Chapter 9 vocal

obesity

The condition of having elevated fat masses in the body. Obesity is defined as having a body mass index (BMI) of 30 or higher.

Published in 1689 by Richard Morton

The first known medical account of anorexia nervosa

What are the two types of anorexia nervosa?

The restricting type and the binge-eating/purging type

set point

The tendency of our bodies to resist efforts to bring about a marked change (increase or decrease) in weight

bous (which means "ox")

The word bulimia comes from the greek

limos ("hunger")

The word bulimia comes from the greek

cognitive-behavioral therapy (CBT)

Therapy based on altering dysfunctional thoughts and cognitive distortions

The national comorbidity survey indicate that the lifetime prevalence in the United states for bulimia nervosa is around

1.5% for women and 0.5% for men

bulimos

Second century, the greek physician Galen referred to a syndrome characterized by overeating, vomiting, and fainting, which he termed _____________.

bulimia nervosa people are often preoccupied with

shame, guilt, and self-deprecation

"pro-ana" or "pro-mia"

short for "pro-anorexia" & "pro-bulimia"

what is another demographic variable linked to obesity?

social class; higher income women are much less likely to be obese than lower income women; for black and mexican american men, however, the opposite is true; men with higher incomes are more likely to be obese

What do anorexia nervosa & bulimia have in common, although separate syndromes?

intense fear of becoming overweight and fat and an accompanying pursuit of thinness.

when does bulimia nervosa typically begin?

with restricted eating motivated by the desire to be slender; during these early stages, the person diets and eats low-calorie foods.

Eating disorders are becoming a problem

worldwide

Other specific subgroups of men who are at higher risk of eating disorders are

wrestlers and jockeys, who need to "make weight" in order to compare or work

bulimia nervosa

Frequent occurrence of binge-eating episodes accompanied by a sense of loss of control of overeating and recurrent inappropriate behavior such as purging or excessive exercise to prevent weight gain

What are individual risk factors for an eating disorder?

GENDER -eating disorders are much more frequently found in women than in men -the greatest period of risk for these disorders occurs in adolescence (not BED) -BED typically well after adolescence -sexual orientation (homosexual) INTERNALIZING THE THIN IDEAL -the extent to which people internalize the thin ideal is associated with a range of problems that are thought to be risk factors for eating disorders -body dissatisfaction, dieting, and negative affect -internalizing the thin ideal may be an early component of the causal chain that culminates in disordered eating PERFECTIONISM -important risk factor for eating disorders -may be much more likely to subscribe to the thin ideal and relentlessly pursue the "perfect body" -helps maintain bulimic pathology thro the rigid adherence to dieting that then drives the binge/purge cycle -found that women with anorexia scored higher on a measure of perfectionism than did a sample of controls without an eating disorder -also seems to predate disordered eating in those with anorexia -perfectionism may also have a genetic basis -men with eating disorders are less perfectionistic than are women with eating disorders NEGATIVE BODY IMAGE -sociocultural influences are implicated in the discrepancy between the way many young girls and women perceive their own bodies and the "ideal" female form as represented in the media. -such perceptual biases lead girls and women to believe that men prefer more slender shapes than they in fact do -the research literature strongly implicates body dissatisfaction as an important risk factor for pathological eating -body dissatisfaction emerged as the most powerful predictor of the onset of eating disorders DIETING -nearly all instances of eating disorders begin with the "normal" dieting that is routine in our culture -approx 39% of women and 21% of men are trying to lose weight -dieting is risk factor for the development or worsening of eating disorders -not everyone who diets develops a eating disorder -when our efforts to diet fall short, it is almost inevitable that we will feel bad about ourselves; it may be the case that the people who often report that they are trying to lose weight are the people who are most unhappy with their bodies and who are most inclined to feel negatively about themselves when they fail to stick to their diet plans. -perfectionism and dieting NEGATIVE EMOTIONALITY -negative affect (feeling bad) is a causal risk factor for body dissatisfaction. -Longitudinal studies have confirmed that depression and general negative affect are predictive of a high risk for later developing an eating disorder -evidence suggests that negative affect may work to maintain binge eating -patients often report that they engage in binges when they feel stressed, down, or bad about themselves. -a major problem is that after binge eating patients feel disappointed or even disgusted with themselves. CHILDHOOD SEXUAL ABUSE -prospective study found that children who had been sexually abused or physically neglected had higher rates of eating disorders and eating problems in adolescence and adulthood. -a weak but positive association between childhood sexual abuse and eating pathology -possibility is that being sexually abused increases the risk of developing other known risk factors for eating disorders, such as having a negative body image or high levels of negative affect

