Binge
- Eating an amount of food in a discrete period of time that is definitely larger than most people eat during a similar period of time and under similar circumstances together with a sense of lack of control over eating during the episode.
Bulimia Nervosa (BN)
- Recurrent binge eating.
- Recurrent compensatory behaviours e.g.;vomiting, laxatives, diuretics, diet pill abuse, fasting or excessive exercise.
- At least two times per week on average for three months.
Self-evaluation is unduly influences by body shape and weight.
BN- 2 types - Purging type or BN non-purging type.
Bulimia Nervosa Stats
- 1-3% of women
- Over 10% of women in college
- 1: 10-20 males : females for teens and adults
- Onset mid/late adolescence to young adulthood
- 10 - 15% of patients with AN cross over to BN
- Most are normal weight but some are above average weight
- In some studies 1/3 were obese as children or had obese parents
BN Recovery Rates
- 60% recovery
- 10-30% symptoms with improvement
- 10% chronically ill
- Up to 4% mortality
- Cross over to other diagnoses
Binge Eating Disorder
- Currently falls under EDNOS (Eating Disorder Not Otherwise Specified)
- Recurrent episodes of binge eating
- A sense of lack of control over eating during the episode
- The binge eating occurs, on average, at least once a week for three months
- The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour (e.g;no purging, no excess exercise)
BED (Binge Eating Disorder)
- 3.5% of women and 2% of men in US
- Onset a bit later - mid twenties
- Course - less known
Anorexia Nervosa (AN)
- Low body weight (less than 85% expected or less than BMI 17.5
- Fear of weight gain
- Body image disturbance or denial of the seriousness of the low body weight
- Amenorrhea
- 2 types - restricting and bunge/purge
- Life time prevalence 0.5% of adolescent and young adult women
EDNOS (Eating Disorder Not Otherwise Specified)
- All other e.g. lower binge frequency
- Often seen as the residual catch all
- It is the most common ED encountered for adolescents and adults and often just as sick and high mortality
- 5 - 11% lifetime prevalence
Psychological Factors of ED
- Low self esteem / difficulty in sensing the self
- Attachment problems
- Parental insensitivity
- Transitions
- Abuse or neglect
- Escape / avoidance style of coping found in families
- Negative comments by parents regarding weight and shape
- Parents who try to limit children’s acceptance of a variety of foods can disrupt there internal cues
Social Factors
- Elevated pressure to be thin from family, peers, media has predicted future eating pathology in several studies
- Promotion of slenderness as the path to social, sexual and occupational success for women
- Fatness as a sign of personal loss of control and failure
- In preadolescent girls ideal shape was much thinner than their current self perception and the boys ideal was very close to their perception of their current shape
- Dieting culture
What Price Would You Pay To Be Thin?
In an online survey of 4,283... In order not to be obese
- 46% would give up a year of life
- 15% would give up ten years of life
- 25% say they would rather be unable to have children
- 14% would rather be an alcoholic
- 5% would rather give up a limb
More Critical Medical Problems
Low heart rate <40 beats per minute
Chest pain
Palpitations (arrhythmia's)
Significant electrolyte abnormalities
Low potassium
Severe abdominal pain
Seizure
Extremely rapid weight loss or complete food refusal
Death
An eating disorder is not just an eating problem. It is complicated and has to do with a person’s ability to identify and communicate feelings, their fear of conflict and self worth.
PREVENTION
- Teaching students about eating disorders likely not effective and may be risky
- Teach ways to promote positive body image and self esteem to young persons educators and parents
- Using messages to counteract weight and appearance related messages in life
- Women’s bodies have been objectified - discuss other ways to accept and support bodies and weight
- Friends important
- Don’t promote dieting
- Consider how not to comment on appearance weight
- Family meal times with a range of foods
- Help children and teens learn how to express feelings
- Promote self esteem through ways other than appearance
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