Anorexia Nervosa

Anorexia nervosa is a complex eating disorder with three key features:

 refusal to maintain a healthy body weight

 an intense fear of gaining weight
 a distorted body image

Types of anorexia nervosa

There are two types of anorexia. In the restricting type of anorexia, weight loss is
achieved by restricting calories (following drastic diets, fasting, and exercising to excess). In
the purging type of anorexia, weight loss is achieved by vomiting or using laxatives and
diuretics.

Causes of Anorexia Nervosa:

There is no single cause of anorexia nervosa. Several different factors are usually involved in
producing this disorder.

 Cultural pressures
 Psychological issues
 Family environment
 Genetic factors
 Life transitions
 Perpetuating factors

Cultural Pressures

In many societies, being extremely thin is the standard of beauty for women and
represents success, happiness, and self-control. Women are bombarded with messages from
the media that they must diet to meet this standard. However, this idealized ultra-thin body
shape is almost impossible for most women to achieve since it does not fit with the biological
and inherited factors that determine natural body weight. This conflict leaves most women very
dissatisfied with their body weight and shape.

More recently, pressure has also increased on men to be lean and muscular. In addition, in
certain occupations (such as dancing, modeling, and sports like gymnastics, figure skating,
running, and wrestling), the pressure to maintain a specific weight and appearance is especially
strong.
Psychological Issues

Psychological characteristics that can make a person more likely to develop anorexia nervosa
include:

 Low self-esteem
 Feelings of ineffectiveness
 Poor body image
 Depression
 Difficulty expressing feelings
 Rigid thinking patterns
 Need for control
 Perfectionism
 Physical or sexual abuse
 Avoidance of conflict with others
 Need to feel special or unique

People with anorexia nervosa often appear emotionally driven not only toward weight loss, but
also in other areas of their life, such as schoolwork, physical fitness, or career. It has also been
suggested that in some cases of anorexia nervosa, self-starvation may be a way to avoid the
sexual and social demands associated with adolescence.

Family Environment

Some family styles may contribute to the development of anorexia nervosa. Families of people
with the disorder are more likely to be:

 Overprotective
 Rigid
 Suffocating in their closeness

In these cases, anorexia nervosa develops as a struggle for independence and individuality. It is
likely to surface in adolescence when new demands for independence occur.

Other characteristics of families that may increase the chance of developing anorexia nervosa
are:

 Overvaluing appearance and thinness

 Criticizing a child's weight or shape
 Being physically or sexually abusive
Genetic Factors

Anorexia nervosa occurs eight times more often in people who have relatives with the disorder.
However, experts do not know exactly what the inherited factor may be. In addition, anorexia
nervosa occurs more often in families with a history of depression or alcohol abuse.

Life Transitions

Life transitions can often trigger anorexia nervosa in someone who is already vulnerable
because of the factors described above. Examples include:

 Beginning of adolescence
 Beginning or failing in school or at work
 Breakup of a relationship
 Death of a loved one

Signs and Symptoms:

Anorexic food behavior signs and symptoms

 Dieting despite being thin – Following a severely restricted diet. Eating only certain low-
calorie foods. Banning “bad” foods such as carbohydrates and fats.
 Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and
weighing portions, keeping a food diary, reading diet books.
 Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to
avoid eating. Making excuses to get out of meals (“I had a huge lunch” or “My stomach
isn’t feeling good.”).
 Preoccupation with food – Constantly thinking about food. Cooking for others,
collecting recipes, reading food magazines, or making meal plans while eating very little.
 Strange or secretive food rituals – Refusing to eat around others or in public places.
Eating in rigid, ritualistic ways (e.g. cutting food “just so”, chewing food and spitting it
out, using a specific plate).

Anorexic appearance and body image signs and symptoms

 Dramatic weight loss – Rapid, drastic weight loss with no medical cause.
 Feeling fat, despite being underweight – You may feel overweight in general or just
“too fat” in certain places such as the stomach, hips, or thighs.
 Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent
weigh-ins and concern over tiny fluctuations in weight.
 Harshly critical of appearance – Spending a lot of time in front of the mirror checking
for flaws. There’s always something to criticize. You’re never thin enough.
  Denial that you’re too thin – You may deny that your low body weight is a problem,
while trying to conceal it (drinking a lot of water before being weighed, wearing baggy
or oversized clothes).

Purging signs and symptoms

 Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite
suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
 Throwing up after eating – Frequently disappearing after meals or going to the
bathroom. May run the water to disguise sounds of vomiting or reappear smelling like
mouthwash or mints.
 Compulsive exercising – Following a punishing exercise regimen aimed at burning
calories. Exercising through injuries, illness, and bad weather. Working out extra hard
after bingeing or eating something “bad.”

Diagnostic test:

The diagnosis and evaluation process usually begins with a detailed interview with the person
with anorexia nervosa and family members. Questions are usually asked about:

 Weight history
 Eating patterns
 Concerns about weight and shape
 Dieting and weight-losing behaviors
 Whether or not binge eating has been a problem
 Problems in the family or other relationships
 Physical and psychological symptoms that occurred before the disorder started
 Physical and psychological symptoms that have occurred since it started

A thorough medical evaluation is also performed in order to assess the physical problems that
may have resulted from weight loss, vomiting, and laxative abuse. This involves a complete
physical examination and may require blood tests and/or an electrocardiogram.

Treatments:

 Psychotherapy
 Support groups
 Medication
 Hospitalization

Source:

http://www.ehealthmd.com/library/anorexia/ANO_help.html
http://helpguide.org/mental/anorexia_signs_symptoms_causes_treatment.htm

Obesity
 It is a chronic condition defined by an excess amount body fat.
 The normal amount of body fat (expressed as percentage of body fat) is between 25% -
30% in women and 18% - 23% in men. Women with over 30% body fat and men with
over 25% body fat are considered obese.
 Calculation of body mass index (BMI) is used in the definition of obesity.

Causes of Obesity:
 Genetics
 Overeating
 A diet high in simple carbohydrates
 Frequency of eating
 Slow metabolism
 Physical inactivity – Lack of exercise
 Medications – Some drugs, such as corticosteroids, blood pressure medication, and
tricyclic antidepressants, can cause you to gain weight.
 Psychological factors – Eating habits in relations to emotions
 Diseases - such as hypothyroidism, insulin resistance, polycystic ovary syndrome and
Cushing's syndrome, are also contributors to obesity.

Signs and Symptoms:

Obesity is usually determined by body mass index, or BMI. It uses a formula that calculates a
ratio of your height to your weight.

 BMI 25 - 29.9 (overweight)

 BMI 30 and above (obese)

Diagnostic Test:
 BMI
 Skin fold thickness measurement
 Bioelectrical impedance analysis (BIA) - is a commonly used method for estimating
body composition.

Treatments:
 Diet changes
 Low Calorie Diet
 Exercise
 Orlistat - A reversible active-site inhibitor of gastrointestinal lipases. Orlistat forms a
covalent bond with the active serine site in gastric and pancreatic lipases, thereby
inhibiting their activity and preventing dietary fat from being hydrolyzed and absorbed.
 Behavior modification programs
 Appetite-suppressant medications
 Anorexia Nervosa

And

Obesity

Joshua d. mira

BSN ii - i