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WHEN FOOD BECOMES AN

ENEMY:EATING DISORDERS
Eating disorders: key facts
•Many ‘eating styles’ can help
us to stay healthy - but some
What are eating are driven by an intense fear of
disorders? becoming fat.
•These can damage our health
and are called eating
disorders.
•The two most common
problems are Anorexia
Nervosa and Bulimia Nervosa.
We describe them separately
here, but the symptoms are
often mixed.
Eating disorders: key facts
(cont)
– Morbid fear of becoming fat
– Intense preoccupation with weight and dieting
– Inaccurate body image
– Self-esteem is dependent on thinness
– 25-50% of patients with eating disorders suffer
from major depressive disorder.
– Affects more women.
– Personality types: OC, sensitive-avoidant
– Tend to be perfectionists – they have unrealistic
expectations of themselves and others.
Who gets eating disorders?

They are 7 to 10 times more


common in women than in
men.
What causes eating disorders?

We do not know for certain, but important


factors include:
• Longstanding unhappiness which may
show itself through eating.
• Control - losing weight can make us feel
good and in control.
• Puberty - anorexia reverses some of the
physical changes of puberty. You can see
it as putting off some of the challenges of
becoming an adult.
• Family - saying “no” to food may be the only
way you can express your feelings.
• Depression - binges may start off as a way of
coping with unhappiness.
• Low self-esteem.
• Social pressure - Western culture, particularly
the media, idealises being thin.
• Genes may play a part.
Anorexia Nervosa - signs and
symptoms
• worrying more and more about
your weight
• eating less
• exercising more In women, periods
become irregular or
• being unable to stop losing stop.
In men and boys,
weight, even when you are erections and wet
below a safe weight dreams stop and
testicles shrink.
• using laxatives or other tablets
to help you lose weight
• smoking and chewing gum to
keep your weight down
• losing interest in sex.
When does it start?
• Usually in the teenage
years, but it can start at
anytime.
• Anorexia nervosa is a
dangerous condition
which can lead to
serious ill health and
even death.
Bulimia Nervosa - signs and
symptoms
• You worry more about
your weight. When does it
start? Often in the mid-
• You binge eat. teens. But people don't
usually seek help for it
• You make yourself vomit
until their twenties
and/or use laxatives. because they are able to
• You have irregular hide it.

periods and feel guilty


about your eating pattern,
but stay a normal weight.
Can treatment help?

• Helping yourself - Bulimia can be tackled using a self-


help manual with guidance from a therapist. Anorexia
usually needs help from a clinic or therapist.

• Keep a diary of what you eat, your thoughts and feelings.


You can use this to see if there are links between how
you feel, think and eat.
• Be honest with yourself and with others. Remind yourself
that you don’t always have to be achieving things – let
yourself off the hook sometimes.
• Think about joining a self-help group and contact the b-
eat
Treatments for anorexia
1. Psychiatric support - A specialist will want to
find out when the problem started and how it
developed.
• You will have your weight measured and will
have a physical examination.
• Although this can be difficult for someone with
anorexia, it will only be done with your
permission and with time for you to prepare for
it.
• With your permission, the specialist might want
to talk with your family or a friend to see what
light they can shed on the problem.
Treatments for anorexia (cont)
2. Psychotherapy or counselling - This involves talking to
a therapist about your thoughts and feelings.
• It can help you to understand how the problem started,
and how you can change some of the ways you think
and feel about things.
• It can be upsetting to talk like this, but a good therapist
will help you to do this in a way which helps you to cope
better and to feel better.
• They will also help you value yourself more, and rebuild
your sense of self-esteem.
Treatments for anorexia (cont

3. Advice and help with eating - You may


need vitamin supplements.
• A dietician may talk to you about healthy
eating.
• This can be difficult for someone with an
eating disorder, but professional are
experiences in raising these issues
sensitively and will make sure you are
ready to discuss them.
Treatments for anorexia (cont
4. Hospital admission - This is only an
option if you have lost so much weight that
it is making you ill.

