Lecture Presentation Outline
I.
The Eating Disorders
 Instructor Resources: Unit 11 Nutrition Scoreboard transparency master; Unit 11 PowerPoint
presentation on Multimedia Manager; ABC video clip on Multimedia Manager: Anorexia in the Whole
Family (5:09); Activity 11-1: Eating Disorders
A. Symptoms of disordered eating behaviors
1. Self-imposed semi-starvation (anorexia nervosa)
2. Feast and famine cycles (bulimia nervosa)
3. Binge eating and purging (binge-eating disorder)
4. Consumption of nonfood substances such as paint chips and clay (pica)
5. Of other forms like compulsive overeating, restrained eating, and food preoccupation, too
little is known
II. Anorexia Nervosa
A. Characteristics
1. Individuals with anorexia nervosa starve themselves
2. People with anorexia nervosa look extraordinarily thin
3. People with anorexia nervosa have little fat (7–13%)
B. Health Effects
1. They have unusually low heart rates and dry skin, low blood pressure, absent or irregular
menstrual cycles, infertility, and poor pregnancy outcomes
2. Approximately 9 in 10 women with anorexia nervosa have significant bone loss, and 38%
have osteoporosis
a. Extent of bone loss correlates strongly with undernutrition
b. Therapies have limited effectiveness in rebuilding bones in females with current or past
anorexia nervosa
C. The Female Athlete Triad
1. Eating disorders, menstrual cycle dysfunction, and decreased bone mineral density occur in
young female athletes
2. Low calorie intakes and underweight from eating disorders can lower estrogen levels and
disrupt menstrual cycles
3. Low estrogen decreases calcium deposition in bones and reduces bone density when peak
bone mass is accumulating
4. Irregular menstrual cycles in young females cause delayed healing of bone and connective
tissue injuries, and bone fractures and osteoporosis later in life
D. Anorexia Motivations
1. Anorexia nervosa victims refuse to eat, even when ravenously hungry, and exercise intensely
2. People with anorexia prepare wonderful meals for others, but eat very little food
3. Family members and friends report high levels of anxiety
4. People with anorexia are “model students” or “ideal children,” but personal lives have low
self-esteem, social isolation, and unhappiness
E. What Causes Anorexia?
1. The cause isn’t clear
2.
Many conditions, psychological and biological, predispose an individual to become
dedicated to extreme thinness
3. Causes for this disorder
a. Value Western societies place on female thinness
b. Need to meet expectations of body weight and shape
c. Low self-esteem
d. Need to control some aspect of one’s life completely are potential causes
F. How Common Is Anorexia?
1. 1% of young women and less than 0.1% of young males have anorexia nervosa
2. Reported in girls as young as five and women through their forties
3. It usually begins during adolescence
4. One in ten females between the ages of 16 and 25 has “subclinical” anorexia nervosa
5. Certain groups are at higher risk of anorexia nervosa than others
6. People at risk tend to be overly concerned about weight and food, attempted weight loss
early
G. Treatment
1. There is no treatment that cures anorexia nervosa quickly and completely
a. The disorder takes a good deal of time and professional help to correct
b. Treating the disorder is difficult because none with anorexia believe their weight needs
to be increased
2. Treatment Programs
a. Treatment programs focus on:
1. Nutritional health and body weight
2. Psychological counseling for self-esteem
3. Attitudes about body weight and shape
4. Antidepressant or other medications
5. Family therapy
6. Normalizing eating and exercise behaviors
b. Successful in 50% and partially successful in others
c. 1/3 of people relapse within seven years
d. By eight years 3% of people with anorexia nervosa will have died
e. It claims the lives of 18% years later
f. Results are excellent when the disorder is treated early
3. Many with the condition deny problems exist and postpone treatment for years
III. Bulimia Nervosa
 Bulimia nervosa occurs in 1 to 3% of young women and in about 0.5% of young males in the United
States
A. Disorder is characterized by:
1. Regular episodes of dieting
2. Binge eating
3. Attempts to prevent weight gain by purging
a. Use of laxatives
b. Diuretics
c. Enemas
d. Dieting
e. Exercise
B. Progression
1. Bulimia nervosa starts with voluntary dieting to lose weight
2. Voluntary control over dieting is lost
3. People compelled to engage in binge eating and vomiting
4. The behaviors become cyclic, food binges are followed by guilt, purging, and dieting
a. Dieting leads to a feeling of deprivation and intense hunger, which leads to binge eating
and so on
b. Once a food binge starts, it is hard to stop
C. Features of bulimia nervosa
1. 86% of people vomit to prevent weight gain
2. Some use laxatives, diuretics, enemas and vomiting
a. Habitual use causes “laxative dependency”
b. Diuretics deplete the body of water and certain minerals and disturb its fluid balance
3. Some affected individuals are so preoccupied with food that they spend days securing food,
bingeing, and purging
4. Others experience only occasional episodes of binge eating, purging, and fasting
5. Unlike those with anorexia nervosa, people with bulimia usually are not underweight or
emaciated
a. They tend to be normal weight or overweight
6. Bulimia nervosa is common among athletes
D. Cause of Bulimia Nervosa
1. Possible causes
a. Depression
b. Abnormal regulation of food intake
c. Feast and famine cycles
1. Fasts and restrained eating prompt feelings of deprivation and hunger
