Download Eating disorders

Kin 110
Ch. Eating Disorders
(574-595)
Ch. 15 Pregnancy and
Breastfeeding
(645-667)
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Eating Disorders
• Eating serves psychological, social and
cultural purposes
• Media bombards us with ‘ideal’ body
types
• may develop unhealthy relationship with
eating, obsessive weight loss and
strange rituals around food
• Food often linked with personal and
emotional experiences
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This Is In
• In 1998, Mattel
overhauled Barbie’s
look for the millennium,
giving her slimmer hips,
a wider waist, and
smaller breasts.
• Barbie’s periodic
overhauls are meant to
fit the fashion of the
times.
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Eating Disorders
• Disordered eating - temporary or mild change in eating
patterns
• Eating disorders - illness that can seriously interfere with
daily activities - persistent inability to eat in moderation
• The eating disorder continuum
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Eating Disorders: No Simple Causes
• Predisposition
• Social factors
– Expectations for body size, shape
• Psychological factors
– Peer relationships, family expectations, emotional
trauma
• Biological factors
– Neurotransmitter levels
• Genetic factors
– Synthesis and release of leptin, orexin
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Anorexia Nervosa
• psychological loss or denial of appetite and self
starvation, related in part to distorted body image
and various social pressures associated with
puberty
• extreme weight loss, irrational fear of obesity and
weight gain
• Diagnostic criteria
– Body weight < 85% of expected
(BMI  17.5 kg/m2)
– Intense fear of weight gain
– Distorted body image
– Amenorrhea
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BMI and Underweight
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Anorexia Nervosa
• Profile - competitive, obsessive, parents set
extremely high standards
• hypergymnasia - excessive exercise
• early warning signs - rituals with food
• cook large meals for others, not self
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Warning Signs of Anorexia
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Side Effects of Excessive Weight
Loss in Anorexia Nervosa
• Neuropsychiatric
– Abnormal taste
sensation
– Depression
– Impaired thought
process
• Cardiac
– Loss of cardiac
muscle, resulting in a
smaller heart
– Abnormal heart
rhythm
– Increased risk of
sudden death
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More Side Effects
• Hematological
– Leukopenia
(abnormal decrease
of white blood cells)
– Iron-deficiency
anemia
• Gastrointestinal
– Delayed gastric
emptying
– Bloating
– Constipation
– Abdominal pain
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The
Progression
of Anorexia
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Anorexia Nervosa: Treatment
• Goals
– Stabilize physical condition
– Convert patient into participant
• Restoring nutritional status
• Gradual weight gain
• Psychotherapy
– Individual
– Group
– Family
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Bulimia Nervosa
• college age young adults
• large quantities of food are eaten at one time
(binge) and then purged from the body by
vomiting, laxatives or other means
• difficult to recognize, outer appearance is normal,
self reported
• Diagnostic criteria
– Recurrent binge eating
– Recurrent purging, excessive exercise, fasting
– Excessive concern about weight, shape
– Absence of anorexia nervosa
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Bulimia Nervosa: Binge/Purge
Cycle
• Binge: large amount
of food, short period
of time
– High-calorie, high-fat
foods
• Purge
– Affects fluid and
electrolyte balance
– Can be lifethreatening
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Bulimia Nervosa: Treatment
• Medical
• Nutritional
• Psychotherapy
– Antidepressant medications
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Binge Disorder
• Compulsive overeating
– binge episodes without purging at least twice per
week
• may not deal with emotional problems
effectively
• never learned appropriate ways to deal with
feelings
• Should learn to eat in response to hunger
• avoid sliming diets initially
• generally require professional help.
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Binge-Eating Disorder
• Diagnostic criteria
– Recurrent binge eating
– Distress over eating
behaviors
– No recurrent purging
– Absence of anorexia
nervosa
• Triggers of binge eating
– Stress
– Conflict
– Frequent dieting
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Binge-Eating Disorder:
Treatment
• Psychotherapy
– Antidepressant
medications
• Long-term support
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Preventing eating Disorders
• Some concern about diet, health and
weight is normal
• some fluctuation in weight and appetite is
normal
• *large changes consult physician
• Discourage restrictive diets, meal skipping
and fasting
• provide information about the normal
changes with puberty
• correct misconceptions about
• nutrition, body weight, weight loss
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Preventing Disorders
• Carefully phrase weight related
comments/recommendations
• encourage normal expression of disruptive
emotions
• encourage children to eat only when they are
hungry
• provide adolescents with some choices and selfaccountability
• Increase self acceptance
• Enhance tolerance for diversity in body weight and
shape
• Emphasize that thinness is not necessarily
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associated with better athletic performance
Eating Disorders: Related Issues
• Males: an overlooked population
– Fewer instances than females
– Men involved in sports, modeling, entertainment
• Pressure for certain weight, shape
• Anorexia athletica
– Sports-related eating disorders
– Body size/shape important in competition
– Pressure from coaches
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Other Eating Disorders
• Female Athlete Triad
• high percentage of female athletes exhibit
disordered eating patterns
• coupled with irregular menstruation
– ammenorhea
• loss of bone mass - osteoporosis
• treatment –
–
–
–
decrease preoccupation with food
increase meals
rebuild body
establish regular menstruation
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Eating Disorders: Related
Issues
•
•
•
•
Vegetarianism and eating disorders
Smoking and eating disorders
Baryophobia
Infantile anorexia
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Scary Statistics
• About 5 million Americans have
anorexia nervosa, bulimia, or bingeeating disorders.
