Disordered Eating &

Nutrition Professionals

Amy Hunter-Manuel, MS, RD, LDNNovember 3, 2009

To identify disordered eating and relevant facts related to it. To review literature regarding DE and nutrition professionals. To discuss examples of when dietitians can model good

leadership skills and help to prevent the spread of disordered eating.

Objectives

DE Definitions• Subthreshold conditions prior to ED dx (ADA position)• Troublesome eating behaviors (restrictive dieting,

bingeing, or purging, which occur less frequently or are less severe than those required to meet the full criteria for the ED dx)

• Eating-related issues which include, but are not limited to, eating for reasons other than hunger (comfort, stress); and labeling foods as “good,” “bad,” “unhealthy,” or “fattening,” (esp. if leading to feelings of anxiety & guilt if these foods are consumed)

• http://www.youtube.com/watch?v=QYeFLVDSUBQ&feature=related Cory Everson

Background Research• Not large amount of data on DE esp concerning RDs• 80s (dance/drama majors)• ‘85 (jrs/srs dietetic college students vomit after

eating• ’89 (24% dietetic majors-EDs/obsessions w/food)• ‘89 (emphasis on body image/food may > risk for dietitians to experience bulimia)• ‘91 (did not find high degree of DE in dietetic majors)• ‘93 (dietetic majors not more susceptible to bulimia)

DE & Nutrition ProfessionalsIncidence of Eating Disorders among Selected Female

University Students, ADA, (Palmquiest Fredenberg, Berglund, Dieken), Jan 1996

• 5 grps female jrs/srs (N=163) 4 midW colleges• Voluntary• EAT (40 objective statements in 6-pt, forced-

choice self report format(score of >29 s/s ED) • SAS used (Statistical Analysis System), scores

analyzed by analysis of variance, Tukeys used for post hoc comparisons of means for ea grp

Table 1 - Dietetic students responses to statements on EAT Often Very Often Always

CP ___ _ DPD CP DPD CP DPD

N=64; 30 students in CPs, 34 students in DPD

Statements n % n % n % n % n % n %Aware of calories ate 7 23 9 26 13 43 9 26 5 17 11 32

Feel guilty after eating 2 7 2 6 1 3 3 9 0 0 4 12

Have dieting behavior 1 3 5 15 2 7 7 21 1 3 3 9

Others say I’m too thin 1 3 3 9 1 3 3 9 1 3 1 3

Preocc with body fat 4 13 7 21 2 7 5 15 1 3 3 9Food controls my life 2 7 3 9 1 3 3 9 0 0 1 3Think about food a lot 2 7 7 21 2 7 4 12 0 0 3 9

Terrified re:overweight 6 20 1 3 1 3 8 24 3 10 5 15

Preoccupied with food 5 17 8 24 3 10 3 9 0 0 4 12

Table 2 - Mean (+/- standard deviation) EAT scores & % of scores symptomatic of ED for female groups

C

*Means are not significantly different according to Tukeys studentized range test (p>.05)

* Percent of subjects who scored in the symptomatic range for an ED as defined by an EAT score of 30 or greater

Scores Dietetics CPn=30

Dietetic DPDn=34

Home Ecn=35

Athletic Progn=31

Sororityn=33

EAT scores*SymptomaticScores (%)*

15.4+/-9.7

3.3

21.1+/-16.8

17.7

14.3+/-11.4

2.9

14.5+/-10.5

6.5

14.5+/-12.1

9.1

DE & Nutrition ProfessionalsEating Disordered Behavior in Dietetics Students and

Students in Other Majors, ADA, (Sept ‘99) Vol 99:9, pg 1100-1102

• If…[women’s]…eating behavior is restrictive, …interest in food may manifest …through food-related activities such as collecting recipes, preparing food for others, or even exploring a career in nutrition. (ED Diagnostic & Statistical Manual of Mental Disorders IV, APA, 1994)

• Based on prev. study’s inconsistencies, this study revisited same subject at NE university with undergraduate students

DE & Nutrition Professionals• 165 women/46 men (BMI normal = 24, ages = early

20s,) 6 majors/5grps, voluntarily answered (anonymous) self-report questionaire developed by National Eating Disorder Screening Program ’96 (21 item instrument scored on 4 choice format (never-all of the time), eg of ?s:-Are you bothered by the thought of having fat on your body?-Have you taken any laxatives to control your weight:-Have you exercised to control your weight even when advised not too?-Do your concerns/behaviors about eating/weight interfere with life?