Risk and causal factors in obesity

GENES -our genetic makeup plays an important role in determining how predisposed we are to becoming obese in the modern environment of increased food availability. -thinness seems to run in families -a genetic mutation has been discovered that is specifically associated with binge eating HORMONES INVOLVED IN APPETITE AND WEIGHT REGULATION -one key element of this homeostatic system is a hormone called leptin -leptin is produced by fat cells, and it acts to reduce our intake of food. Increased body fat leads to increased levels of leptin, which leads to decreased food intake. When body fat levels decrease, leptin production decreases and food intake is stimulated. Rare genetic mutations that result in an inability to produce leptin cause people to have an insatiable appetite and result in morbid obesity. -When leptin is given to overweight individuals, the majority of cases it has little effect. -people who are overweight generally have high levels of leptin in their bloodstream. The problem is that they are resistant to its effects. -grehlin is a powerful appetite stimulator. -under normal circumstances, gremlin levels rise before a meal and fall after we have eaten. -Prader-Willi syndrome have chromosomal abnormalities that create many problems, one of which is very high levels of gremlin. sufferers are extremely obese and often die before age 30 from obesity-related causes SOCIOCULTURAL INFLUENCES -our genetic makeup and personality, are likely to experience more weight-related problems from living in a culture that provides ready access to high-fat, high-sugar (junk) foods, encourages overconsumption, and makes it easy to avoid exercise. -overconsumption of ultra-processed foods could contribute to the development and maintenance of compulsive eating because eating these foods becomes less and less rewarding over time and more and more food is required to obtain the same amount of "reward". -issue of accessibility (movie theater: candy bars instead of apples) -powerful food advertising can be FAMILY INFLUENCES -high-fat, high-calorie diet may lead to obesity in many or all family members, including the family pet. -eating (or overeating) becomes a habitual means of alleviating emotional distress or showing love -children whose mothers smoked during pregnancy or whose mothers gained a lot of weight during the pregnancy are also at a higher risk of being overweight at age 3 -possible that overfeeding infants and young children causes them to develop more adipose cells and may thus predispose them to weight problems in adulthood -"socially contagious" provocative research findings have shown that if someone close to us becomes obese, the chance that we ourselves will later become obese can increase by as much as 57% STRESS AND "COMFORT FOOD" -lifetime rates of mood disorders were higher in people who were obese than in people whose weight was in the normal range -people with an eating disorder binge eat in response to aversive emotional stress, such as feeling depressed or anxious -anxiety, anger, boredom, and depression may lead to overeating. PATHWAYS TO OBESITY -obesity results from a combination of genetic, environmental, and sociocultural influences. -an important step along the pathway to obesity, however, may be binge eating. -binge eating is a predictor of later obesity -research suggesting that one pathway to binge eating may be through social pressure to conform to thin ideal, as ironic as this may seem -another pathway to binge eating may operate thro depression and low self-esteem

people who are obese are often judged

harshly by others; routinely ridiculed, discriminated against, and stigmatized

What kind of medical issues arise with obesity?

high cholesterol, hypertension, heart disease, arthritis, diabetes, and cancer

One established risk factor for eating disorders in men is

homosexuality

Disordered eating behaviors that do not meet criteria for an eating disorder diagnosis are of concern because

in some cases, they may worsen over time, eventually leading to clinically significant problems

The risk of developing anorexia nervosa seemed to ______ during the twentieth century

increase for both male and females

this parallels the view, offered by some, that obesity is a

"food addiction"

Anorexia nervosa literally means,

"lack of appetite induced by nervousness."

Who is most at risk for obesity?

- A tendency toward being thin or heavy may be inherited. Our genetic makeup may make us more or less likely to gain weight in a cultural environment that promotes overconsumption of food and sedentary lifestyle. - Minorities are at especially high risk for obesity. Obesity rates are highest (50%) in black women. Low income is associated with obesity for women, but higher income is associated with obesity in black and Mexican American men.

How are eating disorders treated?

- Anorexia nervosa is very difficult to treat. Treatment is long term, and many patients resist getting well. For younger patients, family therapy appears to be very beneficial. Olanzapine is also helpful. - The treatment of choice for bulimia nervosa is CBT. CBT is also helpful for binge-eating disorder. Interpersonal therapy (IPT) seems to be helpful for binge eating disorder and may be especially acceptable to minorities.