5. Compulsory treatment - This only


happens if someone is so unwell that their
life or health is in danger or they cannot
make proper decisions for themselves and
need to be protected.
How effective is the treatment?
• More than half recover
well, although it can take
a long time.
Nursing Intervention –Anorexia
Nervosa
• Cognitive-behavioral therapy – (+) and (-)
reinforcement.
• Acceptance and nonjudgmental approach –
increase self-esteem.
• Teach about their disorder – the more the
problem is validated, the less the denial.
• Monitor weight 3x a week:
– Patient facing away from the weighing scale.
– No hidden heavy objects.
– Hospital gowns, same time every weighing time.
Nursing Intervention –Anorexia
Nervosa (cont)
• Hi-protein, hi-carbohydrates, client’s preferred
food, small frequent feedings.
• NGT if pt refuses to eat.
• Active friendliness attitude if withdrawn.
• Matter-of-fact (setting limits)
– No use of bathroom for 2 hrs pc.
– Accompany to bathroom.
– Stay with client during meals.
– Don’t accept excuses to leave the eating area.
Treatments for bulimia
• Cognitive Behavioural Therapy (CBT)- This can be done with
a therapist, with a self-help book, in group sessions, or with a
computer program. CBT helps you to look at the links between
your thoughts, feelings and actions.

• Interpersonal Therapy - This is usually done with an individual


therapist. This treatment focuses on your relationships with
other people.

• Eating advice - This helps you to get back to regular eating,


without starving or vomiting.

• Medication - Antidepressantscan reduce the urge to binge.
Unfortunately, without the other forms of help, the benefits wear
off after a while.
Nursing Intervention .Bulimia
• Because of their desire to please and need to
conform they may resort to manipulative behavior.
– Create an atmosphere of trust.
– Accept person as a worthwhile person.
– They will be more open and honest if they know that
they won’t be rejected or punished.
• Develop strength (positive qualities) to cope with
problems.
Nursing Intervention bulimia
(cont)
• Help identify feelings and situations associated
with or that triggers binge eating.
– Assist to explore alternatives and positive ways of
coping.
– Journal of incident and feelings before, during and
after a binge episode.
– Contract with the patient to approach the nurse
when they feel the urge to binge.
• Encourage to adhere to meal and snack
schedule to decrease the incidence of binging.
Nursing Intervention bulimia
(cont
• Encourage participation in group activities to
gain additional support.
• Family therapy to correct dysfunctional family
patterns.
• Cognitive-behavior therapy – ideal to help them
understand their problem and explore
alternative behaviors
How effective is the treatment?
• About half of sufferers recover.
Recovery usually takes place
slowly over a few months or
many years.
Evidence-based treatment
approaches
 There are, currently, no pharmaceutical treatments
specifically for eating disorders, though some
psychiatric medicines can be helpful for co-morbid
conditions. Medical treatments are often necessary
for the medical damage done by malnutrition and
purging behaviors.
Nutritional stability and normalization of body
composition are the initial goals in modern eating
disorder treatment as the psychological symptoms are
understood to be exacerbated and held in place by
brain changes from inadequate or erratic nutrition, and
weight loss.
• Psychotherapy is generally considered to be
an important component of treatment.
• There are many approaches out there, and
many combinations of approaches.
• F.E.A.S.T.(Families Empowered And
Supporting Treatment of Eating Disorders-
milwaukee) believes families have a right and
responsibility to pursue evidence-based care as
appropriate.
• Although most treatments have not been
researched, as of now, only the following have
been researched in controlled trials and
supported for the treatment of eating disorders:

• For patients with anorexia younger than 18:


The Family-Based Maudsley Treatment, also
called FBT, or "Maudsley Approach"

• For bulimia and for adults: Cognitive


behavioral therapy
Do I have a problem?
The 'SCOFF' questionnaire used by doctors asks:
• do you make yourself Sick because you're
uncomfortably full?
• do you worry that you’ve lost Control over how
much you eat?
• have you recently lost more than 6 kilograms
(about One stone) in three months?
• do you believe you’re Fat when others say
you’re thin?
• would you say that Food dominates your life?
If you answer “yes” to two or more of these
questions, you may have an eating disorder.
Helping yourself