• Researchers estimate that 15 percent of
young women have disordered eating
attitudes and behaviors.
• Every year an estimated 1,000 people
die from anorexia nervosa.
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ADA: Nutrition Intervention
• It is the position of the American Dietetic Association
(ADA) that nutrition education and nutrition
intervention, by a registered dietitian, is an essential
component of the team treatment of patients with
anorexia nervosa, bulimia nervosa, and eating
disorders not otherwise specified (EDNOS) during
assessment and treatment across the continuum of
care.
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Pregnancy Overview
• Special considerations for time of life
• illustrates larger importance of nutrition on
body functioning
• Important to plan pregnancy
– modification of lifestyle
– adequate nutrition
– prevent fetal and infant problems
• + 300 kcal per day
– milk, meats and alt.
– Iron, calcium, and folate (600ug/day)
• breastfeeding
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Pregnancy
– Nutrition before conception
• Risk assessment, health
promotion, intervention
• Weight
– Maintain a healthy weight
• Vitamins
– 400 micrograms supplemental folic acid/day
– in addition to folate intake in diet
» total of 600ug recommended
– Avoid high doses of retinol
• Substance use
– Eliminate prior to pregnancy
Photo © Photodisc
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Pregnancy
• Physiology of pregnancy
– Stages of human fetal growth
• Blastogenic stage: first 2 weeks
– Cells differentiate into fetus, placenta
• Embryonic stage: weeks 3–8
– Development
of organ systems
• Fetal stage:
week 9—delivery
– Growth
• nourished until birth by placenta
–
–
–
–
organ formed in mothers uterus
oxygen and nutrient exchange
fetal waste removal
release of hormones of pregnancy
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Early Growth
• Hyperplasia
– increase in cell number
• Hypertrophy
– increase in cell size
• 3 weeks
– specialized organs and body parts begin to form
– * many women still do not know they are
pregnant*
• 13 weeks
– heart is functional, most organs formed, fetus can
move
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First Trimester
• 9 months broken into three sections,
trimesters
• first trimester is critical time
– spontaneous abortion, ~1/3
• miscarriage
– genetic defects or fatal error in fetal development
• very important to avoid harmful substances
and maintain adequate nutrition
– nutritional deficiencies transferred through
placenta
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Second Trimester
• Fetus weighs ~ one ounce at beginning of
second trimester
• limbs fully formed, has ears and begins to
form tooth sockets
• fetal heart beat can be detected with
stethoscope
• begins to look like infant, formed bones, can
kick, suck its thumb
• mothers breast weight inc. 30%
• under nutrition can impair ability to breast
feed
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Third Trimester
• Weighs 2-3 lbs. At beginning
• Fetus will deplete iron stores and blood
glucose of mother
• infants born after 26 weeks have a good
chance of survival in nursery
– difficulties suckling and swallowing
• 9 months
– 7-9 lbs. (3-4 kg) 50 cm long
– soft spot where skull bones will fuse (12-18
months)
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Pregnancy
• Physiology of
pregnancy
– Maternal changes
• Growth of adipose,
breast, uterine tissues
• Increase blood volume
• Slower GI motility
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Nutrient Needs
• emphasis is on increased nutritional
requirements
– individual assessment of requirements and
counselling
• Energy Needs
• + 300 kcal / day
– in 2nd and 3rd trimesters ( 2 cups low fat milk and
piece of bread)
• nutrient dense foods, increased nutrient
requirements vs kcal
• vitamin and mineral needs increase 20-100%;
kcal 15 %
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Weight Gain
• If active, add extra kcal for exercise to total
intake
– Walking, cycling, swimming recommended
activities
– specific precautions
• Weight gain one of best predictors of
pregnancy outcome
– 2 - 4 lbs. in first trimester
– .75 - 1 LB per week, 2nd and 3rd
– total gain 25-35 lbs. (BMI ~20-26 kg/m2)
• Depends on BMI - Table 15.3
– fig 15.7
• Requires regular monitoring
• weekly record, allows for adjustments
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Weight During Pregnancy
• Overweight and obese women have increased risks of several
problems, including preterm delivery and stillbirth.
• In addition, obese women are at higher risk for
– high blood pressure
– gestational diabetes (a form of diabetes that is associated with
pregnancy; it often is controlled through diet alone)
– preeclampsia (a condition marked by high blood pressure, fluid retention,
and protein in the urine)
– prolonged labor
– unplanned cesarean section
– difficulty initiating and continuing breastfeeding
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Specific Nutrients
• RDA for protein
• Increase 10 - 15 g
– many already over this
– important to check,
– role of protein?