What are the risk and causal factors for eating disorders?

- Genetic factors play an important role in eating disorders. Genes may make some people more susceptible to binge eating or to sociocultural influences, or may underlie personality styles (e.g., perfectionism) that increase risk for eating disorders. - The neurotransmitter serotonin has been implicated in eating disorders. This neurotransmitter is also involved in mood disorders, which are highly comorbid with eating disorders. - Sociocultural influences are integral int he development of eating disorders. Our society places great value on being thin. Western values concerning thinness may be spreading. This may help explain why eating disorders are now found throughout the world. - Individual risk factors such as internalizing the thin ideal, body dissatisfaction, dieting, negative affect, and perfectionism have been implicated in the development of eating disorders.

How is obesity treated?

- Obesity is a chronic problem. lifestyle modifications and medications help patients to lose small amounts of weight. Drastic weight loss, however, usually requires bariatric surgery. - Because obesity tends to be a lifelong problem and because treating obesity is so difficult, there is now a focus on trying to prevent people from becoming obese in the first place. Implementing many of the approaches that have been recommended will require changes in social policy.

how do we define obesity and why is it a worldwide problem?

- Obesity is defined as having a body mass index of 30 or above. Obesity is associated with many medical problems and increased mortality. Obesity is not currently viewed as an eating disorder or as a psychiatric condition in the DSM.

what are some ways to prevent obesity?

- eat three fewer bites of food when you eat a meal. -take the stairs, combine a meeting with a walk, or park a little farther from your destination -sleep more

What are the clinical aspects of eating disorders?

- included in DSM-5 are three different eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. Binge eating disorder is a new disorder that was officially recognized for the first time in DSM-5. - both anorexia nervosa and bulimia nervosa are characterized by an intense fear of becoming fat and by a drive for thinness. Patients with anorexia nervosa are severely underweight. This is not true of patients with bulimia nervosa. - Eating disorders are more common in women than in men (3:1 ratio). They can develop at any age, although they typically emerge in adolescence or early adulthood. Anorexia nervosa usually begins at an earlier age (15-19) than bulimia nervosa (20-24) - Anorexia nervosa has a lifetime prevalence of approx. 0.9 percent in women and 0.3 percent in men. Bulimia nervosa is more common, with a lifetime prevalence of 1.5 percent in women and 0.5 percent in men. Binge eating disorder is the most common eating disorder with a prevalence of 3.5 percent in women and 2.0 percent in men. Many more people suffer from less severe form of disturbed eating patterns

Catherine: Distressed by her weight (Bulimia nervosa) typical patterns

-20 years old - concerned about her weight and shape for several years -as a teenager she felt plump and was frequently on a diet -now older, severely restricted her food intake and started punishing exercise regimens. - one point she became significantly underweight -Medical help led to weight gain, which was quickly followed by more dieting and, for the first time, she started binge eating. -Catherine began vomiting in a desparate attempt to lose weight. -over the last six months catherine has skipped breakfast and lunch, eaten a normal evening meal with her family, but gone on to binge eat in the late evening usually two or three times a week. -she binges in response to feeling upset and worried. -Catherine drinks large quantities of water to help her induce vomiting after bingeing. -Started to take 30-40 laxatives, as well as vomiting. -extremely self-conscious -thinks that her friends will not like her if she gains weight -feels very bad about herself if she thinks she has gained weight

Ms. A.: Feeling out of control (binge-eating disorder) often resembles people with bulimia

-38 year old African American -BMI of 39.6 -gained 80 pounds over the past year -reported a lifetime history of obesity and a history of binge eating beginning at approx the age of 11. -felt out of control and ate large amounts of food nearly every day, typically in the evenings -she tended to feel out of control during the day -felt the binge episode was inevitable -ate much more rapidly than usual until she felt uncomfortably full, ate large amts of food when she didn't feel physically hungry, ate alone because she was embarrassed, and felt disgusted with herself and very guilty after eating. -very distressed about her weight -she acknowledged that her weight and shape were the most important factors in determining her feelings about herself.

What are some sociocultural factors for an eating disorder?