DE & Nutrition Professionals• Biology/Nursing higher wt/BMI• Males higher ht/wt/BMI • Mean differences found/data analyzed using

SPSS (Tukey studentized range statistic & Kruskal-Wallis analysis of variance)

• 4 variables summarized ?s– differences by major were examined by one-way analysis of variance w/ Tukeys used for post hoc comparisons, criteria set for .05 level of significance

Means & medians on summary variables for college females by major

Variable(Summarized)

DieteticsMean/Med

ExerciseMean/Med

DanceMean/Med

PsychologyMean/Med

Biology/nursingMean/Med

CognitiveConcerns

8.6/9 y 7.9/8 y 7.6/7 y z 7.3/6 y z 7.2/7 z

Binge/PurgeBehavior

2.6/1 y 1.2/0 z 2.2/2 y z 2.0/1 y z 0.9/0 y

ExcessiveExercise

1.5/1 y z 1.4/1 y z 2.1/1 y 1.3/1 y 1.1/1 z

LifeInterference

1.6/1 y 0.7/1 z 1.6/1 y 1.1/1 y z 0.8/0 z

Means in same row with different superscripts differ significantly, Tukey test p<0.5

DE & Nutrition Professionals

Prevalence of Eating Disorders in Dietetic & other Health-Related Majors: A Study of College Students, (Mehr, Clemens, Roach, Beech) Univ of Memphis, ADA Poster Session

• Dietetic/pre-med/pre-nursing students from 10 TN universities

• Online survey, ANOVA to analyze EAT-26• Pre-med were signif higher than pre-nursing & dietetic majors • No signif difference b/w dietetic & pre-nursing students• Out of 18 participants that had EAT-26 indicative of EDs,

only 4 (3 pre-med, 1 dietetic) had sought help

DE & Nutrition ProfessionalsAttitudes & Behaviors of Dietetic Educators & Their

Students Towards Eating Disorders, (Beary, Flint) ADA, March 2003, Wash State University

• Cross-sect. surveys, EAT-26• 30 diff dietetic programs, 365 undergrads

18% had ED

Scored ED

No ED

71% ED issue

Some type of ED issue

No ED pro

DE & Nutrition Professionals• 41% binge, 12% vomit

• signif amt students agreed they need skills on prevent/tx ED

41% Binge

BingeDo Not Binge

DE & Nutrition Professionals• 93 educators (backward stepwise multiple

regression used to show that educators who taught food prep & MNT agreed [sign.more than other educators] that if a student has a reason why they don’t want to sample foods, they should not have too), students indicated sampling food is problematic for them

• Conclusions: students enrolled in dietetic programs may be more susceptible to eating disorders & educators should be aware of the implications allowing ED students enrollment in food-related courses

DE & Nutrition Professionals

Eating Disorders among Dietetics Students: An Educator’s Dilemma, (Houston, Bassler, Anderson), ADA, April 2008 article

• Dietetic practitioners & DE/obesity – inconsistent evidence “Although study findings are not consistent, evidence suggests that RDs throughout the world may be at greater risk for a wide range of DE issues when compared to other professionals.”

• 1/3 of dietetics students studied are motivated to enter the field by personal experiences (self or friends) with obesity or eating disorders

• Ethical considerations that arise when dietetic students willingly disclose such conditions to their program directors, preceptors, and/or clients makes it important to openly dialogue about these types of situations

DE & Nutrition Professionals• A common concern among educators is whether or not

participation in the rigors of dietetics education will impede successful recovery or remission for those with ED

• Specific resources may be needed to assist students to prevent a relapse or to provide care if a relapse occurs during academic career

• Proactive course work, self assessment, & journaling• Outcomes assessment data indicate that changes

through cognitive restructuring can take place in dietetic students’ relationships with food and their bodies when given the opportunity for this type of reflective journey.

DE & Nutrition Professionals• The ADA/CDR Code of Ethics for the Profession of Dietetics

offers a framework to address the concerns identified by these scenarios…the dietetics practitioner:

● Principle 4: . . . assumes responsibility and accountability for personal competence in practice, continually striving to increase professional knowledge and skills and to apply them in practice.

● Principle 5: . . . recognizes and exercises professional judgment within the limits of his/her qualifications and collaborates with others, seeks counsel, and makes referrals as appropriate.

