Eating Disorder Awareness and Prevention

Transcription

1 Eating Disorder Awareness and Prevention The mental and physical consequences of eating disorders in children and adolescents Kimberly Payne, MA, LMHC Jessika Brown, MS, RD/LDN, CEDRD, CSSD

2 Just eat!

3 Eating Disorders: 50% Psychological 50% Physiological Physiological Psychological

4 Overview Physiological and Psychological Presentation of an Eating Disorder Anorexia Bulimia Binge Eating Disorder Commonalities Across All Eating Disorder Types Messages Student Receive Sending a New Message

5 Anorexia Nervosa The DSM-5 defines Anorexia Nervosa as: Persistent restriction of energy intake leading to significantly low body weight. Intense fear of gaining weight or becoming fat. Disturbance in the way one s body weight or shape is experienced. Undue influence of body shape or weight on self-evaluation.

6 Recognizing the Red Flags of Anorexia Nervosa Preoccupation with weight, calories, and dieting Avoidance of meal time or situations involving food Perfectionistic personality Difficulty in experiencing pleasure Rigidity Withdrawal from friends and activities

7 The Biology of Starvation The Biology of Human Starvation 1950 Ancel Keys and colleagues studied the effects of starvation and rehabilitation 36 (32) healthy men ages week control diet; 24 weeks of semi-starvation to induce ~25% weight loss; 12 weeks of rehabilitation During starvation- what was observed?

8 Resting Energy Expenditure Keys found that the rate of decrease in metabolic rate is in direct proportion to the rate of weight loss. As metabolic rate decreases, all the chemical reactions in the body slow down

9 Hormone Changes Hunger hormones are generated in part due to consistency and timing of meals May be intensified if meals are skipped May be altered if ignored Leptin resistance Reduced ghrelin Increased NPY

10 Electrolyte Changes The body switches from using carbohydrate to fat and protein as the main source of energy Intracellular minerals become depleted although serum levels remain normal Phosphorus- major intracellular mineral (P) Potassium- major intracellular cation (K+) Magnesium- predominant intracellular cation K+ P Mg+

11 Refeeding Syndrome P K+ P Mg+ Mg+ Intracellular ions become depleted, even when serum levels appear normal Consuming <500 calories per day for greater than 5 days puts patient at high risk Addition of carbohydrates can cause an influx of potassium and phosphorus into the cell... leading to cardiac arrest K+

12 Detrimental Fat Loss Essential body fat 12% women 3% men Superior Mesenteric Artery Syndrome

13 Gastrointestinal Changes Small intestines diameter shrinks with lack of food Stomach size changes Decrease microbiota variability in GI tract

14 Bulimia Nervosa The DSM-5 defines Bulimia Nervosa as: Repeated episodes of binge eating (A feeling that one cannot stop eating or control what or how much one is eating) Repeated inappropriate compensatory behaviors to prevent weight gain Undue influence of body shape or weight on self-evaluation.

15 Recognizing the Red Flags of Bulimia Nervosa Evidence of Binge eating Disappearance of large amounts of food Excessive wrappers Evidence of Purging behaviors Frequent trips to the restroom after meals Rigid exercise regimen Impulsive behavior (substance abuse, self harm, suicidality, etc.) Withdrawal from friends and social activities Continued exercise despite injury

16 Diabulimia Diabulimia is not currently recognized in the DSM-5 Diabulimia is a co-occurring condition with Type I Diabetes Purging occurs through the misuse of insulin to induce weight loss. Purging calories occurs through glycosuria (the loss of glucose through urine)

17 Specific Red Flags of Diabulimia Avoidance of going to the Endocrinologist Hyperglycemic symptoms (extreme thirst, frequent urination, sleepiness, etc.) Irregular menses or loss of menses Secretive blood sugar testing or lack of testing

18 Bulimia Myth: Purging Leads to Weight Loss Purging can be performed via excessive exercise, self induced vomiting, laxatives, ipecac, or fasting Frequent binge/purge cycles frequently lead to weight gain Body dissatisfaction highest in bulimia nervosa (Laporta- Herrero, 2016) Laxative abuse causes water retention and micronutrient losses

19 Bulimia Myth: Purging Reducing Caloric Intake Purging leads to less calories consumed and effectively compensates for a binge Up to 1200 calories is absorbed despite vomiting (Kaye, 1993) Exercise purging throws the metabolism, leads to further fatigue, opening up likelihood of another binge Macronutrients begin digestion before micronutrientstherefore purging likely robs the body of digesting micronutrients entirely, but not necessarily macronutrients

20 Pseudo-Barters Syndrome Defect in the kidney s ability to reabsorb sodium causing a rise in aldosterone Aldosterone excretes potassium from the body (potassium wasting) Secondary hyperaldosteronism occurs despite taking electrolyte replacement Hypokalemic alkalosis Amplified if dehydrated

