DYING TO BE THIN AN INTRODUCTION TO NUTRITION AND EATING DISORDERS ALICE MERRITT MPH, RD, LDN, CEDRD
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1 DYING TO BE THIN AN INTRODUCTION TO NUTRITION AND EATING DISORDERS ALICE MERRITT MPH, RD, LDN, CEDRD
2 WHO I AM & WHY I AM HERE Alice Merritt, MPH, RD, LDN, CEDRD Registered Dietitian Certified Eating Disorder Specialist- IAEDP Licensed provider, medical nutrition therapy Master s degree in Public Health Nutrition from The University of North Carolina at Chapel Hill Eight years specialized training in eating disorder nutrition therapy Experience as clinical dietitian & health educator in large university setting Intensive clinical work as dietitian in a hospitalbased eating disorder program for both adults & adolescents
3 WHAT YOU HAVE HEARD All people with eating disorders are super-thin. People with eating disorders are white, upper-class girls. People with eating disorders are spoiled. People with eating disorders are trying to get attention. People with eating disorders should just eat. Eating disorders are the result of bad parenting. Eating disorders are all about vanity.
4 CONFLICTING MESSAGES About 17% (or 12.5 million) of children and adolescents aged 2 19 years are obese. Since 1980, obesity among children and adolescents has almost tripled. In , Hispanic boys, aged 2 to 19 years, were much more likely to be obese than non- Hispanic white boys, and non-hispanic black girls were much more likely to be obese than non- Hispanic white girls.
5 PREVALENCE* OF SELF-REPORTED OBESITY AMONG U.S. ADULTS BRFSS, 2012 *Prevalence reflects BRFSS methodological changes in 2011, and these estimates should not be compared to those before % <20% 20% <25% 25% <30% 30% <35% 35%
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10 DIETING AND THE DRIVE FOR THINNESS Over 1/2 of teenage girls and nearly 1/3 of teenage boys use unhealthy weight control behaviors such as: skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives. (Neumark-Sztainer, 2005) By age fourteen, 57% of girls and 33% of boys have a strong desire to be thinner. An additional 10% of girls and 33% of boys want more a more muscular body. (Tiggemann, 2006)
11 Two out of five females and one out of five males would trade three to five years of their life to achieve their weight goals. Young women ages are more afraid of becoming fat than they are of nuclear war, cancer, or losing their parents.
12 TYPES OF EATING DISORDERS: Anorexia Nervosa (restrictive & binge/purge types) Low weight Intense fear of food and weight gain Bulimia Nervosa (purging & non-purging types) Bingeing followed by Purging (vomiting, laxatives, diuretics) or a non-purging compensatory behavior (fasting, or compulsive over-exercise) Binge Eating Disorder (BED) Bingeing without compensatory behaviors Avoidant/Restrictive Food Intake Disorder (ARFID) Feeding/Eating Disorder Not Elsewhere Classified (FEDNEC)
13 WARNING SIGNS: ANOREXIA Dramatic weight loss and denial of hunger. Preoccupation with weight, food, calories, fat grams, and dieting. Refusal to eat certain foods. Comments about feeling fat. Anxiety about gaining weight or being fat. Development of food rituals. Avoiding mealtimes or situations involving food. Excessive, rigid exercise regimen. Withdrawal from usual friends and activities.
14 WARNING SIGNS: BULIMIA Disappearance of large amounts of food in short periods of time. Frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics. Excessive, rigid exercise regimen. Unusual swelling of the cheeks or jaw area. Calluses on the back of the hands and knuckles from self-induced vomiting. Discoloration or staining of the teeth. Creation of complex lifestyle schedules or rituals.