● Principle 17c: . . . withdraws from professional practice . . . [if he/she has] an emotional or mental disability that affects his/her practice in a manner that could harm the client or others.

DE & Nutrition Professionals• Some RDs liken experiences w/ ED to that of DM,

CAD, or any other chronic condition, stating that real-world learning gives them insight he/she would never have ordinarily.

• But how appropriate is it for RDs to disclose their own issues w/ food & DE/ED?

• Before disclosing, they should ask him- or herself if it will serve a useful purpose?

• Is now the best time to disclose the information?• Does the RD have adequate skills to handle the

interaction once the disclosure has been made?

How Should Healthy Weight Be Defined?

• 63% of healthcare professionals agree that a “healthy weight” falls into “normal” category for BMI

• 91% agree that it is the weight that results from habit of wholesome eating & regular activity to maintain fitness regardless of BMI

• 57% agree both are true• Everyone is an advertisement/role models imp

Resources:The Eating Disorders Clinical Pocket Guide, Quick Reference for Healthcare Providers by Jessica Setnick, MS, RD/LD

understandingnutrition.com

Help Stop the Spread of Eating Disorders

-Stop commenting negatively -Stop praising weight loss-Encourage following natural cues -Listen for the underlying messages -Seek professional help -Do not recommend weight loss as a method to “feel better about yourself.”

Top 10 Reasons Not to Diet

Don’t workDangerousExpensiveCause fatigueDisrupt normal eatingIncrease food preoccupationDiminishes womenDecreases self-esteemStunts mental & physical growthIncreases size prejudice

Etiology of ED•Family environment

-Relatives w/ ED, you have 7-12x greater risk-Study of identical twins in diff family environment with diff diets/Their size & bone structures differed significantly

--Consider a sunflower seed…Environment can activate the seed to grow

Etiology of ED•Genes

-----twin studies show disease is 80% genetic Genetics/Heritability

AN 31-56%BN 50-80%BED 41% (1-5% pop)

Etiology of ED•Culture

DNA does not determine destinyDiet & Exercise count

-Freshmen fifteenED alone are up 10%/9 yrs on college campus’ (20% college students admit to ED)(75% have not sought help)

-Hispanics migrating to US-42% of 1st-3rd graders want to be thinner-Highest risk pop.s: food/culinary industry, fashion models,college students,athletes,& dancers

For every real image of a celebrity that we see, we see 100 untrue images

Most models are 98% thinner then typical American women

80% of women are dissatisfied with their appearance

(being overwt can symbolize: prosperity, the ability to survive, and fertility for women)

30% of women getting infertility tx have ED

Etiology of EDs

•Psychodynamic•Personality traits

Etiology of EDs

•Biology•Ind diet & response

DE & Nutrition ProfessionalsMamavision.com• http://www.youtube.com/watch?v=I2BRuHwu

9RU weight watcher bloggers

• http://www.youtube.com/user/bringhomethebacon00 father verbally abusing daughter

• http://americathebeautifuldoc.com/• http://www.youtube.com/watch?v=C7143sc_

HbU&NR=1 Jean Kilbourne Killing Us Softly

• http://www.youtube.com/watch?v=C7143sc_HbU&NR=1 endfattalk.org

DE & Nutrition Professionals

Considerations re: tx of DE in RDs & others

• Dx Criteria (DSM-IV Criteria for EDNOS (307.50) Disorders of eating that do not meet criteria for any specific ED (ins could eventually pay for prevention)

• Assessing (free screening eatingdisorder.org)• Physical Signs • Medical Components (Labs) • Symptoms (ICD-9 Codes etc.)• Meds

DE Treatment– Individual Therapy• Interpersonal Therapy (IPT)• Cognitive Behavior Therapy (CBT)• Dialectical Behavior Therapy (DBT)Family TherapyArt TherapyPositive Music TherapyOccupational TherapyNutrition Support [MD who will write prescriptions]Decreasing Exposure to Triggers (70% of people feel

worse about their body after 3 min of viewing fashions mag[Eng Parliament may req warnings])

ED Treatment

• Continuum of Care– Impatient (treatment early in the development of dx is crucial – a

changed environment can change prevalence of s/s) the longer the ill eating habits go untreated, the more damaging

– Partial Hospitalization– Intensive Outpatient– Outpatient with long-term support groups

• Find a normal eater & model them

• Factors to Consider when Matching Someone to a Treatment Center– Facility’s capabilities, philosophy, strong f/u care, cost, length of

stay, other issues treated, visitors, religious affiliation

DE & Nutrition Professionals

Position of ADA: Nutrition Intervention in the Tx of Anorexia, Bulimia & other ED (2006)

- “EDNOS… …often overshadowed…it is at least as common as…” “Prevalence rates elude researchers because there is no simple definition of EDNOS.” “…a large proportion…are neglected.”