2. Thinness becomes more difficult as feast and famine cycles continue
E. Treatment
1. Nutrition and counseling break feast/famine cycles
2. Replace disordered eating with regular meals
3. Psychological counseling improves self-esteem and attitudes toward body weight and shape
4. Antidepressants are useful
5. Full recovery of women higher than for anorexia
6. Most women with bulimia achieve partial recovery
7. 1/3 relapse to bingeing and purging in seven years
IV. Binge-Eating Disorder
A. Characteristics
1. People are overweight or obese, 1/3 are male
2. People eat several thousand calories’ worth of food during a solitary binge, feel a lack of
control over the binges, and experience distress or depression after the binges occur
3. People must have binges twice a week over six months to qualify
4. People with binge-eating disorder don’t vomit, use laxatives, fast, or exercise excessively in
an attempt to control weight gain
B. Features
1. 9 to 30% of people in weight-control programs and 30 to 90% of obese people have bingeeating disorder
2. Condition is far less common (2 to 5%) in the general population
3. Stress, depression, anger, anxiety, and other negative emotions prompt episodes
4. Binge eating disorder related to genetic mutation that impairs normal eating behavior
C. Treatment
1. Treatment focuses on disordered eating and underlying psychological issues
2. Persons will be asked to record food intake and note feelings, circumstances, and thoughts
related to each eating event
3. Information identifies circumstances that prompt binge eating and alternative behaviors to
prevent it
4. Individuals treated for binge-eating disorder are given information, attend therapy sessions,
receive nutrition counseling
5. Antidepressants may be part of the treatment
6. Treatment is successful in 85% of women
V. Eating Disorder Resources
A.
B.
C.
D.
Information and services for eating disorders are available
Services delivered by health care teams specializing and experienced
Primary care physician, dietitian, or nurse practitioner is good start to the process
Reliable sources for eating disorders, support groups, nearby treatment centers, and hotlines can
be found on the Internet
VI. Undieting
 Instructor Resources: CNN Today Nutrition Vol. 2: Girls’ Weight (1:58)
A. Pressure to be thin is primary force underlying development of eating disorders
1. Children acquire cultural values of beauty before adolescence
2. By age five children associate negative characteristics with overweight people and positive
characteristics with the thin
3. Beauty defined by models and movie stars includes thinness, but body shape is often
unhealthfully thin and unattainable
B. Disparity between ideal and what people normally weigh gives widespread discontent
 Instructor Resources: Activity 11-2: BMI Estimation
1. 50% of normal-weight adult women are dissatisfied with their weight
2. Many diet, binge, purge or fast to reach the standard of beauty set for them
C. Acceptance of body size
1. Acceptance of body size, attire for larger people, full-size models, and a realistic view of
differences in body shape is emerging
2. A realistic standard of body weight and shape and respect for people of all body sizes may be
the best measures we can take to prevent anorexia nervosa, bulimia nervosa, and bingeeating disorder
VII. Pica
 Pica is seen in chimpanzees and in humans since ancient times
 Health risks associated with eating types of nonfood substances


Young children and pregnant women are most likely to practice pica
Common forms are geophagia (clay or dirt eating), pagophagia (ice eating), amylophagia (laundry
starch and cornstarch eating), or plumbism (lead eating)
A. Geophagia
1. Some people eat clay or dirt
2. Report it tastes or smells good, quells a craving, relieves nausea or upset stomach
3. No evidence that geophagia is motivated by a need for minerals
4. Consequences to health are serious
a. Clay and dirt can block the intestinal tract and cause parasitic and bacterial infections
B. Pagophagia
1. Regular ice eating is associated with an iron-deficient state
2. Ice eating usually stops completely when the iron deficiency is treated
3. Ice eating is common during pregnancy
4. One study found ice eaters had poorer iron status than pregnant women who did not eat ice
C. Amylophagia
1. Sweet taste and crunchy texture of flaked laundry starch attracts small number of women
during pregnancy
2. If laundry starch is not available, cornstarch may be used
3. Taste for starch always disappears after pregnancy
4. Starch eating provides calories and may reduce the intake of nutrient-dense foods
a. Starch may contain contaminants
b. Starch eaters’ diets inferior to diets of pregnant women who don’t consume starch
D. Plumbism
1. Lead-containing paint chips pose a major threat to the health of children
2. Older homes and buildings are covered with lead-based paint and its flakes
3. Children develop lead poisoning if they eat the sweet paint flakes or inhale lead from
contaminated dust and soil near the buildings
4. One million young children have elevated blood lead levels
a. High levels of lead cause mental retardation and death in young children
b. Low exposure leads to hearing problems, growth retardation, reduced intelligence, and
poor classroom performance
c. Children with lead poisoning are likely to fail or drop out of school
VIII. Thoughts
A. Eating disorders affect the health and well-being of many
B. The solution lies in prevention
C. Most effective way to prevent eating disorders is to adjust expectations and cultural norms to
reflect reality