15 WARNING SIGNS: BINGE EATING DISORDER Inability to stop eating or control what you re eating Rapidly eating large amounts of food Eating even when you're full Hiding or stockpiling food to eat later in secret Eating normally around others, but gorging when you re alone Feeling stress or tension that is only relieved by eating Feeling numb while bingeing like you re not really there or you re on auto-pilot. Feeling guilty, disgusted, or depressed after overeating Desperation to control weight and eating habits
16 WHAT CAUSES AN EATING DISORDER? Psychological Factors that contribute: Low Self-esteem Feelings of inadequacy or lack of control Depression, anxiety, anger, or loneliness Interpersonal Factors that contribute: Trouble with family and/or relationships Difficulty expressing emotions and feelings Past of being teased on size or weight History of physical or sexual abuse
17 CONTRIBUTING FACTORS CONT. Social Factors: Society pressures promoting thinness and the perfect body Narrow definitions of beauty Culture influences that value physical appearance Biological Factors: Lots of research on possible biochemical or biological causes, but still under investigation Often run in families thus implying some possible genetic link
18 YIKES.WHAT CAN I POSSIBLY DO??
19 HEALTHY EATING NUTRITION MESSAGE Balance, Variety, and Moderation
20 VS.
21 LISTEN TO YOUR BODY MINDFULNESS 1. Reject the Diet 2. Honor Your Hunger 3. Make Peace with Food 4. Challenge the Food Police 5. Respect Your Fullness 6. Discover the Satisfaction 7. Honor Your Feelings Without Using Food 8. Respect Your Body 9. Exercise--Feel the Difference 10 Honor Your Health
22 INAPPROPRIATE FOOD MESSAGES Diets work Eating fruits and vegetables helps with weight loss Eating high calorie foods causes weight gain and should be avoided Good vs Bad foods Fast food causes weight gain
23 PHYSICAL ACTIVITY/BODY MOVEMENT Activity should be part of your life not all of your life Balanced- different activities (yoga, dance, walking, tennis, soccer, strength training) Fun and enjoyable Moderate min most days of the week (4-5 days) Not just to lose weight Not to achieve a particular body shape or muscle mass
24 INAPPROPRIATE PHYSICAL ACTIVITY MESSAGES More is better If you exercise for longer you can eat more Exercise to burn off a piece of cake Timed activity to reach a specific calorie level You have to exercise to keep from gaining weight No pain no gain
25 PREVENTION OF EATING DISORDERS: Interventions and education on eating disorders! Especially in the highest risk years old Become media literate and recognize advertising strategies. Think critically about media messages that encourage unrealistic, unhealthy body image attitudes. Develop a strong and balanced sense of identity based on inner qualities, rather than superficial appearance.
26 EVOLUTION: DOVE CAMPAIGN FOR REAL BEAUTY
27 OTHER IDEAS FOR MEDIA LITERACY Workshops/Seminars on Media Literacy: Discuss challenges young people experience in the areas of body shape Teach young people to be critical viewers of media messages and getting familiar with advertising tactics
28 INCREASE AWARENESS: National Eating Disorder Awareness Week 2014 Theme: I Had No Idea Arrange for speakers Information Booths Poster Campaigns Panel Discussions Videos/Movies with Discussions
29 ENCOURAGE THE PERSON TO GET PROFESSIONAL HELP Therapist Registered Dietitian Physician- (psychiatrist, pediatrician, family medicine) School Counselor Coach Parents Level of Care What is needed to provide the best chance of recovery? Outpatient, Inpatient, Residential, Partial Hospitalization
30 10 STEPS TO A POSITIVE BODY IMAGE 1) Appreciate all that your body can do! 2) Keep a top 10 list of things you like about your body. 3) Remind yourself that true beauty is not simply skin-deep. 4) Look at yourself as a whole person 5) Surround yourself with positive people. 6) Shut down those voices in your head that tell you that your body is not right or that you are a bad person. 7) Wear clothes that are comfortable and make you feel good about your body. 8) Become a critical viewer of social and media messages. 9) Do something nice for yourself 10) Use the time and energy you may have spent worrying about food, calories, and weight to do something for others.
31 RESOURCES National Eating Disorder Association- Eating Disorder Referral and Information Center Academy of Nutrition and Dietetics Alice Merritt MPH, RD, LDN, CEDRD
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