• Binge eating is often coping to deal with emotional distress…” “often precedes dieting”

• In attempts to identify causes of the obesity epidemic, researchers are addressing associations between binge eating disorder and obesity & overweight

DE & Nutrition Professionals• Factors that may contribute to the development of

binge eating disorder behaviors include repeated exposure to negative comments about shape, weight, and eating; negative self-evaluation; perfectionism; and childhood obesity. Also, low self-esteem, high levels of body concern, high use of escape avoidance coping, and low levels of perceived social support are commonly seen in binge eating disorder

• Supportive social structure in place to prevent relapse during stress (long-term management)

• Nutritional components (meal planning, social eating, strategies, egs of restrictive eating styles)

‘Americans who are 30 or more lb. over wt cost the country an est. $147 billion in wt-related medical bills in 2008 (double from a decade ago)…Former pres. Bill Clinton stated changes must be made in “what goes on at home, in the neighborhood, in the schools and in the community”… “We are trying to turn the Titanic around before it hits the iceberg.”’

-USA Today

“All that is necessary for the triumph of evil is for good men to do nothing” Edmund Burke

Insanity – doing the same thing over and over again and expecting different results

“I had to shift my perspective and my lifestyle before I could let go of the excess weight and work on becoming strong and healthy.” - Victoria Johnson, fitness expert

After Boston Massacre:“If need be I will raise one thousand men, subsist them at my own expense, and march myself at their head for the relief of Boston.”

George Washington

DE & Nutrition Professionals• What are you saying individually?• What are we saying corporately (together) to

the public with DE?• Are we in harmony & louder than nutrition

quackery or fast food commercials (to get a clear message across)

• Is our lifestyle matching what we are saying? Does it matter?

• Are we being proactive/operating on the offense?

NEDA:“Prevention efforts will fail, or worse, inadvertently encourage disordered eating, if they concentrate solely on warning the public about the signs, symptoms, and dangers of eating disorders. Effective prevention programs must also address:-Our cultural obsession with slenderness as a physical, psychological, & moral issue.-The roles of men & women in our society.-The development of people’s self-esteem & self-respect in a variety of areas (school, work, community service, hobbies, etc.) that transcend physical appearance.”

ED & DE Resources

• Intuitive Eating: A Revolutionary Program that Works By Evelyn Tribole, MS, RD and Elyse Resch, MS, RD, FADA. New York, NY: St. Martin’s Paperbacks; 1995.

• The Rules of Normal Eating By Karen R. Koenig, MEd. Carlsbad, CA: Gurze Books; 2005.

• Underage and Overweight: America’s Childhood Obesity Epidemic: What Every Family

• Needs to Know By Frances M. Berg, MS. New York, NY: Hatherleigh Press; 2003.

• Big Fat Lies: The Truth about Your Weight and Your Health By Glenn A. Gaesser, PhD. Carlsbad, CA: Gurze Books; 2002.

• Am I Fat? Helping Young Children Accept Differences in Body Size By Joanne P. Ikeda, MA, RD and Priscilla Naworski, MS. Scotts Valley, CA: Education, Training, and Research Assoc; 1993.

ED & DE Resources• How to Get Your Kids to Eat . . . but Not Too Much By Ellyn

Satter, RD. Palo Alto, CA: Bull Publishing; 1987. ellynsatter.com (competent eater, normal eating, internal regulation, eating attitudes)

• Eating Disorders: A Clinical Guide to Counseling and Treatment. By Monika M. Woolsey, MS, RD. Chicago, IL: American Dietetic Association; 2002.

• Eating Disorders Review http://www.gurze.com/client/client_pages/newsletteredt.cfm

• Perspectives http://www.renfrewcenter.com/for-professionals/index.asp

• The Remuda Review http://www.remudaranch.com/professional/index.asp

• Kate Clemmer LGSW…AC Library Eating D/O Awareness on Campus

My Personal Story-Raised around DE & premature death like they are normal-Temp. experienced ED & low self-esteem-Recognized a problem to fix in society-Traditional healthcare industry/life…lost my vision-Appreciate AHEC/caucus

Good news: More RDs:• (Old saying: If you hang around with 4 people who are struggling (DE),

you are probably going to the 5th.)

