Weight-Related Concerns

and Disorders Among

Adolescents

PKK 3203
Nutrition Throughout the Life
Cycle
 Introduction
Thinness is valued in affluent societies where
food is abundant
This has lead to an increase in weight related
concerns
Adolescents are particularly vulnerable to theses
concerns due to physiological and psychological
changes
These concerns often result in eating disorders
Prevention, early detection and treatment are
necessary for these disorders
Changes in Adolescents
 Physical/Physiological changes
Growth and development increase nutritional needs
However, eating patterns are not ideal
Many adolescents consume deficient or excessive
amounts of some nutrients
Body dissatisfaction is high
Many normal changes are perceived as being
overweight
Many try to control these changes by controlling
food intake
Gender differences in body dissatisfaction reflected
in prevalence of eating disorders among the sexes
 Psychological/Social changes
Adolescents focus on finding their identify
Physical identity is intertwined with overall identity
Body dissatisfaction can increase risk of low self
esteem
Adolescents are sensitive to comments by others
Moodiness caused by hormonal changes
exaggerate body perception
Increased interest in the opposite sex leads to
concern over appearance
The risk of eating disorders are increased at this
time
 The Spectrum of Weight
Related Disorders
Eating disorders range from extreme
underweight to extreme overweight
The spectrum useful for the detection of milder
conditions
Similarities in the etiology of the spectrum of
eating disorders include concerns about
Body image
Food intake
Societal attitudes
Continuum of Weight-Related
Concerns and Disorders
 Diagnostic and Statistical
Manual of Mental Disorders,
5th Edition: DSM-5
2013
 Diagnostic Criteria for Anorexia Nervosa
Persistent restriction of energy intake leading to
significantly low body weight (in context of what is
minimally expected for age, sex, developmental
trajectory, and physical health) .
Either an intense fear of gaining weight or of becoming
fat, or persistent behaviour that interferes with weight
gain (even though significantly low weight).
Disturbance in the way one's body weight or shape is
experienced, undue influence of body shape and weight
on self-evaluation, or persistent lack of recognition of the
seriousness of the current low body weight.
Subtypes:
Restricting type
Binge-eating/purging type
 Diagnostic Criteria for Bulimia Nervosa
Recurrent episodes of binge eating. An episode of binge eating is
characterised by both of the following:
Eating, in a discrete period of time (e.g. within any 2-hour period), an
amount of food that is definitely larger than most people would eat
during a similar period of time and under similar circumstances.
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).
Recurrent inappropriate compensatory behaviour in order to
prevent weight gain, such as self-induced vomiting, misuse of
laxatives, diuretics, or other medications, fasting, or excessive
exercise.
The binge eating and inappropriate compensatory behaviours
both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of
Anorexia Nervosa.
 Binge Eating Disorder
Recurrent episodes of binge eating. An episode of binge
eating is characterised by both of the following:
Eating, in a discrete period of time (e.g. within any 2-hour period), an
amount of food that is definitely larger than most people would eat
during a similar period of time and under similar circumstances.
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).
The binge eating episodes are associated with three or
more of the following:
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 feeling embarrassed by how much one is
eating
feeling disgusted with oneself, depressed or very guilty afterward
 Binge Eating Disorder

