Eating Disorders and Adult Nutrition
Eating Disorders and Adult Nutrition FDNS 4050
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Date Created: 11/06/15
FDNS Test 5 Notes 10282015 Eating Disorders and their Management Introduction 0 Eating disorders are psychiatric disorders with signi cant medical and psychosocial complications that affect approximately 5 million Americans Primarily adolescent girls and young women 0 A number of factors can drive individuals to develop an eating disorder 0 Much more common among females than males 0 Core of treating eating disorders the individual must own up and realize that they have an eating disorder 0 Unlike other conditions eating is a necessary bodily function in order to survive 0 Individuals with an eating disorder may have difficulty admitting that they have a problem Eating Disorders ED or Disordered Eating DE Disordered eating is fairly common 0 65 DE 0 10 ED 0 75 total unhealthy relationship with foodphysical activity 0 Most everyone engages in some type of disordered eating 6570 0 Example binge eating 0 Eating disorders are actually the disorder that can negatively affect one s life 0 Common problem but we tend not to talk about it or pay attention to it Continuum of WeightRelated Concerns and Disorders 0 Clinically signi cant eating disorders anorexia bulimia or bing ea ng Body dissatisfaction leads to dieting behaviors which leads to disordered eating and ultimately clinically signi cant eating disorders Etiology and Course of Eating Disorders Eating disorders have multifactorial etiologies which include Sociocultural 0 Genetic 0 Family 0 Personality factors excessive exercise selfesteem body image Environmental factors 0 Food availability and accessibility Obesity paradox those who are food insecure are obese because they eat calorie dense foods 0 Media in uences o Societal and cultural norms 0 Food availability and accessibility Family factors 0 Family dynamics Mother s weight has a big in uence on child s weight mentality Weightrelated behaviors of parents and siblings Feeding behaviors reinforced during childhood and adolescence Interpersonal factors 0 Peer norms and behaviors wanting to t in 0 Abuse experience common in women young girls who were sexually abused as children to develop eating disorders because it is the one way she can control her body Personal factors biological psychological knowledge attitudes and behaviors O Dieting Behaviors Dieting and unhealthy weight control behaviors may increase chance of future overweight or obesity Effective nutrition messages should focus on lifestyle changes Adolescents with low levels of body satisfaction are more likely to use unhealthy weight control behaviors and participate in less physical activity Disordered Eating Behaviors Anorexic or bulimic behaviors with less frequency or intensity unable to do a formal diagnosis Most frequently used behaviors o Vomiting O O O LaxaUves Fasting or extreme dieting Excessive exercise Three Main Eating Disorders 0 Anorexia nervosa characterized by extreme weight loss poor 0 0 body image and irrational fears of weight gain and obesity Bulimia nervosa characterized by recurrent episodes of rapid uncontrolled eating of large amounts of food in a short period of time frequently followed by purging Bingeeating disorder characterized by periodic binge eating not followed by vomiting or use of laxatives Two types of anorexia O O Restricting anorexia the individual does not eat or eats very little Nonrestricting the individual eats and then purges themselves might binge eat prior to the purge what the individual eats is much smaller than what purging bulimics eats Two types of bulimia O O Purging as soon as the individual binge eats they will nd a way to purge the food either through laxatives or vomiting Nonpurging binge eat for some time then go days without eaUng o Bulimics tend to have normal weight or could even be overweight Binge eaters must binge eat at least twice a week for a substantial amount of time Prognoses Anorexia Nervosa 0 10 to 15 die from the disease 0 Deaths related to Weakened immune system Gastric ruptures Cardiac arrhythmia Heart failure Suicide 0 Early diagnosis and treatment improves chances for recovery 0 Recovery rates lt50 fully recover 33 show improvement 20 chronically affected Bulimia Nervosa o 23 die from disease 0 Recovery rates 48 full recovery 26 improvement 26 chronicity Treating of Eating Disorders 0 A multidisciplinary team approach 0 Team may consist of Physician Dietitian Nurse Psychologist Psychiatrist 0 Social worker Anorexics goal is to rst restore their weight then normalize their eating behaviors o Bulimics rst step in recovery is to normalize eating habits and then educate them 0 Emphasize that physical activity is for health not weight 0 Typical approaches to treatment 0 Setting depends on client s medical stability motivation to participate in treatment social support situation and other factors Level 1 Outpatient Level 2 Intensive Outpatient Level 3 Partial HospitalizationFullDay Outpatient Care Level 4 Residential Treatment Center Level 5 Inpatient Hospitalization Goal of eatingdisorder treatment programs OOOOO O O 0 Restore body weight Improve social and emotional wellbeing Normalize eating behaviors Core components of programs O 0000 0 Treatment of medical comorbidities Restoration of body weight to normal Nutrition education and counseling Individualized psychotherapy Family therapy Group therapy 0 Goal of Treatment from RD Perspective 0 0 First goal is nutritional rehabilitation End goals include Help client make peace with food eating weight and physical activity Promote eating and physical activity for health and not weight Assist client in moving towards quotintuitive eatingquot