• are getting tx for balancing life• asking themselves what motivates them• exploring if their goals are for the common good• discovering unique purposes/strengths• taking time off until they find their niche in nutrition

in order to be replenished mentally, physically, & emotionally

• learning to express their creativity • marketing (fashionable) nutrition to the populations

only they can reach

DE & Nutrition ProfessionalsIn Summary:• DE is troublesome eating behavior that usually

includes labeling foods and wt issues (national problem)

• Words (esp negative comments) and actions can contribute to negative body image and DE…professionals should be aware of them

• 1/3 of RDs enter the field w/ DE/obesity experience, some studies say there in higher risk for RDs to develop ED/DE & some indicate there is not (support systems should be avail)

DE & Nutrition Professionals• Some researchers propose DPDs need

examined• Others believe all dietetic programs help

reduce anxiety by exposure to accurate nut’n info

• Results do not reflect epidemic of ED in dietetic majors

• There is not enough research completed re: DE and nutrition professionals

Which RD would you trust or which would prevent DE disease and what messages are being given?

• I don’t have a lot of time. This is my routine but no one seems to mind. Nutrition is frustrating anyway.

• Casually dressed girl in a donut shop with donuts• She is being influenced more than she in

influencing & has become complacent• When people look at her, what do they think• “She needs help.”

Which RD would you trust or which would prevent DE disease and what messages are

being given?• This is so delicious. Do you want to taste it? I absolutely

love my field.• Kitchen, Business attire, Fruited Bagel• After CE – time management life coaches to balance

personal/professional goals, RD friends, change circle of influence who saw her as insignificant to those who believer in her learning about emotional, mental, physical and spiritual needs, getting her needs met so she can confidently go out into a nutritionally confused world and speak and model truth and balance

DE & Nutrition Professionals• Identify triggers & resolve or discuss what to do when

they arise (eg. Popcorn, friends with bad attitudes) find positive triggers (creative hobbies/+music) & explain that these need to outweigh neg triggers or imbalance & unwanted behaviors will occur

• Individual tx goals-include environmental goals (By next visit I will no longer allow myself to be entertained by TV programming that endorses overeating or I will have changed my lingo about food being something that control me)

• Medical/physical stability & physical health restoration – eg. Reaching desired wt, corrected BP/BS, improved mental health (decreased depression meds)

• “Normalized” (non-restrictive) eating, including variety, balance, nutritional adequacy & comfort with food

DE & Nutrition Professionals• Absence of purging behaviors• Family therapy, healthy relationships• Be aware that some health professionals suffer

from DE & are not portraying good leadership in our field (industrialized countries w/ obesity & DM issues)

DE & Nutrition Professionals• motivators: inspiration vs. guilt & fear

(what do my words primarily create?) do I call America addicted & at risk for disease & premature death vs. overcoming a consequence of being industrialized and shifting toward prevention (how do you see yourself and others?) how powerful are words in determining future outcomes?

DE & Nutrition Professionals• Most question if they are a good person

because they struggle with disordered eating. The fact that this bothers them is the best argument that they are a good person…once this is explained, it motivates most to change

• Those who profess to be good but do not consider their abnormal eating…I would question if they are good nutrition professionals. We should not live comfortably with it.

DE & Nutrition Professionals• It takes a while to change negative nutrition

lingo…mostly because people usually want to fit in & some like their peers and that is what has been culturally accepted (counteract negativity and change what surrounds you or what you listen too (media & music that downplays people) ears are not garbage cans…they connect to your brain and what goes in them over time and sometimes immediately affects how you think

DE & Nutrition Professionals

• We are born into a physically sick country/world• I want to challenge you to recognize the negative

mentality of many and focus on Americans because we are supposed to be world leaders and ask yourself how am I not going to adopt this thinking or worse yet let it influence my eating and my health. Can we separate ourselves long enough (diff for qone) to stay strong with the message of balance and variety & live out our goals?

