An Invitation to HealthAn Invitation to HealthChapter 6Chapter 6

Eating Patterns and ProblemsEating Patterns and Problems

Dr. Lana Zinger

©2004 Wadsworth Publishing Co.

The Overweight and Obesity The Overweight and Obesity EpidemicEpidemic

64.5% of adult 64.5% of adult Americans (2 out of Americans (2 out of 3 individuals) are 3 individuals) are overweight or obese.overweight or obese.

15% of children ages 15% of children ages 6-19 are overweight 6-19 are overweight or obese.or obese.

Obesity’s CostObesity’s Cost:: $100 billion/year$100 billion/year 300,000 excess 300,000 excess

deathsdeaths

Body Dissatisfaction in Body Dissatisfaction in African-American and African-American and

White StudentsWhite Students

Weight AssessmentWeight Assessment

Body Mass IndexBody Mass Index:: OverweightOverweight: BMI : BMI >> 25; 25; ObesityObesity: BMI : BMI

>>30.30. Waist CircumferenceWaist Circumference::

MenMen: : >> 40 inches; 40 inches; WomenWomen: : >>35 inches35 inches These measurements indicate that These measurements indicate that

individuals have excess central or individuals have excess central or visceral fat.visceral fat.

Waist-to-Hip RatioWaist-to-Hip Ratio:: MenMen: apple shape; : apple shape; WomenWomen: pear shaped.: pear shaped.

The Pear versus the AppleThe Pear versus the AppleWaist-to-Hip RatioWaist-to-Hip Ratio

Definition: waist circumference measurement divided bythe measurement of the widest circumference around the hips.

Men’s Goal:Men’s Goal:Men<0.95

Women’s Goal:Women’s Goal:<0.80

Visceral Fat vs. Visceral Fat vs. Subcutaneous FatSubcutaneous Fat

How Many Calories Do I How Many Calories Do I Need?Need? CaloriesCalories::

The measure of the amount of energy The measure of the amount of energy that can be derived from food.that can be derived from food.

Multiply your current weight Multiply your current weight by:___x__=__by:___x__=__

14 if you are sedentary14 if you are sedentary

15 if you exercise 3 x/week; 40 min.15 if you exercise 3 x/week; 40 min.

16 if you exercise 5-7x/wk; 40-60 min.16 if you exercise 5-7x/wk; 40-60 min.

Remember, regardless of whether Remember, regardless of whether you consume you consume

carbohydrates, protein or fat, if you carbohydrates, protein or fat, if you take in more calories than your body take in more calories than your body requires, your body will convert the requires, your body will convert the

excess to fat.excess to fat.

GlobesityGlobesityHow Did We Get So Fat?How Did We Get So Fat?

Americans are eating more and Americans are eating more and exercising less.exercising less.

Americans are eating 200-400 more calories Americans are eating 200-400 more calories than they did several decades ago, and they than they did several decades ago, and they are expending 200-300 fewer calories than are expending 200-300 fewer calories than people did 25 years ago.people did 25 years ago.

Portion distortion.Portion distortion. Refined carbohydrates.Refined carbohydrates. Media and food marketing.Media and food marketing.

The Multiple Causes of The Multiple Causes of ObesityObesity

GeneticsGenetics

LifestyleLifestylePhysicalPhysicalActivityActivity

DevelopmentalDevelopmentalFactorsFactors

SocialSocialDeterminantsDeterminants

EmotionalEmotionalInfluencesInfluences

Health Health Dangers Dangers of Excess of Excess

WeightWeight

Getting Ready for Weight Getting Ready for Weight LossLoss

Make health a priority.Make health a priority. Follow a healthful eating Follow a healthful eating

regimen.regimen. Incorporate regular physical Incorporate regular physical

activity into your daily routine.activity into your daily routine. Set realistic, attainable goals.Set realistic, attainable goals. Focus on a healthy lifestyle.Focus on a healthy lifestyle. Focus your strategies so they are Focus your strategies so they are

action-oriented and specific.action-oriented and specific. Tailor your strategies to your Tailor your strategies to your

lifestyle.lifestyle. Think long term.Think long term.