-Social pressures toward thinness may be particularly powerful in higher socioeconomic backgrounds, from which a majority of girls and women with anorexia appear to come. -it is likely that thinness became deeply rooted as a cultural ideal in the 1960s

People hardly recognize him (bariatric surgery=gastric bypass surgery)

-Stanley's weight problems began when he was 19. -he hated exercising, tried dieting but nothing was working for him -mobility issues -diabetes -comfortable with how he was, he knew he had to fix it -agreed with gastric bypass surgery -stanley's stomach was permanently closed off with staples. -His stomach was reduced from the size of a football to the size of an egg -after the surgery his diabetes disappeared -lost 140 lbs after surgery a year later

what are some treatments for binge eating disorder?

-due to the high level of comorbidity between binge eating disorder and depression, antidepressant medications are sometimes used to treat this disorder. -appetite suppressants and anticonvulsant medications, have also been a focus of interest -Sibutramine, a medication that inhibits the repute of serotonin and norepinephrine, has been shown to reduce the frequency of binges and to be associated with more weight loss than a placebo medication in a one clinical trial -findings therefore suggest that for racial and ethnic minorities with BED, interpersonal psychotherapy might be a particularly suitable treatment approach

Ms. R: going to extremes (restricting type of anorexia nervosa & obsessive-compulsive disorder)

-Very thin, 19-year-old -difficulties with eating since 15 -Ballet student -induced vomiting after she felt was overeating -Binge eating once a day then followed by self-induced vomiting -exercises regularly -avoids eating in front of people

"crash" diets

-and extreme treatments to bring about dramatic weight loss (including starvation of patients in a hospital setting) are now considered to be outmoded and ineffective approaches -people who do this usually end up weighing more than they did before the treatment started

How do people look with anorexia nervosa?

-extremely unwell -hair on scalp thins and becomes brittle -nails become brittle -skin becomes very dry, and downy hair (called "lanugo") starts to grow on the face, neck, arms, back, and legs. -develop a yellowish tinge to their skin, especially on their palms of their hands and bottoms of their feet

What do people with anorexia nervosa experience bodily?

-hands and feet are often cold to the touch and have a purplish-blue tinge due to problems with temperature regulation and lack of oxygen to the extremities -chronically low blood pressure, patients often feel tired, week, dizzy, and faint. -Thiamin (vitamin B1) deficiency may also be present

How can people with anorexia nervosa die?

-heart arrhythmias (irregular heartbeats) = caused by major imbalances in key electrolytes such as potassium -chronically low levels of potassium can also result in kidney damage and renal failure severe enough to require dialysis -laxative abuse can lead to dehydration, electrolyte imbalances, and kidney disease as well as damage to the bowels, and gastrointestinal tract

What are some causal factors for an eating disorder?

-interaction between genetic and environmental factors -being exposed to cultural attitudes that emphasize thinness is significant in the development of eating disorders -diathesis-stress model, where genes render some people more susceptible to environmental pressures and hence to the development of problematic eating attitudes and behaviors

What are some treatments for bulimia nervosa?

-it is quite common for patients with bulimia nervosa to be treated with antidepressant medications after it has become clear that many patients also suffer from mood disorders. -a positive response is usually apparent within the first 3 weeks, people who do not show early improvement most likely won't benefit from further treatment with the medication -antidepressants seem to decrease the frequency of binges as well as improve patients' mood and preoccupation with shape and weight COGNITIVE-BEHAVIORAL THERAPY -this is the leading treatment for bulimia nervosa -the "behavioral" component of CBT for bulimia focuses on normalizing eating patterns -the "cognitive" element of the treatment is aimed at changing the cognitions and behaviors that initiate or perpetuate a binge cycle. -binging and purging is eliminated in around 30 to 50% of cases -in an effort to improve efficiency , new approaches such as dialectical behavior therapy (which is a treatment for borderline personality disorder) are now being explored -(transdiagnostic approach) focused on targeting eating issues as well as concerns about shape and weight, extreme dieting, purging, and binge eating. -other form of the treatment is broader and also addresses such things as perfectionism, low self-esteem, and relationship problems.

What are some family influences for an eating disorder?

-more than 1/3 of patients with anorexia reported that family dysfunction was a factor that contributed to the development of their eating disorder -patients with anorexia perceive their families as more rigid, less cohesive, and as having poorer communication than healthy control participants do -bulimia patients perceive their families to be less cohesive than their parents do -The strongest predictor of bulimic symptoms was the extent to which family members made disparaging comments about the woman's appearance and focused on her need to diet

What are the medical concerns with bulimia?