Marked distress regarding binge eating is present

Binge eating occurs, on average, at least once a week for
three months
Binge eating not associated with the recurrent use of
inappropriate compensatory behaviours as in Bulimia
Nervosa and does not occur exclusively during the course of
Bulimia Nervosa, or Anorexia Nervosa methods to
compensate for overeating, such as self-induced vomiting.
Note: Binge Eating Disorder is less common but much more
severe than overeating. Binge Eating Disorder is associated
with more subjective distress regarding the eating
behaviour, and commonly other co-occurring psychological
problems.
 Other Specified Feeding or Eating
Disorder (OSFED)
According to the DSM-5 criteria, to be
diagnosed as having OSFED a person
must present with a feeding or eating
behaviours that cause clinically significant
distress and impairment in areas of
functioning, but do not meet the full criteria
for any of the other feeding and eating
disorders.
 Other Specified Feeding or Eating
Disorder (OSFED)
Atypical Anorexia Nervosa: All criteria are met, except
despite significant weight loss, the individuals weight is
within or above the normal range.
Binge Eating Disorder (of low frequency and/or limited
duration): All of the criteria for BED are met, except at a
lower frequency and/or for less than three months.
Bulimia Nervosa (of low frequency and/or limited
duration): All of the criteria for Bulimia Nervosa are met,
except that the binge eating and inappropriate
compensatory behaviour occurs at a lower frequency
and/or for less than three months.
 Other Specified Feeding or Eating
Disorder (OSFED)
Purging Disorder: Recurrent purging behaviour to
influence weight or shape in the absence of binge eating
Night Eating Syndrome: Recurrent episodes of night
eating. Eating after awakening from sleep, or by
excessive food consumption after the evening meal. The
behavior is not better explained by environmental
influences or social norms. The behavior causes
significant distress/impairment. The behavior is not
better explained by another mental health disorder (e.g.
BED).
 Unspecified Feeding or Eating
Disorder (UFED)
According to the DSM-5 criteria this category
applies to where behaviours cause clinically
significant distress/impairment of functioning, but
do not meet the full criteria of any of the Feeding
or Eating Disorder criteria. This category may be
used by clinicians where a clinician chooses not
to specify why criteria are not met, including
presentations where there may be insufficient
information to make a more specific diagnosis
(e.g. in emergency room settings).
 Weight related conditions
Dieting behaviors
Reported in 50-60% of adolescent girls
Dieting behavior also reported in 15% males
Dieting interpreted differently
Particular concern in those not overweight
Inadequate intake of many nutrients
Increased risk of binge eating
 Weight related conditions
Obesity
BMI commonly used in obesity assessment
Values compared with data from NHANESI.
BMI > 95th percentile overweight
BMI 85th-95th percentile-at risk of overweight
Prevalence of overweight adolescents increasing
1976-80 - 5.7%
1988-94 - 12%
2006 18.3%
Prevalence of those at risk of also increasing
 Patterns of Distribution in the
Population
Anorexia Nervosa more prevalent in
industrialized societies where
Food is abundant
Thinness in females linked to attractiveness
Prevalence linked to socioeconomic class
Certain subgroups at higher risk
Athletes
Vegetarians
Youth with chronic diseases
Sexually or physically abused individuals
 Etiology of Weight-Related
Concerns and Conditions
Complex involving interactions between several
factors
Psychological
Biological
Familial
Sociocultural
Environmental
Behavioral
Contribution of each factor varies
Important in developing an intervention plan
 Etiology of Eating Disorders
Main groups of contributing factors for
eating disorders
1. Environmental
2. Familial factors
3. Interpersonal factors
4. Personal factors
 Etiology of Eating Disorders
Environmental factors:
Media Influences
Societal and cultural norms
Food availability and accessibility
 Etiology of Eating Disorders
Family factors:
Family dynamics
Weight-related behaviors of parents and
siblings
Feeding behaviors reinforced during
childhood and adolescence
 Etiology of Eating Disorders

Interpersonal factors:
Peer norms and behaviors
Abuse experiences
 Etiology of Eating Disorders