Treatment for Weight Treatment for Weight ProblemsProblems

Overweight (BMI = 25-29)Overweight (BMI = 25-29) Cut back moderately on food intake and

concentrate on developing healthy eating and exercise habits.

Mild to Moderate Obesity (BMI = 30-39)Mild to Moderate Obesity (BMI = 30-39) Six-month trial of lifestyle therapy, including a

supervised diet and exercise. GoalGoal: 10% reduction in weight to reduce obesity-

related risks. Severe Obesity (BMI = 40+)Severe Obesity (BMI = 40+)

Gastric bypass or stomach stapling may be indicated.

Avoiding Diet TrapsAvoiding Diet Traps

Diet Diet FoodsFoods

Diet Pills &Diet Pills &ProductsProducts

The Yo-YoThe Yo-YoSyndromeSyndrome

Very Low-Very Low-Calorie DietsCalorie Diets

Weight-Cycling Effect of Weight-Cycling Effect of Repeated DietingRepeated Dieting

Is It Physical Hunger or Emotional Is It Physical Hunger or Emotional Hunger?Hunger?

Physical HungerPhysical Hunger Builds gradually.Builds gradually. Strikes below the Strikes below the

neck.neck. No sense of No sense of

compulsion.compulsion. Occurs several hours Occurs several hours

after a meal.after a meal. General.General. Goes away when full.Goes away when full. Eating leads to feeling Eating leads to feeling

of satisfaction.of satisfaction.

Emotional HungerEmotional Hunger Develops suddenly.Develops suddenly. Above the neck.Above the neck. An urgent need to eat.An urgent need to eat. Unrelated to time since Unrelated to time since

last meal.last meal. Specific, often for a Specific, often for a

particular food or particular food or brand.brand.

Persists despite Persists despite fullness.fullness.

Eating leads to guilt Eating leads to guilt and shame.and shame.

Healthy Weight Management Healthy Weight Management for Lifefor Life

Establish your goalsEstablish your goals

Never say dietNever say diet

Be realisticBe realistic

Recognize that there are no Recognize that there are no quick fixesquick fixes

Note your progressNote your progress

Adopt the 90 percent ruleAdopt the 90 percent rule

Try, try againTry, try again

How Hormones Help Regulate Our How Hormones Help Regulate Our AppetiteAppetite

The Female Athlete TriadThe Female Athlete Triad

Disordered Eating Patterns

Menstrual DysfunctionBone Mineral Disorders

Disordered Eating In College Disordered Eating In College StudentsStudentsThe FactsThe Facts

Younger women are more likely than older Younger women are more likely than older women to have an eating disorder.women to have an eating disorder.

Eating disorders equally affect women of Eating disorders equally affect women of different races.different races.

Eating disorders do not only affect women.Eating disorders do not only affect women. Body dissatisfaction and unhealthy eating Body dissatisfaction and unhealthy eating

patterns can lead to eating disorders.patterns can lead to eating disorders. Extreme DietingExtreme Dieting: :

Cutting calories, exercising, preoccupation with Cutting calories, exercising, preoccupation with food and weight.food and weight.

Is The Freshman 15 Is The Freshman 15 Reality?Reality?

Signs of Compulsive Signs of Compulsive OvereatingOvereating

Using food as an escape from depression, Using food as an escape from depression, loneliness, and rejection.loneliness, and rejection.

A history of failed diets and anxiety when dieting.A history of failed diets and anxiety when dieting. Thinking about food throughout the day.Thinking about food throughout the day. Eating quickly and without pleasure.Eating quickly and without pleasure. Continuing to eat even when you’re no longer Continuing to eat even when you’re no longer

hungry.hungry. Frequent talking about food, or refusing to talk Frequent talking about food, or refusing to talk

about food.about food. Fear of not being able to stop eating once you Fear of not being able to stop eating once you

start.start.

