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Lecture 10

Lecture 10 - Weight Control, Eating Disorders, Disordered Eating.doc

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Health Studies
HLTH 230
Jeffery Lalonde

Lecture 10 - Weight Control, Eating Disorders, Disordered Eating READING: Statistics Canada. (2010). Overweight and obese adults, (self-reported), 2010 • obesity linked with many chronic diseases (ex. hypertension, Type II diabetes, cardiovascular disease, osteoarthritis, certain types of cancer) BMI • a measure that examines weight in relation to height • calculated for populations 18+, excluding pregnant women • WHO uses BMI to assess health risks of obesity • can be used to compare weight patterns related to health risks • needs to be used with caution => especially for lean or muscular individuals, elderly, and some ethnic and racial groups Survey • women underestimate weight • men overestimate height 2010: 18.1% obese Canadians -men: obesity rose from 16% - 19.8% (from 2003 to 2010) -women: obesity rose from 14.5% - 16.5% (from 2003 to 2010) 60.9% overweight Canadian men (rates stable from 2003 to 2010) 43.7% overweight Canadian women (rates stable from 2003 to 2010) => obesity rates rose, overweight rates stayed the same Quebec and B.C. -> lower than national average in obese residents NFLD, Nova Scotia, NB, Manitoba, Saskatchewan -> significantly above national avg. all other provinces and territories -> obesity rate about the same as national level • from 18-64, % of Canadians with normal weight declined, % of overweight + obese increased • seniors (65+) had lower rates of obesity+overweight than 55-64 age group -about the same as 45-54 age group Lecture 10 - Weight Control, Eating Disorders, Disordered Eating Causes of Overweight and Obesity 1) Genetics 2) Environment Last Week: Genetics • Prader-Willi Syndrome -genetic disorder characterized by excessive appetite, massive obesity and short stature • Twin Studies (identical are more genetically similar tend to have more similar body weights) -adopted kids’ bodies more like their biological parents rather than adopted parents • Leptin -decreases appetite and increases energy expenditure -promotes a negative energy balance • Ghrelin “opposite of leptin” -a protein produced mainly by stomach cells that enhances appetite and decreases energy expenditure -acts as a hormone primarily in hypothalamus -stimulates appetite and promotes efficient energy storage -triggers desire to eat -levels typically rise before a meal (desire to eat) and fall rapidly after -fights to maintain a stable body weight -high levels: negative energy balance -low levels: positive energy balance -helps explain why it is difficult to keep off weight that has been lost -lack of sleep may increase ghrelin, explains link between inadequate sleep overweight Genetics • 2 types of Fat 1) White fat (white adipose tissue) -stores fat for other cells to use for energy 2) Brown fat (brown adipose tissue) -releases stored energy as heat -generally when fat is oxidized, some energy is released in heat and captured in ATP -in brown fat, heat is produced instead of ATP -important in newborns, freezing climate, hibernating animals -most adults only have a small amount of brown fat (<1%) -quantity seems to be inversely related to BMI -ex. someone who is very lead has a little more brown fat Lecture 10 - Weight Control, Eating Disorders, Disordered Eating Environment • also play a role in obesity • obesity rates have risen over the last 3 decades, but gene pool remains unchanged • environment: everything we encounter every day • obesogenic environment: all factors surrounding a person that promotes weight gain Overeating • both normal weight and overweight people misreport intake (generally underreport) • obese/overweight people may no longer be in + energy balance, but even with input equalling output weight won’t be lost -just because someone is overweight/obese doesn’t mean they are exceeding they’re caloric needs (just at some point, they exceeded. now they are just maintaining) • abundance of high calorie foods • foods are readily available, inexpensive, heavily advertised and reasonably tasty *portion sizes of food today is much larger than it was before • bombarded with advertisements serving sizes out of control (study: $0.67 to upsize adds 400kcal) • • increased portions => increase in overweight + obesity • low energy density foods are often more expensive and less convenient • socializing: people tend to eat more with people they are comfortable with • distractions: newspaper, TV, not paying attention to intake Physical Inactivity -calorie expending activities have been replaced with non-calorie burning ones -ex. cars, escalators, garage door openers, microwaves, dry cleaning -hours spent watching TV or in