the psychiatrist.
And it's about trying to create an appropriate relationship
with food.
So it's often quite complex.
And I will say that talking to dietitians and nutritionists
who work with eating disorder patients,
they don't last very long.
Generally, it's a couple years.
It's rare to see someone who's dedicated their entire career
to this because it's so draining and it's so difficult.
So let's take a little shift here
and look at bulimia nervosa.
And this is a little different.
Anorexia, we see self-starvation.
And bulimia nervosa is about these cycles
of binging, a huge amount of energy
being consumed, and then purging.
So there are a couple things to kind of keep
in mind with this cycle.
We're looking at sometimes just a tremendous amount
of extra energy.
1,000 calories would not be unusual.
And I would say the literature would suggest
that might be somewhat conservative.
Because if I think about 1,000 calories,
that's four Hersey bars.
If I wanted to have four Hersey bars,
I could do that in probably less than five minutes.
So the idea here is still the same.
It's that the person is having a lot of energy
in a very short amount of time.
And they feel very often out of control.
They can't control this.
And kind of the way that this whole cycle takes place
is that people start with restrictive dieting.
And that might even start here with
the negative self-perceptions.
And this cycle is one we often see.
But I would say that these negative self-perceptions
and images are throughout the cycle.
So it's restrictive dieting.
And you get so far and you're like, oh, the heck with it.
I'm just going to have these foods.
And they eat these foods.
They have these binges.
And then we get into feelings of guilt and remorse and shame.
And then we have the purging.
And then we go back up to the I'm a bad person.
I'm out of control.
And then the restrictive dieting.
This time I'm going to get it right.
And then we go back into the cycle of binging.
And a lot of people report choosing
foods that are easy to consume.
That should make sense.
I'm not going to sit down and necessarily binge
on a whole bowl of apple slices.
It takes too long.
So these are low fiber foods, high fat, very smooth,
ice cream, cake, cookies, that kind of thing.
So we've talked about the binging.
Now, we have to look at the purging.
And there's a lot of physical issues
that come along with this.
People will kind of go one of two routes
to get the food out of their body,
because that's all we have.
Well, actually we have a third.
And we'll talk about that in a minute.
But they'll some use kind of a cathartic or an emetic.
So they're either going to be looking
at vomiting or a laxative agent.
So when people are vomiting, you can sometimes
see this across their hand because putting your finger
down your throat, there's a reflex.
And they'll often kind of abrade the skin
on the back of your hands with their teeth.
Swollen glands in the in the neck
and the eyes tend to be bloodshot, also
a lot of bloating and fatigue, pain.
You can end up with really, really horrible infections
in your salivary glands and sores in your mouth.
Dentists are very, very good at diagnosing this.
Because as the stomach contents comes up, it's acidic.
And it erodes the enamel, especially
on the back of the teeth.
Because think about this, if you vomit,
what's the first thing you do?
You want to go brush your teeth.
And it's actually that brushing of your teeth
and the toothpaste that causes more damage.
Because you have this low acidic environment and then
you add this toothpaste.
The best thing to actually do if you vomit--
this is good practice-- is to rinse out your mouth
and wait a few minutes and then brush your teeth.
But of course, a lot of people don't know this.
And they cause more dental damage as a result of that.
You can also see stomach rupture and esophageal rupture.
You can imagine how horrible that would be.
And it has to do with that regurgitation.
And this isn't the direction food
is meant to go in your body.
And it's really, really destructive over time.
And it can take a long time for people
to get a handle on this in this disease state.
It's much more prevalent than anorexia nervosa.
And you might suspect cases of it
kind of in your social network.
And it's not uncommon.
And we see more men suffering from bulimia nervosa
than anorexia nervosa.
But it's still very, very common in women.
Now, I mentioned there's a third way
to get that food out of your body.
And there I'm talking about exercise bulimia.
So this has that binge cycle.
And what happens then instead of using
a purging agent, like a laxative or a vomiting agent,
instead the person is going to exercise away
all of those calories.
Now, one of the problems here is that people don't often
understand that your body isn't just
using energy for voluntary activity.
We also have to have energy to work our heart and our lungs
and all of these things that are normal activities,
our basal metabolic rate and that basal metabolic energy
use.
So they'll say to themselves, well,
I ate 2,000 calories today.
I need to exercise 2,000 calories off.
So these folks are very obsessive at the gym.
They look at the calorie counter.
They keep track of all this stuff.
They're very good record keepers very often.
So they're using all of that energy
they've consumed through physical activity.
And it tends to wear out your body very,
very quickly because you're not feeding all of those things
that normally we're using food for.
They also tend to wear out their knees, and their hips,
and shoulder joints, and elbows pretty easily.
So you see a lot of arthritis.
You see early hip replacement and knee replacement as well.
So again, people just need to understand
how energy is being used in their body.
So let's turn our attention to binge eating disorder.
So this has one of the characteristics
of bulimia nervosa, which is the binge cycle,
but not the purging cycle.
And this can be a result of restrictive eating.
And often people do this without necessarily identifying it
as binge eating.
For instance, if someone is on that 800 calorie diet
and if they can maintain it for a day or maybe two days.
And then suddenly they say, oh, heck with it.
I'm having a bowl of ice cream.
And pretty soon, they've had the carton of ice cream.
That's binge eating.
For some people, it has nothing to do with restrictive eating
necessarily.
It can just be that they're feeling out
of control emotionally or they're
trying to soothe themselves.
And they can eat a tremendous amount of food
at a particular time.
So we want to kind of look at that
more closely in people's lives.
And that's why I said earlier in our talk
about weight loss and weight maintenance,
that generally I recommend that people
have no more than two servings of a particular food at one
time.
I mean if it's something like carrots
and you're really wanting to have a lot of carrots,
three servings isn't bad.
But you wouldn't want to have three servings of Doritos,
or chocolate chip cookies, or ice cream,
or something like that.
It might signal that there's something else going on
that we need to pay attention to.
There's some controversy about whether or not
we want to include obesity as an eating disorder.
I would suggest that it's actually
nonspecified eating disorder or disordered eating, just
kind of across the map in some way.
We do know that it's considered malnutrition.
So we can still kind of classify there,
that there's some changes that need to be made for the person.
But again, it's about lifestyle choices as well.
And then there are a whole bunch of other social considerations
that don't really have to do a whole lot with the individual.
It's their environment, heredity, genetics,
all these other pieces as well.