Signs of Binge EatingSigns of Binge Eating

Eating much more rapidly than usual.Eating much more rapidly than usual. Eating until they feel uncomfortably full.Eating until they feel uncomfortably full. Eating large amounts of food when not Eating large amounts of food when not

feeling physically hungry.feeling physically hungry. Eating large amounts of food throughout Eating large amounts of food throughout

the day with no planned mealtimes.the day with no planned mealtimes. Eating alone because they are Eating alone because they are

embarrassed by how much they eat and embarrassed by how much they eat and by their eating habits.by their eating habits.

Do You Have An Eating Do You Have An Eating Disorder?Disorder?

Do you make yourself sick because you Do you make yourself sick because you feel uncomfortably full?feel uncomfortably full?

Do you worry you have lost control over Do you worry you have lost control over how much you eat?how much you eat?

Have you recently lost more then 14 Have you recently lost more then 14 pounds in a three-month period?pounds in a three-month period?

Do you believe yourself to be fat when Do you believe yourself to be fat when others say you are too thin?others say you are too thin?

Would you say that food dominates your Would you say that food dominates your life?life?

If you answered ‘yes’ to two or more of the questions above you may be toying with anorexia nervosa or bulimia nervosa.

Common Factors Associated Common Factors Associated with Eating Disorderswith Eating Disorders

Low self-esteem & negative body imageLow self-esteem & negative body image Major life transition or traumatic life Major life transition or traumatic life

eventevent Troubled family and/or personal Troubled family and/or personal

relationshipsrelationships Fear of failure & lack of control in lifeFear of failure & lack of control in life Specific personality traits and Specific personality traits and

psychological disorderspsychological disorders Attraction to sports and exerciseAttraction to sports and exercise Recommendation to lose weight without Recommendation to lose weight without

guidanceguidance Initiation of dieting at an early ageInitiation of dieting at an early age Cultural ideals and pressuresCultural ideals and pressures

Clinical Diagnostic Criteria for Clinical Diagnostic Criteria for

Anorexia NervosaAnorexia NervosaA.A. Refusal to maintain body weight at Refusal to maintain body weight at

or above a minimally normal or above a minimally normal weight for age and height.weight for age and height.

B.B. Intense fear of gaining weight or Intense fear of gaining weight or becoming fat, even though becoming fat, even though underweight.underweight.

C.C. Disturbance in the way in which Disturbance in the way in which one’s body weight or shape is one’s body weight or shape is experienced, undue influence of experienced, undue influence of body weight or shape on self-body weight or shape on self-evaluation, or denial of the evaluation, or denial of the seriousness of the current low seriousness of the current low body weight.body weight.

D.D. AmenorrheaAmenorrhea

Medical Complications of Medical Complications of Weight Loss From Anorexia Weight Loss From Anorexia

NervosaNervosa

Clinical Diagnostic Criteria for Clinical Diagnostic Criteria for

Bulimia NervosaBulimia NervosaA.A. Recurrent episodes of binge eating.Recurrent episodes of binge eating.

B.B. Recurrent inappropriate compensatory Recurrent inappropriate compensatory behavior in order to prevent weight gain behavior in order to prevent weight gain (laxatives, diuretics, vomiting and excessive (laxatives, diuretics, vomiting and excessive exercise).exercise).

C.C. Binge eating and inappropriate Binge eating and inappropriate compensatory behaviors both occur, on compensatory behaviors both occur, on average, at least twice a week for 3 months.average, at least twice a week for 3 months.

D.D. Self evaluation is unduly influenced by body Self evaluation is unduly influenced by body shape and weight.shape and weight.

Medical Complications Related to Medical Complications Related to PurgingPurging

Treatment Options for Eating Treatment Options for Eating DisordersDisorders

Anorexia NervosaAnorexia Nervosa Medical therapyMedical therapy

““refeeding”refeeding” Behavioral therapyBehavioral therapy Cognitive therapyCognitive therapy Psychodynamic Psychodynamic

therapytherapy Family therapyFamily therapy Occasionally Occasionally

medicationsmedications

Bulimia NervosaBulimia Nervosa Nutritional Nutritional

counselingcounseling PsychodynamicsPsychodynamics Cognitive-behavior Cognitive-behavior

therapytherapy Individual and group Individual and group

psychotherapypsychotherapy MedicationsMedications

Fluoxetine (Prozac)Fluoxetine (Prozac)