front of computer -3 ways sedentary activities contribute to weight gain 1)require little energy more than Resting Metabolic rate 2) replace time spent doing vigorous activities 3) watching tv influences purchases, correlates with between meal snacking and high kcal foods -difficult to meet RDA/AI while maintaining healthy body weight without any activity -need to eat pretty well if you’re not active -allows you to eat foods that might not be so good for you -some overweight people are so inactive that they eat less than lean people -obese and lean people spend differences in time lying, sitting, standing - account for 350 kcal difference/day -lean people tend to be more active spontaneously in their occupations and free time ->Non-exercise activity thermogenesis (NEAT) plays important role in weight mngmnt -tend to be more active in leisure time -to prevent weight gain, 60 min of moderate activity is recommended in addition to activities of daily living Lecture 10 - Weight Control, Eating Disorders, Disordered Eating -for weight-loss, greater duration, intensity, and frequency is recommended Prejudices Regarding Obesity Social Consequences • discrimination at school, jobs, social situations • obesity may be unfairly associated with laziness/lack of self control Psychological Problems • obese people may suffer embarrassment when treated with hostility/contempt may view their bodies as flawed • • anxiety and depression more common (may worsen obesity) • ineffective treatments of obesity often lead to feelings of failure and a psychological burden Eating Disorders 70% of women, 35% of men are dieting • • women between 15-25 yrs (statistics Canada survey) -1-2% have anorexia -3-5% have bulimia • eating disorders have the highest mortality rate of all mental illnesses -10% to 20% eventually dying from complications • estimated that 3% of women will be affected by an eating disorder their entire lifetime • American Psychiatric Association Work Group on Eating Disorders estimates that 8% of women suffer from either anorexia nervosa or bulimia nervosa • 27% of Ontario girls 12-18 yrs reported to be engaged in severely problematic food and weight behaviour • many individuals suffer from eating disorders, rates tend to be higher in women • include anorexia nervosa, bulimia nervosa, binge eating • causes: combination of sociocultural, psychological, perhaps neurochemical factors • athletes are among the most likely group to develop eating disorders Hotel Dieu Hospital - Outpatient Eating Disorder Clinic - Adult • clinic serves outpatients 18+ • team includes: nurse, occupational therapist, psychiatrist, research assistant, social worker, psychometrist, dietitian -interdisciplinary -> needs lots of different people working together Hotel Dieu Hospital - Outpatient Eating Disorder Clinic - Child & Adolescent • clinic serves outpatients up to 18 team includes: nurse, occupational therapist, psychiatrist, research assistant, social worker, • psychometrist, dietitian Disordered Eating • can develop in athletes because of: -desire to improve performance -enhance aesthetic appeal of performance Lecture 10 - Weight Control, Eating Disorders, Disordered Eating -meet unsuitable weight standards *Figure H8-1 (Female Athlete Triad) -triangle that can occur in female athletes -eating disorder -> amenorrhea -> osteoporosis • risk factors for disordered eating among athletes: -young age -pressure to excel at a sport -focus on achieving/maintaining an ideal bodyweight/fat % -sports which require lean appearance, judged on aesthetic appeal -weightloss dieting at an early age -unsupervised dieting The Female Athlete Triad amenorrhea US: 2-5% of women; 66% female athletes • • **not considered a normal adaptation to strenuous physical training • characterized by low blood estrogen, infertility, and mineral losses from bone • contributors: excess training, depleted body fat, low body weight, inadequate nutrition osteoporosis • stress fractures common due to vigorous training, hormonal imbalance, poor intakes • adequate calcium recommended Other Dangerous Practices of Athletes • dangerous practices -sweating to get weight down • food and fluid restrictions to make weight • practicing in rubber suits • training in hot rooms extended periods in saunas • • diuretics and laxatives • muscle dysmorphia: psychiatric disorder concerning obsession with building body mass Preventing Eating Disorders in Athletes • Follow Canada’s Food Guide for food servings • eat frequently, especially healthy snacks • establish a reasonable weight goal • allow reasonable time to achieve weight goal (1/2 - 1lb per week) Lecture 10 - Weight Control, Eating Disorders, Disordered Eating Anorexia Nervosa • distorted body image -central to diagnosis -> cannot be self diagnosed • malnutrition -impacts brain