Eating Disorders among Adolescents Eating disorders a continuum ranging from body dissatisfaction to clinically signi cant eating disorders 0 Parents peers educators and health care providers should take and important role to help decrease prevalence of eating disorders Preventing Eating Disorders 0 Programs that focus on changing weightrelated attitudes of youth and promoted healthy weightcontrol strategies were found to be more effective 0 Effects have lasted up to 2 years 0 Characteristics of successful eating disorder prevention programs 0 Target highrisk groups Target adolescents gt 15 years of age Information provided by trained interventionists Multiple sessions Integrated interactive learning 0000 Adult Nutrition De nition of Adulthood in the Life Cycle 0 Early adulthood ages 2039 years 0 lnvolve becoming independent and leaving the parental home 0 In the 205 planning buying and preparing food are newly developing skills 0 In the 305 renewed interest in nutrition quotfor the kids sakequot Midlife ages 4054 years 0 Period of active family responsibilities 0 Managing schedules and meals becomes a challenge 0 Time of reviewing life s accomplishments and recognition of mortality 0 Sandwich generation the 50 s 0 Many are multigenerational caregivers juggle roles of caring for children and aging parents while maintaining a career 0 Health concerns frequently are added Chronic disease Managing identi ed risk factors to prevent diseases 0 Later adulthood age 65 0 Transition to retirement 0 More leisure time greater attention to physical activity and nutrition 0 Food choices and lifestyle factor especially for those with chronic disease Importance of Nutrition 0 The span of years between ages 20 and 64 is a time when the future course of health and wellness are in uenced by 0 Diet 0 Physical activity 0 Smokingdrinking 0 Body weight 0 How do food and nutrition enhance life 0 Nutrition and exercise are among the main lifestyle factors that reduce risk of the onset and severity of 5 of the 10 leading causes of death Cancer Heart disease Stroke Diabetes Liver disease Health Disparities among groups of Adults 0 Some population groups have a higher prevalence of chronic diseases than others Some groups have a genetic disposition for certain diseases Genetics and environment interact Physiological Changes of Adulthood Growing stops by the 20 s Bone density continues until 30 Muscular strength peaks around 25 to 30 years of age 0 Decline in size and mass of muscle and increase in body fat Dexterity and exibility decline Hormonal and Climacteric Changes 0 Women Decline of estrogen leads to menopause Increase in abdominal fat Increase in risk of cardiovascular diseases and accelerated loss of bone mass 0 Men gradual decline in testosterone level and muscle mass Body Composition Changes in Adults 0 Bone loss begins around age 40 0 Positive energy balance resulting in increase in weight and adiposity decrease in muscle mass 0 Fat redistribution gains in the central and intraabdominal space decrease in subcutaneous fat 0 Fat redistribution associated with increased risk of chronic disease Hypertension Insulin resistance Diabetes Stroke Gallbladder disease Coronary artery disease Continuum of Nutritional Status 0 Nutritional health can be viewed as a continuum from healthy and resilient state to a quotterminal statequot body system shut down and life ceases Estimating Energy Needs in Adults 0 Estimating energy needs based on BMR TEF Activity 0 Basal Metabolic Rate BMR daily BMR expenditure 6075 for involuntary processes 0 Thermic Effect of Food TEF metabolism of food 10 0 Activity thermogenesis most variable component which accounts for 2040 of total energy needs 0 Double labeled water DLW 0 Subjects are given a dose of tagged water 0 Excretion of isotopes in saliva and urine is used to calculate average energy utilization over several days 0 Used to determine estimated energy requirements EER 0 Indirect Calorimetry 0 Measurement of heat given off and utilized for the body s metabolic processes 0 Indirect Calorimetry determines REE which is nearly to BMR o The respiratory quotient C02 02 is used to estimate 24 hour energy expenditure Mif inSt Jeor Energy Estimation Formula validated and more accurate than old HarrisBenedict equation 0 Formulas are different for males and females 0 Weight must be in kilograms 0 Height must be in centimeters o Ballpark caloric levels 0 Simple calculation Weight maintenance 15 calories per pound Weight loss 13 calories per pound Weight gain 17 calories per pound Energy Adjustments for Weight Change 0 1 lb of body fat 3500 calories 0 Weight loss must be done gradually in order for the body to get used to it 0 Recommendation lose about 1b per week 0 Each day must cut at least 500 calsday in order to lose 1 lb per week 0 A combination of decrease intake and increased use exercise is one approach to use Ideally important not to cut out all 500 calories because it could affect micronutrient intake a At least 200 cals can come from exercise 0 A positive balance of just 100 extra calories per day will result in gain of 10 lbs in a year Macronutrients o Nutrients that produce energy carbs protein fat Carbohydrate recommendation is based on the DRI which is 130 g for both men and women 0 Protein recommendations are based on the RDA of 08 gkg body weight Grams of fat per day are not determinable but rather are recommended in terms of AMDR 0 Add on intake of fat based on carbohydrate and protein intake Most fat should be unsaturated limit saturated 7 and trans fat intake lt1 0 Nutrient Recommendations 0 When looking at AMDRs make sure to take into account certain risk factors and distribute calorie intake accordingly 0 AMDRs Fat 2035 of calories Carbohydrate 4565 of