• Bulimia can sometimes be tackled using a


self-help manual with some guidance from
a therapist.
• Anorexia usually needs more organised
help from a clinic or therapist. It is still
worth getting as much information as you
can about the options, so that you can
make the best choices for yourself.
DO
1. Stick to regular mealtimes – breakfast, lunch
and dinner. If your weight is very low, have
morning, afternoon and night time snacks too.
2. Try to think of one small step you could take
towards a healthier way of eating. If you can’t
face eating breakfast, try sitting at the table for
a few minutes at breakfast time and just
drinking a glass of water. When you have got
used to doing this, have just a little to eat, even
half a slice of toast – but do it every day.
DO (CONT)
3. Try to be honest about what you are or
are not eating, both with yourself and with
other people. Secrecy is one of the most
isolating aspects of an eating disorder.
4. Try to be kind to your body, don’t punish it.
5. Make sure you know what a reasonable
weight is for you, and that you understand
why.
DON’T
1. Don’t weigh yourself more than once a week.
2. Don’t spend time checking your body and
looking at yourself in the mirror. Nobody is
perfect. The longer you look at yourself, the
more likely you are to find something you don’t
like. Constant checking can make the most
attractive person unhappy with the way they
look.
3. Don’t cut yourself off from family and friends.
You may want to because they think you are
too thin, but they could be a lifeline
“Eating is not a crime. It’s not a moral
issue. It’s normal. It’s enjoyable. It just
is.”
― Carrie Arnold
• EATING DISORDERS
– Morbid fear of becoming fat
– Intense preoccupation with weight
and dieting
– Inaccurate body image
– Self-esteem is dependent on
thinness
– 25-50% of patients with eating
disorders suffer from major
depressive disorder.
– Affects more women.
– Personality types: OC, sensitive-
avoidant
– Tend to be perfectionists – they have
unrealistic expectations of
themselves and others.
– Often belong to overprotective families (rigid
rules and ineffective at resolving conflicts).
– Relationships that encourages eating disorders.
– Have histories of physical or sexual abuse.
• Way of escape by numbing themselves with binge
food or starvation.
• Symbolical cleansing through laxative or
vomiting.
• Believe they are bad and do not deserve the
comfort of the food.
– The starving and stuffing are coping
behaviors.
– The key to recovery is finding out
what the client is trying to achieve,
or avoid, with the behaviors.
• BULIMIA NERVOSA
– Bulimia – insatiable
appetite.
– Binge eating – ingestion
of large amount of food
in short time, emotional
events trigger binge
– Purging – compensatory
behavior to prevent
weight gain, includes
self-induced vomiting or
misuse of laxatives,
enemas, or other
medications
– Usually manifest first during late
adolescence and early adulthood.
– Often belong to a family and society that
place great value on external appearance.
– Put up a brave front, but they are often
depressed, lonely, ashamed, and empty
inside.
– They hide their disorder because of fear of
rejection.
– Aware that the behavior is abnormal
but is unable to stop because she is
immobilized by her fear that she
cannot stop her behavior voluntarily.
– After the episode, she becomes guilty
and depressed that she was unable to
control herself and engages in self-
criticisms.
– Assessment findings:
• Fluid-volume deficit
• Hoarseness and esophagitis
• Dental erosion from vomiting
• Enlarged parotid glands
• Hypokalemia (diarrhea)
• Hypochloremia (vomiting)
• Hyponatremia (diarrhea and vomiting)
• Dehydration
• Cardiac arrythmias
– Nursing Interventions:
• Because of their desire to please and need to
conform they may resort to manipulative
behavior.
– Create an atmosphere of trust.
– Accept person as a worthwhile person.
– They will be more open and honest if they know that
they won’t be rejected or punished.
• Develop strength (positive qualities) to cope
with problems.
• Help identify feelings and situations associated
with or that triggers binge eating.
– Assist to explore alternatives and positive ways of
coping.
– Journal of incident and feelings before, during and
after a binge episode.
– Contract with the patient to approach the nurse
when they feel the urge to binge.
• Encourage to adhere to meal and snack
schedule to decrease the incidence of binging.
• Encourage participation in group activities to
gain additional support.
• Family therapy to correct dysfunctional family
patterns.
• Cognitive-behavior therapy – ideal to help them
understand their problem and explore
alternative behaviors.
• ANOREXIA NERVOSA
– Refusal to eat or abnormal