-Positive role models-Positive music

DE & Nutrition Professionals

DE & Nutrition Professionals• What you do is a product of what you believe

therefore good counselors know not to focus on behavior. Once beliefs change, behaviors follow eventually. Most people criticize themselves (this is not normal but a symptom to low-self esteem) and therefore they eat in behaviors to reinforce what they believe. How many Dr.s are going to listen to a dietitian with poor self esteem. Most don’t have time to encourage us…we have to find our own accountability circle to influence to boost our moral and keep it high…it takes work because most of the world is working in the other direction…against us…some directly some indirectly

DE & Nutrition Professionals• Nutrition Stigmas/Negative Nutrition Lingo• Leading with Verbal Skills– Power of

words/triggers-words/foods/places/persons– There are some people with DE who are teachable,

listening, asking genuine ?s who are not going to go along with society norms of doing what everyone else is doing & if your observations are different then I suggest repeating what I just said until your perspective changes – once you are convinced, it is much easier to convince others & to persuade them to conform

DE & Nutrition Professionals• Is our message positive/negative ? Which

message motivates people to shift/change habit/lifestyle?

• Which statement do you like best?:– “Dark chocolate has antioxidants.” or “Don’t eat

chocolate.” When do repeatative words become develop into a mentality? Self-fulfilling prophecies. How many times can you say something negative without it affecting your behavior or someone else’s? Even if it’s a joke.

DE & Nutrition Professionals• Eg. “I always eat the whole box of chocolates.

I can’t control myself.”– On the flip side How many times can you say

something positive without it affecting behavior? Are the positive things we say outweighing the negative---think how you feel if someone belittles or discourages you vs. encourages you

– Which atmosphere is success more likely to occur?– Many with unhealthy habits (including DE & ED)

need to verbalize what they are going to do before they can actually do it overtime words build or break down

DE & Nutrition Professionals• Leading with Diet and Exercise (Lifestyle)- modeling

behaviors is the most influential thing on others around us eg. Parents & children adopting food likes/dislikes , peer pressure (is the positive at home outweighing negative in society

• What if all the dietitians ate and exercised right and got heavily involved in community activities (esp. where parents are) we might extinguish our own field ( I hope there is no need for it someday) another benefit would be that we would be in good moods (foods affect mood) and mood affects our whole being and those around us

DE & Nutrition Professionals• Leading with dress/attire: professionalism

resources, this is what helps others take us serioiusly, do I take this national crisis seriously Ask Theresa re: fashion consultant– Life coaches to help balance out other areas of lifeDo RDs have the right to tell people what to do if

they have not mastered it themselves?

DE & Nutrition Professionals• Leading with where you spend most of your

time/your environment/where people see youMost people are like sponges- soaking in

consciously/subconsciously ideas that when acted upon affect food choices/body image/ self esteem

3 previous points – verbalization/diet/dress can all be examples of how we treat others

DE & Nutrition Professionals• Do we have positive mentors with balanced

mentalities without DE surrounding us or those who are at least a phone call away – they help us to grow so we don’t repeat mistakes (mistakes we made or they made)

(NE,ADA,Family…how do we talk about these?)The environments we create for ourselves

usually determine environments we provide for our clients ( limited time to make an impression)

DE & Nutrition Professionals• Are we treating them the way we want to be

treated? If not, we are probably not feeling successful

• In general, if you place yourself in the right environments- everything else will fall into place – verbal skills, diet, dress

Old saying: If you hang around with 4 people who are struggling (DE), you are probably going to the 5th.How much time is spent looking at underwt models with ED or computer altered photos.

DE & Nutrition Professionals• Be proactive/on the offense for balanced

lifestyle get assistance when needed– Life coaches – don’t stop at one– RDS, Homeopaths, CN– Mentors– Relationship counseling

RDs are helping.

Proverbs 13:25 “The good man eats to live, while the evil man lives to eat.”

Disordered Eating & Nutrition Professionals

• Anorexia may be caused by dopamine over activity in the brain which control reward and how positive & negative reinforcement are viewed. It is the number one cause of death from any psychiatric illness

Walter H. Kaye MD, University of Pittsburgh Medical Center Biological Psychiatry

Disordered Eating &Nutrition Professionals

• In attempts to identify causes of the obesity epidemic, researchers are addressing associations between binge eating disorder and obesity and overweight (3). Differing from anorexia nervosa and bulimia nervosa, bingeing often precedes dieting behaviors (44), binge eating disorder occurrences among men and women are