function and judgement -causes lethargy, confusion, and delirium denial • -levels are high among individuals with anorexia nervosa • need for self-control***common characteristic • protein-energy malnutrition (PEM) - so little food energy is being taken in -similar to marasmus • impact on body -growth ceases and normal development falters -changes in heart size and strength -other bodily consequences -multiple organ system failure: heart, kidneys, liver Criteria for Diagnosis • refusal to maintain body weight • intense fear of gaining weight/becoming fat, even though underweight • disturbance in the way that one’s body weight/shape is experiences • in postmenarcheal females, amenorrhea (absence of at least 3 consecutive menstrual cycles) - removed in DSMV* 2 Types -restricting type: person does not regularly engage in binge eating/purging -binge eating/purging type: regularly engages in binge eating/purging -self-induced vomiting, use of laxatives etc. Treatment • multidisciplinary approach -food and weight issues -relationship issues • After recovery -energy intakes and eating behaviours may not return to normal • high mortality rate among psychiatric disorders Lecture 10 - Weight Control, Eating Disorders, Disordered Eating Bulimia Nervosa • distinct and more prevalent than anorexia nervosa -true incidence is difficult to establish -> secretive nature -> not as physically apparent *don’t have low body weight (sometimes even slightly above average weight) Criteria for Diagnosis • episodes of both the following: -eating an amount of food that is larger than what most people would eat -sense of lack of control over eating * UNCONTROLLABLE EATING • recurrent inappropriate behaviour in order to prevent weight gain -self-induced vomiting, diuretics, enemas • happens at least twice a week for 3 months changed to 1/week in DSMV • self-evaluation influenced by body weight and shape • disturbances do not occur exclusively during episodes of Anorexia Nervosa 2 Types -Purging types: regularly engages in self-induced vomiting/misuse of laxatives/diuretics/enemas -Non-purging types: inappropriate compensatory behaviours -fasting/excessive exercise -does not regularly engage in self-induced vomiting/misuse of laxatives/diuretics/enemas Binge-purge cycle -lack of control -consume food for emotional comfort (cannot stop, done in secret) -purge -cathartic (agent to empty bowel, ex. laxative) -emetic (makes you vomit) -shame and guilt Physical Consequences of Binge-purge cycle -subclinical malnutrition - weakened immune system -fluid and electrolyte imbalances - may lead to abnormal heart rhythms and kidney issues -physical effects -irritation/infection of pharynx and esophagus, tooth erosion, red eyes, calloused hands • Clinical depression and substance abuse rates are high Treatment • discontinuing purging and restrictive diet habits learn to eat 3 meals a day plus snacks • Lecture 10 - Weight Control, Eating Disorders, Disordered Eating • treatment team Binge-Eating Disorder • periodic binging (typically no purging) • contrast with bulimia nervosa -typically consume less during a binge and exert less restraint with dieting obesity is not the same as binge eating • • behavioural disorder responsive to treatment Eating Disorders in Society • society plays central role in eating disorders -known only in developed nations -more prevalent as wealth increases -food becomes plentiful • body dissatisfaction *be able to differentiate the different eating disorders, know the criteria 3 questions on exam Weight-loss interventions - Potentially dangerous interventions • Fad Diets -typically sound really good, but don’t deliver -exaggerated/false theories -a lot of people saying it worked for them -effectiveness based on testimonials and stories -adverse reactions include headaches, nausea, dizziness, death • Over the counter weight loss products -non-prescription weight loss products -herbal products and dietary supplements ex. St. Johns Wort • -may inhibit uptake of serotonin -> suppresses appetite -often combined with ephedrine Ephedrine • ephedra: several species of herbs that commonly grow in desert areas -best known as botanical source of alkaloids ephedrine & pseudoephedrine • stimulates CNS and cardiovascular systems -> causes lung bronchi to dilate • Health Canada authorizes sale of oral products containing recommended/low dosages of Ephedra/ephedrine used for short periods of time as nasal decongestants • are also products that contain Ephedra for use as traditional medicines • authorized products carry an 8 digit Drug ID Number (DIN) which indicates they have been approved by Health Canada • Health Canada warns against unapproved products being sold for: Lecture 10 - Weight Control, Eating Disorders, Disordered Eatin
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