eating patterns in severe
emaciation that can be life
threatening
– Intense fear of becoming fat
though underweight.
– Clients are typically high
achievers and described as
perfect children.
– Usually the youngest child is
affected.
– Uses denial thus they are
difficult to treat.
– 10-20% die (half of the deaths
is due to suicide)
– They normally eat in social situation
but purge after.
– They avoid socializations (social
isolation).
– They often start as chubby or
overweight children. They lose
weight to feel accepted again.
– Personality s perfectionist,
introverted, with low self-esteem
and often has problems with peer
relationship.
– Have low tolerance to change
and do not adjust well to
situations – dieting may
represent avoidance of, or
ineffective attempts to cope.
– Symptoms are thought to be a
symbolic language: “I’m not
ready to group up yet.” or “I’m
starving for attention.”
– Sociocultural factors – great
importance placed on physical
appearance (motivating factor).
– Nursing Interventions:
• Cognitive-behavioral therapy – (+) and (-) reinforcement.
• Acceptance and nonjudgmental approach – increase self-
esteem.
• Teach about their disorder – the more the problem is
validated, the less the denial.
• Monitor weight 3x a week:
– Patient facing away from the weighing scale.
– No hidden heavy objects.
– Hospital gowns, same time every weighing time.
• Allow patient’s progression on the program once ideal
weight is gained.
• Hi-protein, hi-carbohydrates, client’s preferred food,
small frequent feedings.
• NGT if pt refuses to eat.
• Active friendliness attitude if withdrawn.
• Matter-of-fact (setting limits)
– No use of bathroom for 2 hrs pc.
– Accompany to bathroom.
– Stay with client during meals.
– Don’t accept excuses to leave the eating area.
• Help identify and express feelings without being
judgmental.
• Identify pt’s non-weight related interests.
• Avoid being confrontational and engaging n long
discussions or explanations about food or body.
• Antidepressants after electrolyte imbalance is
corrected.
• Individual and family therapy.
• Refer to self-help groups.
• PICA
– Persistent eating of non-edible substances
(plaster, sand, etc)
• Anorexia athletica(compulsive
exercising)-the person is excessively
obsessed with exercise and engaged in it
beyond the requirements for good health
• Muscle dysmophia(bigorexia)
sometimes called the bigorexia muscle,
opposite of anorexia nervosa. People
with this disorder worry excessively that
they are too small, undevelop and frail
even if they have a good muscle mass
Orthorexia nervosa- people who feel superior to
others who eat “improper” foo, which might include
non-organic to health food stores
Night –eating syndrome- characterized by lack of
appetite for breakfast because of pre occupation
on the amount of food eaten the night before.
Eating occurs late in the day or night
Nocturnal sleep-related eating disorders- classified
as a sleeping disorder characterized by the person
who eats while asleep. In the morning, the person
has no recollection that she/he has eaten during
the night while asleep
Rumination syndrome- a bizarre eating pattern
hwrein in the person eats, swallows and then
regurgitates food back into the mouth where it
chewed and swallowed again.
• Gourmand syndrome- a rare disorder charecterized
by obsession with fine food , including its purchase,
preparation, presentation and consumption
• Prader-willi syndrome- a congenital problem usually
associated with retardation and behavior problems that
includes incessant eating
• Chewing and spitting –commonly seen in anorexia
and sometimes in bulimia, characterized by a person
putting food in the mouth, tasting, chewing then spitting
it. It is a calories behavior in which the person enjoys the
taste of food but avoids its calories by not swallowing it.
• Elton John(Soundtrack, The Lion King)history of
Bulimia and substance abuse
Princess Diana(Self,
Diary of a Princess)
Her first struggles
with bulimia took
place in 1981, she
sought help in the late
80's. ” - johanna-
khristina
Ashlee Simpson
Actress, The Hot Chick
Had an eating
disorder in her pre-
teen years ” - johanna-
khristina
• Kate Winslet
Actress, Titanic
“Struggled with an eating
disorder in her youth ” -
johanna-khristina
• Lady Gaga Self, A Very Gaga
Thanksgiving “ Had bulimia
when she was younger ” -
johanna-khristina
• Oprah Winfrey Self, Oprah's
50th Birthday Bash! “ Has
been struggling with
overeating and yo-yo dieting
for many years ” - johanna-
khristina
Filipino Celebrities suffering from
Eating Disorders
• Snooky Serna
• Tricia Santos (Pinoy Big Brother ex-housemate is
suffering from an eating disorder called Anorexia
Nervosa
• The Late Francis Magalona

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