-purging can cause electrolyte imbalances and low potassium, which puts the patient at risk for heart abnormalities -damage to the heart muscle, which may be due to using ipecac syrup (a poison that causes vomiting) -patients develop calluses on their hands from sticking their fingers down their throats to make themselves sick -tears to the throat can occur -patients damage their teeth from the stomach acid -Mouth ulcers and dental cavities -small red dots around the eyes that are caused from the pressure of throwing up -very swollen parotid (salivary) glands caused by repeatedly vomiting (known as puffy cheeks or chipmunk cheeks)

What does the old ratio to the new ratio show us?

-the fact that eating disorders in men may have been under diagnosed in the past because of the stereotype that they are female disorders -Another reason for the under diagnosis of eating disorders in men is the gender bias in the DSM criteria.

What is the lifetime prevalence of anorexia nervosa?

0.9% in women and 0.3% in men

what is the prevalence rate of bulimia nervosa?

1%

a recent study suggests that when people order from a menu that includes calorie info, they consume _____ percent fewer calories than people who order form a menu that contains no calorie information

14%

anorexia nervosa is most likely to develop in

15 - to 19-year-olds

Approximately ____% of patients with severe eating disorders have to be committed to a hospital for treatment against their will

17%

Lifetime rates of anorexia nervosa were higher in people born after

1945

When did eating disorders begin to attract significant attention?

1970s and 1980s

Bulimia nervosa's highest risk age group is

20 to 24

Bulimia is not associated with increased risk of completed suicide, although suicide attempts are made in ___ to ____ percent of cases

25 - 30%

approximately ____ percent of people with anorexia nervosa die from the consequences of their self-imposed starvation.

3%

somewhere between ____ and ____ percent of patients with anorexia will make a suicide attempt, and rates of completed suicides are ____ times greater than they are in the general population

3%;23%;50 times

The National comorbidity survey indicate a lifetime prevalence of binge eating disorder is around

3.5 percent in women and 2 percent in men

("do negative messages about being overweight encourage overweight people to eat more or less") After seeing the stigmatizing videos the overweight women consumed

303 calories of snack food; this is more than three times as much as the 89 calories consumed by the overweight women who had watched the neutral film.

Almost _____ percent of children and teens are now overweight or obese

32%

Children consume ____ to _____ percent of their daily calories while they are at school.

35 to 50%

What is the ratio for women and men with eating disorders?

3:1

how many calories are consumed during an average binge with bulimia nervosa?

4,800 calories

people who are obese have a reduced life expectancy of

5 to 20 years

what percentage of us weigh more than we should?

63.3%

Meta-analysis

A meta-analysis is a statistical method used to combine the results of a number of similar research studies. The data from each separate study are transformed into a common metric called the effect size. Doing this allows data from the various studies to be combined and then analyzed. You can think of a meta-analysis as being just like the research with which you are already familiar, except that the "participants" are individual research studies, not individual people.

criteria for Binge-eating disorder

A. Recurrent episodes of binge eating. An episode of being eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. The binge-eating episodes are associated with three (or more) of the following: 1. Eating much more rapidly than normal 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry 4. Eating alone because of feeling embarrassed by how much one is eating 5. Feeling disgusted with oneself, depressed, or very guilty afterward C. Marked distress regarding binge eating is present D. The binge eating occurs, on average, at least once a week for 3 months E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

criteria for bulimia nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise C. The binge eating and inappropiate compensatory behaviors both occur, on average, at least once a week for 3 months D. Self-evaluation is unduly influenced by body shape and weight E. The disturbances does not occur exclusively during episodes of anorexia nervosa.

Criteria for anorexia nervosa

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

What is the difference between binge-eating disorder and bulimia nervosa?

After a binge (which may be at a level comparable to that of a patient with bulimia nervosa), the person with BED does not engage in any form of inappropriate "compensatory" behavior. purging, using laxatives, or even exercising to limit weight gain

body mass index

An estimation of total body fat calculated as body weight in kilograms divided by height (in meters) squared

binge

An out-of-control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances

What disorder did not receive its current name until 1873, when Charles Lasegue in Paris and Sir William Gull in London independently described the clinical syndrome?

Anorexia nervosa

Within the DSM-5 these are considered to be separate syndromes, and they reflect two types of adult eating disorders.

Anorexia nervosa & bulimia nervosa

Less dietary restraint than is typical of either bulimia nervosa or anorexia nervosa

BED

anxiety disorders, mood disorders, and substance use disorders are seen in what eating disorders?