Personal factors:
Biological
Psychological
Knowledge, attitudes and behaviors
Extremes of the Spectrum: A
Closer Look at Anorexia
Nervosa
 Symptoms
Intense fear of being fat
Self starvation
Loss of appetite rare
Distorted body image
Amenorrhea
Need to control food intake in spite of
extreme hunger
 Prevalence
Evidence indicates an increased
incidence, particularly of the milder forms
Could be due to increased recognition
Course of the disease
Begins with food restriction
Progresses to other methods of weight loss
Weight gain is perceived as failure
Regular or intermittent binge eating or purging
 Onset and Diagnosis
Onset
Peaks at 14 and 18
Onset often associated with a stressful event
40 - 50% recovery rate
Diagnosis
after marked weight loss
Other key symptoms may be present
Denial common
 Consequences
Death in 10-15% cases due to
Weakened immune system
Gastric rupture
Cardiac arrhythmias
Heart failure
Suicide
Neurological damage
Dehydration
Cramps
Electrolyte imbalance
Insomnia
 Consequences
Psychological complications
Distorted body image
Depression
Social isolation
Moodiness
Psychosis
Severe consequences for the family
 Etiology
Biological factors
Gender
Heritability
Neurotransmitter abnormalities
Psychological factors
Poor body image
strong drive for thinness
Low self esteem
Sociocultural factors
Societal pressure to be thin
Discrepancy between average women and model
Unrealistic expectations
 Assessment
Determine the presence of the condition
The type
Severity
 Treatment
Weight restoration
Cessation of weight reduction
Improved eating behaviors and nutrition
Improved psychological and emotional state
Components of treatment include therapy:
Individual
Group
Family
Medication
Nutrition counseling
Development of trust
A new approach to food
A Closer Look at Bulimia
Nervosa
 Descriptions
Maintain close to normal weight
Gorging or bingeing.
Followed by vomiting or purging
Use of laxatives and diuretics
Strict dieting or fasting
Vigorous exercise
Over concern with body shape and weight
 Bulimia Nervosa
Distorted view of
weight and
shape

Shame, self-
loathing Binge eating
Low self-esteem

Compensatory
behaviour
Purging/exercise
 Symptoms
Eating in secret
Disappearance into bathroom for long periods of time to
induce vomiting
Bingeing and purging from once a week to five times a day
Abuse of alcohol or drugs
Possible weight fluctuations
Extreme fear of gaining even a small amount of weight
Distorted body image
Dry skin and dry brittle hair
Swollen salivary glands under the jaw and along sides of
face from bingeing and purging
Depression, guilt, fear and mood swings
Fatigue and cold sweats from rapid changes in blood sugar
levels
 Incidence
Later age of onset than anorexia nervosa
Recovery rate of 50-60%
Individuals with:
Family conflict
Low self esteem
Lack of self-control
Pain, problems, anxiety
 Consequences
Death in 5%
Electrolyte imbalance
Dehydration
Intestinal atrophy
Dental problems
Irregular menstruation
Psychosocial consequences
 Etiology
Biological
Heredity
Neurotransmitter disturbances
Psychosocial
Low self-esteem
Depression
Anxiety
Conflict within the family
High level of substance abuse
Sociocultural
Thinness as an ideal of beauty
 Treatment
Stabilization of binge/purge behavior
Nutritional rehabilitation
Therapy
Medication
Coping mechanisms
Nutrition counseling
Meal planning
Knowledge about body weight regulation
Effects of dieting and bulimic behavior
Establishment of regular eating pattern
 Nutritional goals
Balance energy intake and expenditure
Avoid unhealthy weight control behaviors
Adequate nutrient intake, especially of
calcium
Develop healthy long-term eating patterns
 Eating Disorders Among
Adolescents: Summing It Up
Eating disordersa continuum ranging
from body dissatisfaction to clinically
significant eating disorders
Parents, peers, educators, & health care
providers should take an important role to
help decrease prevalence of eating
disorders
 Preventing Eating Disorders
Programs that focus on changing weight-
related attitudes of youth & promoted
healthy weight-control strategies were
found to be more effective
Effects have lasted up to 2 years
 Preventing Eating Disorders
Characteristics of successful eating
disorder prevention programs:
Target high-risk groups
Target adolescents > 15 years of age
Information provided by trained
interventionists
Multiple sessions
Integrated interactive learning