• Carbohydrates
– 100 g / day to prevent ketosis(avg 200)
• vitamins
• most increase slightly - B vit +30%
– B6 + 45%
• Folate (RDA 600ug) + 50%
– synthesis of DNA, rbc formation
– folate rich fruits and veg, fortified cereals
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Mineral Needs
• Iodide - 220mg
• IRON
• 2 times the RDA in last two trimesters (30
mg/day)
• hemoglobin synthesis
– *fortified breakfast cereals*
– attention to nausea and absorption (caffeine,
dairy can inhibit absorption)
• With severe iron deficiency, LBW, and risk of
fetal death
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Mineral Needs
• Calcium
– adequate mineralization of fetal skeleton and teeth
in 3rd tri
– increase intake with conception
– 1200 - 1500 mg (milk group)
• Zinc
– growth and development
– Increase 35 % above RDA
– Protein rich foods in healthy diet should supply
this
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Vegetarian Mothers
• Lacto ova or lacto should have no special
concerns, with earlier recommendations in
mind
• Iron supplementation
• Vegans
• focus on protein, vitamins D, B-6, B-12, iron
and calcium
• increase grains, beans nuts and seeds
• Avoid Ketosis - difficult for fetal brain to
utilize
• need iron and calcium supplementation as
these are difficult to absorb from plant
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sources
Pregnancy: GI Distress
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•
•
•
•
•
•
•
•
•
Activity Recommendations
American College of Obstetrics and Gynecology
Do not allow HR to exceed 140
Avoid exercise in hot, humid weather
Discontinue exercise if discomfort or overheating
results
Drink plenty of liquids
After month 4 do not exercise while lying on your
back
Avoid abrupt decrease in exertion - must warm
down
Engage in weight training only if done consistently
prior to pregnancy
Do not push flexibility training very hard - gentle43
and relaxing
Lactation
• Physiology of lactation
• Changes during
pregnancy
– Increased breast tissue
– Maturation of structure
• Hormonal controls
– Prolactin: stimulates milk
production
– Oxytocin: stimulates milk
release
• “Let-down” reflex
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Lactation
• Nutrition for breastfeeding women
– Energy and protein
• Higher needs than pregnancy
– Vitamins and minerals
• Most are higher or same as pregnancy
• Iron and folate needs are lower
– Water
• Food choices
• Practices to avoid while breastfeeding
– Alcohol, drugs, smoking, excess caffeine
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Lactation
• Benefits of breastfeeding
– Benefits for infants
• Optimal nutrition
• Reduced incidence of
respiratory, GI, ear infections
• Convenience
• Other benefits
– Benefits for mother
• Convenience
• Enhanced recovery of uterus size
• Other benefits
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Nutrition of Milk
• Asses adequate intake by monitoring
wetness and stool production
• supplements with formula may be needed
and are OK
• should not start before breastfeeding is well
established
• important differences from cows milk (wait 1
year)
– casien - protein difficult to digest
– different minerals and carbohydrates
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Nutrition of Milk
• Colostrum
– first product of breast
• antibodies
– compensate for immature immune system
– promotes intestinal health of infant
• Mature Milk
– after a few days, very different from cows
milk
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Mature Milk
• Main proteins form a soft light curd in GI
• binds iron and reduces bacterial growth
• high in essential fatty acids and fats
needed for brain development
• DHA, visual acuity and nervous system
development (omega 3)
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Mature Milk
• Composition changes
• increased fat content with feeding,
should last 20 min. to get good growth
and infant satisfaction
• can supplement up to 4 ounces of water
/ day
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Food Plan and Breastfeeding
• Only slightly different from pregnancy
• no longer require iron, folate
• increased need for energy, vit. A,E and C,
riboflavin, copper, chromium, iodide,
magnanese, selemium and zinc
• * increase milk group intake*
– Especially teens
• should maintain balanced diet, moderate fat
content, maintain fluid intake
• avoid crash diets
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Attributes of Breast Feeding
• Requires ~ 800 kcal /day
– recommend increase only 500 kcal per day
– facilitates return to pre-pregnancy weight
• breast feeding enhances reduction of uterus
• may prevent breast cancer if maintained for
several months
• Facilitates bonding with infant
• Establishes habit of eating in moderation for
infant
• Proper development of jaws and teeth
• May reduce risk of certain disorders in baby
– Table 15.7
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Promoting and Supporting
Breastfeeding
• It is the position of the American Dietetic Association
(ADA) that exclusive breastfeeding provides optimal
nutrition and health protection for the first 6 months of
life, and breastfeeding with complementary foods for
at least 12 months is the ideal feeding pattern for
infants. Breastfeeding is also a public health strategy
for improving infant and child health survival,
improving maternal morbidity, controlling health care
costs, and conserving natural resources.
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ADA: Key Recommendations
• Women of childbearing age who may become
pregnant. Eat foods high in heme iron and/or
consume iron-rich plant foods or iron-fortified foods
with an enhancer of iron absorption, such as vitamin
C-rich foods.
• Women of childbearing age who may become
pregnant and those in the first trimester of pregnancy.
Consume adequate synthetic folic acid daily (from
fortified foods or supplements) in addition to food
forms of folate from a varied diet.
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