Disordered Eating & Nutrition Professionals

similar (45), and binge eating disorder occurs across ethnically diverse samples (46). Factors that may contribute to the development of binge eating disorder behaviors include repeated exposure to negative comments about shape, weight, and eating; negative self-evaluation; perfectionism; and childhood obesity (47). Also, low self-esteem, high levels of body concern, high use of escape avoidance coping, and low levels of perceived social support are commonly seen in binge eating disorder (4). DM ? Position Statement

• psychotherapy, behavioral weight-loss treatment, & psychopharmacology,…dialectical behavior therapy, which is a form of psychotherapy that teaches mindful eating and targets emotion

regulation, has shown preliminary efficacy in reducing binge eating• Primary emphasis on binge eating reduction and a secondary emphasis on weight loss

Positon statement paper/conclusion

• Another DE pattern• Night eating syndrome is characterized by 50% of

caloric intake consumed after 7 PM; trouble getting to sleep or staying asleep, morning anorexia (55), nighttime awakenings (one or more episodes per night) with full alertness and frequently accompanied by ingestion of snacks; the presence of symptoms for a duration of 3

months; and the absence of bulimia nervosa and binge eating disorder

When to refer to treatment centers

• Admission to inpatient eating disorder treatment is justified when the patient is diagnosed with an eating disorder that meets DSMIV Criteria and when the patient manifests disabling medical or psychiatric symptoms which impede the treatment of the eating disorder in a less restrictive setting.

“Young girls are more afraid of becoming fat than they are of cancer, nuclear war, or losing their parents.“ -Liza Berzins, PhD. 1997 Congressional briefing on eating disorders

DE & Nutrition Professionals

• Types of Binge Eating– Deprivation-sensitive – caused by actual or mental

restriction of certain foods or food in general. “I’ll diet tomorrow, so I’ll eat a lot now.”

– Affect-triggered – eating in response to strong emotions. “I’m so angry at my husband. I’m going to finish his last piece of pie”

– Addictive or Dissociative – eating used to “numb out”, avoid, or procrastinate. “I’m bored. Eating would fill the time.” see slides at end

DE & Nutrition ProfessionalsInternet Resources,ED & Special Groups,Prevention in

Diff Groups, when to refer to tx centers

• http://www.remudaranch.com/professional/when_refer/index.php (referral info & s/s)

• Factors to Consider when Matching Someone to a Treatment Center– Facility’s capabilities, philosophy, strong f/u care,

cost, length of stay, other issues treated, visitors, religious affiliation

Common MNT ICD-9 Codes• COMMON MNT DIAGNOSTIC CODES (ICD-9):• • □ Abdominal Pain 789.0 □ Abnormal Weight Gain 783.1• □ Abnormal Weight Loss 783.2 □ Allergy, Food Related 683.1• □ Anemia 281.9 □ Anorexia 783• □ Anorexia Nervosa 307.1 □ Bowel, Irritable Syndrome 564.1• □ Bulimia 307.51 □ Cardiovascular Disease 429.2• □ Celiac Sprue 579.0 □ Congestive Heart Failure 398.91• □ Constipation, Unspecified 564.00 □ Coronary Artery Diseases 414.0• □ Crohn’s Disease 555.9 □ Dehydration 276.5• □ Diabetes, Gestational 648.8 □ Diabetes, Type I 250.01• □ Diabetes, Type II 250.00 □ Diarrhea 558.9• □ Eating Disorder, NOS 307.5 □ Failure to Thrive 783.4• □ Gastritis 535.4 □ Glucose Intolerance 271.9• □ Hypercholesterolemia 272.0 □ Hyperlipidemia, NOS 272.4• □ Hypertension, Essential 401.9 □ Hypoglycemia 276.8• □ Lactose Intolerance 271.3 □ Malnutrition, Mild 263.1• □ Malnutrition, Moderate 263.0 □ Nausea / Vomiting 787.0• □ Nutritional Deficiency 269.9 □ Obesity 278.0• □ Osteoporosis 733.0 □ Weight Loss 783.21

Basic ED Statistics

• ED have the highest mortality rate of any mental illness…this does not include DE and deaths associated with obesity

Unhealthy Foods Habits• DE is real, going undx, & costing the nation (the

opposite of balance, variety, & moderation)– Persistent dieting– Eating hamburger and potatoes every night for dinner– Eating chocolate ice cream every night before bed– Eating a bag of chips every time you watch the TV– Getting up every night at midnight to have a full

course meal– Eating fast food every day– Bingeing while you drive because there is no time

(truck drivers)