BED

What was changed in the DSM-IV to DSM-5 of bulimia?

Binge eating and purging now have to occur on average once a week (instead of twice a week) over a 3-month period

The British psychiatrist G. F. M. Russell proposed the term in 1979, and it was adopted into the DSM in 1987. Which term was this?

Bulimia nervosa

What disorder was recognized as a psychiatric syndrome relatively recently?

Bulimia nervosa

eating disorder

Disorders of food ingestion, regurgitation, or attitude that affect health and well-being, such as anorexia, bulimia, or binge eating.

binge eating disorder (BED)

Distinct from non purging bulimia nervosa, whereby binging is not accompanied by inappropriate compensatory behavior to limit weight gain

what are some biological factors for an eating disorder?

GENETICS -tendency for anorexia to run in families (11.4 times greater) -tendency for bulimia to run in families (3.7 times greater) -evidence for a gene on chromosome 1 that might be linked to susceptibility to the restrictive type of anorexia -chromosome 10 for bulimia -eating disorders have additionally been linked to genes that are involved in the regulation of the neurotransmitter serotonin BRAIN ABNORMALITIES -Hypothalamus -Damage to the frontal cortex (particularly an area called the orbitofrontal cortex) also play a role in monitoring the pleasantness of stimuli such as smell and taste SET POINTS -one important kind of physiologic opposition designed to prevent us from moving far from our set point is hunger -as we lose more and more weight, hunger may rise to extreme levels, encouraging eating, weight gain, and a return to a state of equilibrium SEROTONIN -Modulates appetite and feeding behavior -because many patients with eating disorders respond well to treatment with antidepressants (which target serotonin), some researchers have concluded that eating disorders involve a disruption in the serotonergic system -Serotonin is made from an essential amino acid called tryptophan, which can only be obtained through food.

grehlin

Grehlin is a hormone that is produced by the stomach. It stimulates appetite

anorexia nervosa

Intense fear of gaining weight or becoming "fat" coupled with refusal to maintain adequate nutrition and with severe loss of body weight

The word bulimia comes from the greek boys (which means "ox") and limos ("hunger").

It is meant to denote a hunger of such proportions that the person "could eat an ox"

hypothalamus

Key structure at the base of the brain; important in emotion and motivation

what are some treatments for obesity?

LIFESTYLE MODIFICATIONS -clinical approach that involves a low-calorie diet, exercise, and some form of behavioral intervention -those who followed the atkins diet had lost the most weight -crash diets and extreme treatments to being about dramatic weight loss are now considered to be outmoded and ineffective approaches. -recent research has shown that focusing on the proportion of fat, protein, or carbohydrates in the diet is far less important than just eating less -relapse rates are so high after weight loss and that people who attempt to lose weight often feel so discouraged. MEDICATIONS -one group of medications reduces eating by suppressing appetite, typically by increasing the availability of neurotransmitters. -second group of medications works by preventing some of the nutrients in food from being absorbed -Sibutramine (Meridia) inhibits the repute of serotonin and norepinephrine and, to a lesser extent, dopamine. -Orlistate (Xenical) works by reducing the amount of fat in the diet that can be absorbed once it enters the gut BARIATRIC SURGERY -most effective long-term treatment for people who are morbidly obese -before the surgery, the stomach might be able to hold about a quart of food and liquid. After the procedure, the stomach might be able to hold only the contents of a shot glass.

leptin

Leptin is a hormone produced by fat cells that acts to reduce food intake.

What are some treatments for anorexia nervosa?

