PUBH 358: 3.2 Nutrition and Eating Disorders

World Health Organization (WHO) defines physical growth as:

"the period of life when a child experiences physical, hormonal, sexual and social changes and becomes capable of reproduction."

Micronutrients - Iron (1)

- Adolescents have increased requirements for iron due to rapid growth, increased blood volume, and cognitive development - Adolescent girls are at increased risk of iron deficiency due to inadequate dietary iron intake along with the iron loss that occurs with menstruation

Cultivating Positive Body Image

- Appreciate all that your body can do and do something nice for yourself - Keep a list of things you like about yourself and read it often - Remind yourself that "true beauty" more than what you can see - Look at yourself as a unique whole and not focus on specific body parts - Surround yourself with positive people - Turn off the voice that says your body is not "right" - Be a critical viewer of social media messages

Therapy in conjunction with mediation

- Appreciate all that your body can do and do something nice for yourself. - Keep a list of things you like about yourself and read it often - Remind yourself of "true beauty" more than what you can see. - Look at yourself as a unique whole and not focus on specific body parts. - Surround yourself with positive people. - Turn off the voice that says your body is not"right" - Be a critical viewer of social media messages

Body image perception:

- By age 6 (when children enter school) sociocultural factors start to influence body dissatisfaction. - 50% of girls are dissatisfied with weight and shape of their body by late elementary school and reaches up to 70% in middle school girls. - Adolescents often think that losing weight will make them happier, healthier and better looking

Eating disorder health impact: hormone imbalance

- Delayed menarche - Chronic Amenorrhea (absence of menstruation)-for sex or more cycles - Impaired breast development - Infertility

Anorexia warning signs:

- Deliberate self-starvation with weight loss - Intense, persistent fear of gaining weight - Refusal to eat or highly restrictive eating - Continuous dieting - Excessive facial/body hair because of inadequate protein in the diet - Compulsive exercise - Abnormal weight loss - Sensitive to cold - Absent or irregular menstruation - Hair loss

Undernutrition:

- Undernourished adolescents have commonly experienced stunted growth in childhood. - Undernutrition in early life can result in fewer pancreatic cells that produce insulin.

Men and Eating disorders - warning signs

- Viewing one's body as puny despite efforts and success at bodybuilding. - Having a distorted body perception that leads to extreme efforts to increase lean muscle mass and overall body size. - Taking extreme measures to increase muscle mass, including excessive exercise, dietary manipulation and high protein intake, use of anabolic steroids

TedTalk Thomas Curran: Our Dangerous Obsession with Perfectionism is Getting Worse (2)

- Young people are more preoccupied with having the perfect life - Perfectionism is a symbol of worth and being successful - People feel discontented and dissatisfied with the sense that they are never going to be perfect enough - Perfectionism conceals a host of psychological difficulties, such as anxiety, depression, anorexia, bulimia, and suicide

Physical Growth: Girls - The stage of early female puberty is characterized by

- breast development, - the appearance of pubic and underarm hair - increased height - menstrual onset - widening hips - Growth continues on until 17 or 18 years old, but at a slower rate

Half of total bone density is attained during adolescence:

- children begin their critical bone-building around 9 and fully develop their bone mass by 18 - bones continue getting denser until they reach peak bone mass

Disordered eating includes behaviors that are known common features of eating disorders:

- chronic restrained eating - compulsive eating - binge eating - self-induced vomiting

Eating disorder health impact: Cardiovascular complications

- heart failure - arrhythmias

Risk factors related to disordered eating

- negative mood - level of self-esteem - emphasis on perfectionism - drug use - perceived pressure to lose weight - participation in sports and other activities, such as dance that emphasize physical leanness

TedTalk Thomas Curran: Our Dangerous Obsession with Perfectionism is Getting Worse (1)

- perfectionism is rising at an alarming rate - Suicide has increased 25% in the past decade - Change of society reflects upon a changed sense of personal identity and differences in the ways people interact with each other and the world around them - Unrestricted choice and personal freedom contribute to the problem

Physical Growth: Boys - Secondary sexual characteristics include

- the emergence of pubic and underarm hair - the lengthening of the penis - an increase in height - a deepened voice - significantly added muscle mass compared with girls

Peak bone mass:

- the point when an individual has the greatest amount of bone that they will ever have - usually reached between the ages of 18 and 25. - insufficient amounts of calcium and vitamin D during this stage increase the lifetime risk of fractures and osteoporosis

Rapid changes that unfold during puberty:

- weight, height, body shape - body composition, primary and secondary sex characteristics

Mental development: History of malnutrition has been linked with -

-- Lower school performance -- Depression -- Aggression towards peers -- Conduct problem -- Attention deficit - Macronutrient deficit as well as micronutrients (iron,vitamin B)

Risk factor for eating disorders - biological

Family history of eating disorder/mental health condition and negative energy balance

Examples of calcium:

dairy products, sardines with bones, fortified soymilk, turnip greens and kale

Effects of body image and social media

these transformative steps coincide with increased exposure to media and societal messages on idealized versions of physical beauty, which in turn influence eating habits and attitudes toward food

Eating disorders (1)

- Eating disorders are more likely to occur during and shortly after puberty - Ninety-five percent of those who have an eating disorder are between the ages of 12 and 25 - Females are much more likely than males to develop the condition - Eating disorders have the highest death rate of any mental illness - Common co-occurring conditions include major depression and anxiety.

Targeted risk groups:

- Eating disorders are often thought of as an issue for young girls. This misconception leads to fewer diagnosis and treatment options -- Athletes -- Disability community -- LBGTQ -- Men and boys

Binge eating disorder warning signs:

- Eating much more rapidly than normal - Eating until feeling uncomfortably full - Eating large amounts of food when not feeling physically hungry - Eating alone because of being embarrassed by how much one is eating - Feeling disgusted with oneself, depressed, or feeling very guilty after overeating - A sense of lack of control overeating during binge episodes - Marked psychological distress

During adolescence, children transition from childhood to adulthood:

- Gain up to 50 percent of their adult body weight and 50 percent of their bone mass - Attain the physical capacity to reproduce - Experience ongoing brain development

TedTalk Thomas Curran: Our Dangerous Obsession with Perfectionism is Getting Worse (6)

- How to help young people outgrow perfectionism: society needs to outgrow it first - Young people need to celebrate the joys and the beauties of imperfection as a normal and natural part of everyday living and loving - Perfectionists are typically bright, ambitious, conscientious and hardworking -- Treatment is complex, needs self-compassion

Constant Physiologic and psychologic stress (like ACE)

- Increasing the production of stress hormones that weaken the body and - Decreasing the production of thyroid hormones and insulin-like growth factor that regulate growth

Normal body-image and eating concerns include: (1)

- Interest in improving physical appearance, health, and overall wellness - Enthusiasm about a new fitness or healthy eating plan - Focus on body image, while maintaining a reasonable level of self-acceptance - Pursuit of a challenging physical training program that incorporates good nutrition and balance

Micronutrients - Iron (2)

- Iron deficiency during adolescence may impair immunity as well as growth and cognition - The adolescent's diet, therefore, must provide enough iron and other nutrients, such as vitamin C, that promote adequate iron bioavailability and utilization by the body. - Many teenagers consume unbalanced diets with a lack of variety,which may limit their iron intake and hinder its bioavailability, leading to a possible deficiency

TedTalk Thomas Curran: Our Dangerous Obsession with Perfectionism is Getting Worse (5)

- It captures 3 core elements of perfectionism 1. Self-oriented perfectionism: the irrational desire to be perfect ("I strive to be as perfect as I can be") 2. Socially prescribed perfectionism, the sense that the social environment is excessively demanding ("I feel that others are too demanding of me") 3. Other-oriented perfectionism: the imposition of unrealistic standards on other people ("if I ask somebody to do something, I expect it to be done perfectly")

Treatment for eating disorders -

- Many individuals with eating disorders never receive any form of treatment -- Reluctance to treat those who don't appear ill or emaciated -- Lack of money -- Lack of access to health services -- Lack of insurance coverage

TedTalk Thomas Curran: Our Dangerous Obsession with Perfectionism is Getting Worse (4)

- Perfectionism is never about perfecting things or perfecting tasks or striving for excellence: -- It's about perfecting the self (an imperfect self)

Bulimia nervosa warning signs:

- Preoccupation with food - Binge eating, usually in secret - Vomiting after binging - Abuse of laxatives, diuretics, diet pills - Denial of hunger or drugs to induce vomiting - Compulsive exercise - Swollen salivary glands - Broken blood vessels in the eyes

Physical Growth:

- Primary sexual characteristics: Prenatal development of external and internal organs (ovaries, uterus, testis, etc.) - Secondary sexual characteristics during puberty - For girls, puberty typically starts between the ages of 8 and 13; and for boys, it begins between the ages of 9 and 14

Eating disorder health impact:

- Reduced growth spurt and loss of muscle mass - Anemia - Osteoporosis - Dental enamel erosion from regular vomiting

Not normal body-image and eating concerns include: (2)

- Singular focus on weight loss or obsession with restrictive (yo-yo) dieting - Punitive approach to body image which includes self-denigrating comments and/or excessive exercise or purging after eating - Working out to lose weight without regard for health and nutritional needs - Self-worth based entirely on body image - Compulsive, rigid or inflexible approach to a diet/exercise routine

TedTalk Thomas Curran: Our Dangerous Obsession with Perfectionism is Getting Worse (3)

- Standardized tests in American public schools have led to people report a strong need to strive, perform, and achieve at the center of modern life - They have been conditioned to define themselves in the strict and narrow terms of grades, percentiles, and lead tables - This society preys on insecurities of how they are performing or appearing to other people

Body image and social media:

- Survey of girls 13-17 reported that 90% of adolescent girls felt pressure by fashion and media to be skinny. - Previous study on magazine and TV exposure show association with body dissatisfaction. - Mobile social media platforms amplify the duration and the amount of the exposure idealizing a thin body. - Judging by "likes"

Importance of nutrition in adolescence (2)

- These changes in nutrient demand is further complicated by: -- Becoming more independent in their food choices -- More likely to be influenced by their peers -- Less likely to pick healthy foods

Eating disorders (2)

- Transgender individuals experience eating disorders at rates significantly higher than cisgender individuals. - 40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming too fat. - In a large study of 14-and 15-year-olds, dieting was the most important predictor of a developing eating disorder

________________ is a critical period for establishing a healthy body image

Adolescence

Male body image:

Boys report lower levels of body dissatisfaction and exhibit fewer eating disordered compared to girls but tend to be quieter about their body negativity, seeking treatment less frequently

Bulimia Nervosa

Characterized by binge eating followed by purging, which refers to attempts to rid oneself of the food consumed

Anorexia Nervosa

Characterized by tremendous fear and anxiety over gaining weight, combined with a strong desire to be thin and enormous food restriction

Binge Eating Disorder

Eating an inordinate amount of food in a short period of time without subsequent purging episodes

Risk factor for eating disorders - psychological

Perfectionism, body image dissatisfaction, anxiety disorder, behavioral inflexibility

Importance of nutrition in adolescence (1)

These rapid physical growth and changes increase the nutrient demand

____________ ____ is a fat-soluble nutrient produced in the skin through exposure to the sun, and it facilitates the intestinal absorption of calcium

Vitamin D

Risk factor for eating disorders - social

Weight stigma, teasing/bullying, history of trauma or ACE, appearance idealization, limited social networks

Define body image

a complex mental picture of how individuals perceive, think, feel, and act towards their own body

Disordered eating describes a variety of:

abnormal eating behaviors that observed on their own are not individually classified as an eating disorder, which is a distinct psychological illness

Definition - Micronutrient Iron

an essential component of hundreds of proteins and enzymes involved in many metabolic processes, including oxygen transport and energy metabolism.

__________ is the most abundant mineral in the human body and the main constituent of bones and teeth

calcium

Achieving an adequate intake of __________ and sufficient blood levels of ____________ ___ during adolescence is crucial to physical growth and development

calcium, vitamin D

Macronutrients

carbohydrates, protein, fats

Mental disorders defined by abnormal eating habits _______________ impact a person's physical or mental health.

negatively

A pubertal growth spurt in boys usually begins:

one to two years after most girls and continues for three to four years

Examples of vitamin D

some include fatty fish, such as salmon, herring, and catfish, fishliver oil, and fortified milk

Adolescence is challenging for most teenagers because of:

the type and extent of the developmental transitions that occur