calories Protein 1035 of calories Micronutrients 0 Most vitamin and mineral requirements for healthy people remain the same as they move throughout each life stage group Risk Nutrients Certain nutrients exceed or fall short of recommendations 0 Fiber Vitamins A D and E Folic acid 812 ChoHne Calcium Magnesium Potassium OOOOOOO 0 Sodium 0 Vitamin A and Sodium o In the US we exceed these nutrients Dietary Recommendations 0 Dietary guidance systems focus on o Consuming greater amounts of Fruits vegetables ber and lowfat dairy product Limiting saturated fat intake trans fats More nutrient rich foods less sugar Keeping sodium low Regular physical activity 0 Energy intake balanced with energy expenditure healthy weight 0 2010 Dietary Guidelines and MyPlate 0 Enjoy food but choose wisely and eat less 0 Select a variety of foods 0 Get the most nutrition out of their calories 0 Stay within daily calorie needs 0 Consider shifting to a plant based diet Beverage lntake Recommendations 0 Recommendations in dietary guidance systems 0 Consume fewer or smaller portions of beverages containing fats and added sugar O 0 Plan beverage intake as part of total calorie intake Make beverage choices that t into the dairy vegetable and fruit groups 0 Alcohol 0 O 0 Water 61 of US adults drink alcohol Nations vary on alcohol consumption guidelines quotIf you drink do so in moderationquot Recommendation 2 drinks a day for men and 1 drink a day for women Difference due to body composition and the ability to produce ADH Varies between countries A drink contains roughly 1315 grams of alcohol or 05 oz of ethanol 0 Water should be considered one of the most important nutrients because humans can survive only days without it compared to weeks or months without food 0 Water should be our primary source of uid 0 Every 1000 calories should drink at least 1 liter of water 0 Intake Recommendations Based on median total water intake Upper level for water intake not set but toxicity can occur Total for adults a Men 37 liters n Women 27 liters Other uids o Diuretic effects of caffeine While caffeine does act as a diuretic the DRI committee concluded caffeinecontaining beverages contribute to the total daily water intake Dietary Supplements and Functional Foods Dietary supplements indicated pregnancy certain illness low calorie or nutrient restricted diets Survey data indicates that 44 of adult males and 53 of adult females take vitamin or mineral supplement nearly everyday o In America those that take supplements tend to be food secure Functional foods term used for food products that have a physiological bene t or reduce the risk of chronic disease beyond basic nutritional functions 0 Functional food during adult years helps protect us a lot Fermented foods considered functional foods because they have other health bene ts Physical Activity Recommendations Healthy eating and increased physical activity are the featured duo for combating obesity Any physical activity is better than none Physical activity helps to manage weight and reduce disease risk factors At least 150 minutesweek of moderate intensity physical activity Muscle strengthening activities 2 times a week Regular physical activity leads to changes in body composition with reduced fat mass and increased lean mass Even without caloric restriction aerobic physical activity results in decrease of adiposity Promotion of Physical Activity Healthy People 2020 Objectives 0 Reduce proportion of adults who engage in no leisuretime physical activity 0 Increase proportion of adults who meet federal guidelines for aerobic physical activity and musclestrengthening activity Diet and Physical Activity 0 Physical activity is supported by a general healthful diet 0 Competitive sports may have increased nutrient needs 0 Nutritional ergogenic aids Caffeine sports drinks protein powders energy and gel bars Few improve performance may be harmful Nutrition Intervention for Risk Reduction 0 Many types of interventions 0 Individual counseling 0 MultiOcomponent programs 0 Policy and system changes 0 A Model HealthPromotion Program Sisters Together Public Food and Nutrition Programs SNAP food stamps Government extension programs 0 Meals on Wheels 0 Soup kitchens and shelters for homeless Overall 0 Adults need 0 Variety of healthful foods 0 Knowledge to guide food choices 0 Positive attitudes about food and eating 0 Balance with discipline The message is to follow the principles of variety moderation and balance in choosing a diet Movie When obese hearts are much larger because they have to work so much harder to circulate blood around the body The thickened wall causes the heart to be virtually ineffective over time When enlarged fat could accumulate around the heart If too much blood plaque forms it completely blocks the arteries to the heart Early life experiences in the development of obesity has major consequences much earlier than we should see particularly in the arteries High blood pressure is directly related to heart attacks and strokes Hormones released from fat cells interact with heart and other organs that can affect them negatively Deposit fat into visceral depot readily mobilized burned quickly Women rely on calories from hips and thighs to help with breastfeeding or retaining a pregnancy Both males and females tend to store fat inside their abdomen underneath the skin liver and stomach Greater number of liver transplants due to cirrhosis a stiff diseased liver that is a result of fat being stuck on the liver due to obesity 0 Could be the leading reason soon that we re doing liver transplants If an obese person has normal liver fat they can be relatively metabolically healthy Once an obese person loses weight the liver returns back to its original status with no fat