MEDICATIONS -antidepressants are sometimes used, although they have not been proven to be effective -antipsychotic medication called olanzapine may be beneficial -side effect of olanzapine is weight gain FAMILY THERAPY -For adolescents with anorexia nervosa, family therapy is considered to be the treatment of choice. -Maudsley model -typical treatment program: involves 10 to 20 sessions spaced over 6 to 12 months. has three phrases. In the referring phase, the therapist works with the parents and supports their efforts to help their child (typically a daughter) to eat healthily once more. after the patient starts to gain weight, the negotiations for a new pattern of relationships phase begins, and family issues and problems begin to be addressed. Later, in the termination phase of treatment, the focus is on the development of more healthy relationships between the patient and her parents. -randomized controlled trials has shown that patients treated with family therapy for 1 year do better than patients who are assigned to a control treatment (where they receive supportive counseling on an individual basis) -five years after treatment, 75 to 90 percent of patients show full recovery -patients who develop anorexia nervosa before age 19 and have been ill for fewer than 3 years seem to do better than patients who have been ill for longer or who have bulimia nervosa; this highlights the importance of early treatment, which may save some patients from a lifetime of suffering -for patients who are older or who have a long history of anorexia, the Maudsley approach unfortunately provides little clinical benefit COGNITIVE-BEHAVIORAL THERAPY -has proved to be very effective in treating bulimia -recommended length of treatment is 1 to 2 years -major focus: involves modifying distorted beliefs concerning weight and food, as well as distorted beliefs about the self that may have contributed to the disorder -only 17% of patients who received CBT showed full recovery -the limited success of CBT for patients with anorexia may be due to the extreme cognitive rigidity that is characteristic of those with this disorder

Tim: obsessed wit his weight (eating disorders & obsessive-compulsive disorder)

Tim (8 year old boy) -Extremely concerned with his weight and weights himself daily -complains he is too fat, cuts food if he does not lose weight -lost 10 pounds in the past year and still feels he is too fat -keeping track of the calories he eats daily -is described as being obsessed with cleanliness and neatness -Doesn't like when people touch him -has no friends because he refuses to go their "dirty" houses -gets anxiety and agitated if things are not done the way they should be done -wakes up 2 hours before school starts

Calculating body mass index

Weight (lb.) / height (in.) squared x 703 = BMI

sertonin

a neurotransmitter from the indolamine class that is synthesized from the amino acid tryptophan. Also referred to as 5-HT (5-hydroxytryptamine), this neurotransmitter is thought to be involved in a wide range of psychopathological conditions

Obesity can be regarded as

a state of excessive, chronic fat storage

Anorexia nervosa and bulimia nervose do not occur in large numbers before

adolescence

What was the important change made from the DSM-IV to DSM-5 regarding anorexia nervosa?

amenorrhea (cessation of menstruation) is no longer required for a person to be given the diagnosis

Obsessive-compulsive disorder is seen in what eating disorder?

anorexia and bulimia

Which disorder has the highest mortality rate of any psychiatric disorder?

anorexia nervosa

What disorder has a high dropout rate from therapy

anorexia nervosa, especially the binge-purging subtype of anorexia nervosa permanently

depression is seen in what eating disorder

anorexia, bulimia, BED

what is the lifetime prevalence of binge eating disorder?

around 2%

Who are at an especially high risk for eating disorders?

ballet dancers

Binge-eating disorder is associated with

being overweight or even obese, although weight is not a factor involved in making the diagnosis.

What is the most common form of eating disorder?

binge-eating disorder

substance-abuse disorders are seen in what eating disorder?

binge-purging subtype of anorexia and bulimia

who has the highest rate of obesity found for any group?

black women; ½ are obese

Maudsley model

blames neither the parents nor the child for the anorexia nervosa

The clinical picture of the binge-eating/purging type of anorexia nervosa has much in common with

bulimia nervosa

binge-eating disorder resemble people with

bulimia nervosa

symptoms of obesity

compulsive consumption of food and the inability to restrain eating despite the wish to do so

What are the difference between the two types of anorexia nervosa?

concerns the way in which patients maintain their very low weight. 1. In the restricting type, every effort is made to limit the quantity of food consumed; avoid eating in front of others; when at the table they may eat excessively slow, cut their food into very small pieces, or dispose of food secretly. 2. In the binge-eating/purging type, they either binge, purge, or binge and purge.

Many patients with anorexia nervosa

deny having any problem; they may come to feel fulfilled by their weight loss.

Eating disorder diagnoses are commonly associated with other

diagnosable psychiatric conditions; depression, obsessive-compulsive disorder, substance-abuse disorders, personality disorders, anxiety disorders

bulimia _______ to be a culture-bound syndrome

does seem

Bidirectional transitions between the two subtypes of anorexia nervosa (restricting and binge-purging) were

especially common

obesity is more prevalent in

ethnic minorities

What age do binge-eating disorder typically develop

generally between 30 and 50 years of age.