21 Bulimia and Malnutrition Macronutrients begin breakdown before micronutrientstherefore purging likely robs the body of digesting micronutrients entirely, but not necessarily macronutrients

22 Physical Symptoms of Purging Acute sialadenitis: Chipmunk cheeks ; bacterial infection or due to fluid loss causes the swelling of the parotid glands; may be permanent; can appear 3 days after purging Russell s sign: scarring on dorsum of the hand from acid during vomiting Edema

23 Binge Eating Disorder The DSM-5 defines Binge Eating Disorder as: Recurrent and persistent episodes of binge eating Marked distress regarding binge eating Absence of compensatory behaviors

24 Recognizing the Red Flags of Binge Eating Disorder Eating large amounts when not physically hungry Secretive food behaviors including eating alone and stealing or hiding food Creating life style schedules or rituals to make time for binges Feeling disgusted, depressed, or guilty following the binge

25 How we perceive food matters Crum, 2011

26 Food Makes Us Feel Better Saturated fat appears to fend off negative emotions: Under the study of fmri brain scans, the effect of saline vs. fatty acids on sad emotions was investigated Results: The behavioral and neural responses to sad emotion induction were attenuated by fatty acid infusion Oudenhove 2011

27 Food Addiction? Dopamine is a neurotransmitter that Signals when rewards are present Motivates us to seek rewards Promotes exploring and learning about rewards Maintain awareness about reward-related cues

28 Distribution of Food Intake

29 The psychological profile of those with Eating Disorders Depression Anxiety Obsessive/Compulsive Avoids Conflict Feelings of ineffectiveness Highly emotional and sensitive Unable to identify and/or express emotions Unable to experience pleasure of play

30 Common characteristics in Eating Disorders Focus on body shape or size Body image distortion Body checking (pinching skin, staring in the mirror, focusing on a specific body part) Obsessive weighing Food Rituals Secretive behavior Avoidance of social activities Compulsive behaviors Rigidity

31 Common Characteristics of Families in which Eating Disorders Occur Perfectionistic Don t hurt anyone s feelings. Think of others first. Always be a good boy/girl. Overprotective What am I going to do when you are gone? No one will treat you the way we do. Chaotic No Consistency No Reliability No Structure All-for-None-and-None-for-All I have to be completely selfreliant

32 The Influence of Families When families feel out of control or overly-controlling eating disorders thrive. Too much too muchness or Too much not enough-ness High achievement standards Fixation on eating healthy (Orthorexia) Athleticism Highly common in the development of Eating Disorders in males Mother-daughter competition

33 Individuals with Eating Disorders Do Not Know How to Talk The behaviors in the Eating Disorder represent the unspoken language

34 Body Image Distortion is a common characteristic in Eating Disorders

35 The Language of the Eating Disorder Keeps one s world manageable and predictable Provides a sense of control Self-soothes (a way to cope ) Says NO Prevents or Forces Separation and Individuation Strengthens/tests power and boundaries in the family

36 Core Thoughts in the Eating Disorder I don t measure up I should be invisible I can t take up space I m not good enough I m worthless I m not loveable I shouldn t exist I need to be perfect in order to deserve

37 Messages that are Being Sent to Children and Adolescents

38 Messages that are Being Sent to Children and Adolescents

39 There are only TWO food groups: Good and Bad Foods

40 Photoshop and Filters

41 Sending a New Message Self-worth and value is based on much more than appearance Separation and individuation can happen in a healthy way Every person is valuable and deserves to take up space/time/attention There is no such thing as perfect

42 Send a New Message What can you talk about besides diet and exercise? What can you compliment before appearance? Can you legalize all foods? Can you let go of labeling foods as good/bad? Can you portray the value of living in your body as an instrument, rather than an ornament?

43 The Role of the School Delivering appropriate messages about health and weight Sending appropriate messages about health vs. being thin or ideal Education about eating disorders and the consequences of these behaviors National Eating Disorders Awareness Week Identifying the warning signs

44 Ways to Support Individuals with Eating Disorders Encourage seeking treatment from professionals specializing in eating disorders Do NOT comment on their appearance Offer time and space for children/adolescents to have supervised meals Model appropriate relationships with food and weight Communicate with outside providers when concerns arise

45 The Treatment Team The treatment team for children/adolescents includes: Parents/guardians Dietitians Therapists Primary Care Physician School Nurse(s) School Counselor(s) Teachers Schools are a BIG part of creating a supportive environment during treatment

46 EATING DISORDERS TREATMENT CENTER, LLC A warm, safe and friendly atmosphere a special place to heal JUAN TABO BLVD. NE, SUITE 2A ALBUQUERQUE, NM PHONE: FAX: Whatever seed you water it will grow!