Course overview Eating disorders and obesity are issues that healthcare workers confront on a regular basis. This course provides current information about the disorders, triggers, and strategies to help Definitions of Terms Constance is 14 years old and a freshman in high school. She is eager to be popular and is a bit overweight. Eager to lose weight so that she can “finally wear awesome clothes,” Constance goes on a diet and loses about 10 pounds. Delighted with her weight loss, Constance is determined to “be as thin as a super model.” She is preoccupied with food and eats as little as possible. No matter how much weight she loses, Constance is convinced that she is fat and must continue to diet. She is becoming dangerously thin. Marjorie is 32 years old. She is married and has two children ages 4 and 2. Marjorie’s husband is a prominent physician, and she volunteers for a wide variety of charitable causes. She and her husband are often featured in the local society pages, and Marjorie is conscious of “needing to look my best.” Marjorie has always been concerned about her physical appearance and, even as a young girl, would go on fad diets. Marjorie has discovered a way to eat what she wants and not gain weight. She often secretly eats a large amount of food in a short period and then forces herself to purge (vomit). Marjorie also exercises obsessively. She convinces herself that what she is doing is OK because she is within the normal weight range for her age and height. Mark is a shy 17-year-old. He is not good at sports, which disappoints his father, who was an outstanding high school and college athlete. Mark has a few close friends who are his major support system. Despite the encouragement of his friends, Mark is unhappy and finds compensation in food. He eats excessive amounts of food but does not try to compensate for his large calorie intake with exercise or purging. Mark is becoming obese. What are eating disorders? Eating disorders are defined as serious conditions characterized by a preoccupation with food that not only interferes with activities of daily living but also can have serious, even fatal, health consequences (American Psychiatric Association, 2013; National Institute of Mental Health, n.d.). The preceding scenarios are examples of three of
clients recover from eating disorders and overcome obesity and achieve and maintain a healthy lifestyle for their height and age.
INTRODUCTION
the most common eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder. Anorexia nervosa is a syndrome in which affected clients aggressively take steps to be thin, sometimes to the point of serious physiological consequences and even death. Even though clients are obviously dangerously thin, they perceive themselves as fat. Clients are obsessed with food and body image, which is distorted as they continue to see themselves as fat even though they are extremely thin (Gersch et al., 2016). Bulimia nervosa, commonly referred to as bulimia, is characterized by episodes of binge eating (eating huge amounts of food) and then purging (using inappropriate methods to prevent weight gain such as self-induced vomiting, extreme use of laxatives, or excessive exercising). Binge eating is defined as eating, usually within two hours, an extremely large amount of food. The amount of food is larger than most persons would eat in a similar period (Gersch et al., 2016). Binge-eating disorder is characterized by behaviors that involve eating excessive amounts of food (binging) and by the absence of behaviors that attempt to compensate for this large intake of calories. In other words, the person eats excessively but does not attempt to purge. Persons with binge-eating disorder are often overweight or obese. They feel a loss of control and marked distress over their eating behaviors (Mayo Clinic, 2018a). Any of the preceding eating disorders can lead to serious health complications and even death. They can interfere with activities of daily living, interpersonal relationships, and ability to function at home, at work, and in school. Healthcare consideration : Members of the general public and even some healthcare professionals believe that eating disorders are a matter of lifestyle choices (National Institute of Mental Health, n.d.). Healthcare professionals must help to educate clients, families, and colleagues about the seriousness of these often-fatal illnesses.
INCIDENCE AND PREVALENCE OF EATING DISORDERS
Eating disorders can affect anyone of any age, gender, or socioeconomic status. In the United States alone, a clinically significant eating disorder affects an estimated 20 million females and 10 million males at some time in their lives (National Eating Disorders Association, 2016). Eating disorders begin as ways to cope with problems in psychosocial functioning or goals in living (Mehler & Andersen, 2017). It appears that the prevalence and severity of eating disorders may be spiking even more due to the anxiety and stress unleashed by the COVID-19 pandemic. A survey reported in the International Journal of Eating Disorders in July 2020, for example, found that overall individuals with anorexia “experienced a worsening of symptoms as the pandemic hit.” In addition, individuals with bulimia nervosa and binge-eating disorder “reported increases in their binge-eating episodes and urges to binge” (Graber, 2021) Historically, more women than men have suffered from eating disorders. However, the rate of occurrence among men is increasing. Research has shown that the number of teenage males dissatisfied with their bodies has tripled over the last 25 years, going from 15% of teenage males being dissatisfied with their body image to 45% in 2016 (Malcore, 2016). Both males and females with eating disorders have distorted senses of body image and exhibit many of the same signs and symptoms. However, males are less likely to receive an accurate diagnosis
because many people, including some healthcare professionals, view eating disorders as female diseases (Malcore, 2016; National Eating Disorders Association, 2016). Females and males generally have different types of concerns over body image. Females with eating disorders are generally obsessed with losing weight to become thin; some males have a disorder characterized by an obsession with becoming more muscular. This disorder is referred to as body dysmorphic disorder (BDD) (sometimes called muscle dysmorphia). To increase their muscle mass, males with this disorder are often likely to use steroids or other types of dangerous drugs to increase muscle mass and “bulk up” (Malcore, 2016). Evidence-Based Practice Alert! Research has shown that 50% of males with muscle dysmorphia abuse steroids in attempts to add muscle mass to their bodies. In addition to using injectable steroids, some males use what are advertised as “natural” protein powders and supplements. These powders and supplements are not regulated by the Food and Drug Administration (FDA), may contain unhealthy and even dangerous ingredients, and may cause adverse side effects (Malcore, 2016). Nurses and other healthcare professionals must be alert to steroid use and ask about such use when evaluating nutritional status.
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