Randomized controlled trials

involves a specific treatment group (which is the group the researchers are most interested in) as well as a control treatment group (against which the treatment group will be compared). participants have an equal chance of being placed in either group because which group they go into is randomly determined

What is the difference between mortality rates of girls 15-24 with anorexia nervosa and girls without the disorder?

it is 12 times higher in girls with anorexia nervosa

What are some advantages to be able to store surplus energy as fat?

it serves as a hedge against periods of food shortage and makes survival more likely during times of famine

Obesity is not considered to be an eating disorder or a psychiatric condition in the DSM; however,

it's prevalence is rising at an alarming rate

It has also been suggested that obesity and addiction may both concern problems in

key brain regions involved in motivation, reward, and inhibitory control

black adolescent girls seem

less inclined to use weight and appearance to fuel their sense of identity and self-worth

women who had stronger ethnic identities were

less likely to have internalized U.S. societal beauty ideals about the importance of being thin and attractive

rates of obesity are slightly higher in

men than they are in women

Individuals with binge-eating disorder are _______ likely to have overvalued ideas about the importance of weight and shape than overweight or obese patients who do not have binge-eating disorder.

more

Obesity accounts for...

more morbidity and mortality than all other eating disorders combined

anorexia is _____ a culture-bound syndrome

not

from a diagnostic perspective, obesity is

not an eating disorder, and it is not included in DSM-5.

binge-eating disorder is higher in ______ people and in the range of 6.5 to 8%

obese

Crossovers from the restricting subtype of anorexia into binge-eating disorder do not seem to

occur at all

The most recent estimates show that ________ of adults in the United States are obese

one-third

who are more likely to have a premature death of anorexia?

patients who are older when they first receive clinical attention

purge

purging refers to the removal of food from the body by such means as self-induced vomiting or misuse of laxatives, diuretics, and enemas.

personality disorders are seen in what eating disorders?

restrictive type of anorexia, binge-purging type of anorexia, bulimia, BED (especially)

"rexy" means

said by kate moss, hybrid term that combines "anorexic" and "sexy"

In anorexia nervosa in its severe form it is about as common as

schizophrenia

When when well, many individuals who recover from anorexia and bulimia

still harbor residual food issues; someone who no longer meets all of the diagnostic criteria for an eating disorder may still have issues with food and body image

The second most common cause of death in those who suffer from anorexia nervosa is

suicide; 1/5 of the deaths of anorexia

negative affect

the experience of an emotional state characterized by negative emotions. Such negative emotions might include anger, anxiety, irritability, and sadness.

What was one patient's belief of being successful in anorexia nervosa?

the hallmark of a truly successful person with anorexia nervosa was death from starvation, and that patients who were able to accomplish this should somehow be revered.

perfectionism

the need to get things exactly right. a personality trait that may increase risk for the development of eating disorders, perhaps because perfectionistic people may be more likely to idealize thinness.

high risk of suicide with anorexia

who have lost their ability to maintain an "emotionally protective" low body weight

Individuals with anorexia view the disorder as a chronic condition and are generally pessimistic about

their potential for recovery

One way in which eating disorders differ from other types of disorders?

there is a lot of diagnostic crossover; it is quite common for someone who is diagnosed with one form of eating disorder to be later diagnosed with another eating disorder.

compared to thin television characters,

those who are overweight or obese are more likely to be shown when eating, are less likely to be depicted as being involved in romantic relationships, and are more likely to be the target of derisive comments;' audiences also laugh more when negative comments are directed towards overweight characters, especially female ones.

What type of disorder is often greatly admired by others with eating disorders?

those with restricting type of anorexia nervosa

what is the most immediate concern with patients who have anorexia nervosa?

to restore their weight to a level that is no longer life threatening.

Childhodo obesity has ______ since 1980.

tripled

From 1980 to 2002 the prevalence of obesity almost _______ in adults in the United Kingdom

tripled

Even after a series of treatment failures, it is still possible for women with anorexia nervosa to become well again

true

Bulimia is less lethal than anorexia, however it is still associated with a mortality rate that is approx ________ that found in people of comparable age in the general population.

twice

prognosis for binge-eating disorder

very good

Prognosis for bulimia

very good; 70% recover

After a binge, people with bulimia nervosa the person begins to

vomit, fast, exercise excessively, or abuse laxatives; disgusted with their behavior, the purging alleviates the fear of gaining weight that comes from eating

What is the difference between a person with bulimia nervosa and a person with the binge-eating/purging type of anorexia nervosa?

weight anorexia is severely underweight bulimia is not; typically normal weight or sometimes even slightly overweight

Purging disorder

which involves purging in normal weight people who have not eaten large amounts of food