Jacalyn J. Robert-McComb

Eating disorders in women and children : prevention, stress management, and treatment

PART I THE CONSTITUTION OF EATING DISORDERS Eating Disorders Psychology of an Eating Disorder Physiology of Eating Disorders Eating Disorder Inventories Used in Clinical and Non-Clinical Settings PART II THE CHARATERISTICS OF STRESS Definition of Stress Psychology of Stress and Coping Physiology of Stress Stress Inventories Used in Clinical and Non-Clinical Settings PART III SOCIETY AND EATING DISORDERS Family Dynamics Media Involvement and the Idea of Beauty Body Image Sexuality PART IV PRIMARY PREVENTION OF EATING DISORDERS IN CHILDREN Factors Associated with Eating Disorders in Children Educational Programs Aimed at Primary Prevention The Role of Parents, School Personnel, and the Community in the Primary Prevention of Eating Disorders Among Children PART V DEVELOPING HEALTHY ATTITUDES AND BEHAVIORS TO MANAGE THE STRESS ASSOCIATED WITH AN EATING DISORDER Behavior Modification Cognitive Restructuring Self-Esteem/Self-Efficacy Expressing Feelings/ Communication Spirituality Exercise Prescription for Fitness and Health PART VI THERAPEUTIC APPROACHES TO THE TREATMENT OF EATING DISORDERS Contact Movement Therapy for Clients with Eating Disorders Dance/ Movement Treatment Perspectives Creating a Healthy Balance Between Nutrition and Other Modalities of Healthcare Necessary in Treatment of an Eating Disorder Patient APPENDICES

The Effects of Mindfulness-Based Movement on Parameters of Stress

The Mindfulness-Based Stress Reduction program (MBSR) of Kabat-Zinn includes a combination of sitting meditation, yoga, and walking; thus, movement is not emphasized primarily to induce a state of awareness. The purpose of this study was to investigate the effects of a Mindfulness-Based Movement Program (MBM) in women on parameters of stress and coping; that is, in contrast to MBSR, MBM primarily emphasized yoga to cultivate awareness. This study investigated: (a) an objective measure of stress (the cortisol response to a laboratory stressor) following an 8-week MBM in year 1 participants only (n = 17; MBM group = 9; Control group = 8); (b) subjective measures of stress following an 8-week MBM in years 1 and 2 (n = 32; MBM = 16; C = 16); and (c) changes in coping style following an 8- week MBM in years 1 and 2 (n = 32; MBM = 16; C = 16). A mixed plot 2 (Group: TC or MBM) by 5 (Trial: Baseline, Stressor, Recovery 1, Recovery 2, and Recovery 3) repeated measures ANOVA was run for cortisol. Preliminary results indicated a strong trend towards a lowered cortisol response for the MBM group compared to the control group. A mixed plot 2 (Group: TC or MBM) by 2 (Time: Pretest, Post-test) repeated measures ANOVA was run for Spielbergs State Anxiety, the Perceived Stress Scale, and the Problem Focused Style of Coping Scale for the Suppressive, Reflective, and the Reactive Coping Style. There were significant main effects for time, group, and an interaction of time and group for Spielbergs State Anxiety and the Perceived Stress Scale. Significant differences were also found for time and the interaction of time and group for the Problem Focused Style of Coping for the Reflective Coping Style (p < 0.05). In conclusion, results indicate positive effects of the MBM program on perceived measures of stress and coping style in women.

Estimating Energy Requirements

Women energy requirements need be balance with total daily energy expenditure (TDEE). Hence, meeting of energy needs for all components of TDEE must be the most important concern for active females. Resting metabolic rate (RMR), thermic effect of food (TEF), and physical activity energy expenditure (PAEE) are the most important components of TDEE; where the most variable is the PAEE. The quantification of each component implies time consuming and expensive techniques, which are unviable in field and clinical settings. However, indirect methods have been developed to allow coaches, physicians, and nutritionists estimate TDEE. In this chapter, we cover the physiological relevance of RMR, TEF, and PAEE, and the indirect ways to obtain estimations of their values. On the other hand, other variables factors affecting TDEE as adaptive thermogenesis and non-exercise activity thermogenesis (NEAT) are highlighted. Finally, a case study is suggested in order to introduce basic metabolic calculations and physical activity level (PAL) concept.

Investigating the influence of shame, depression, and distress tolerance on the relationship between internalized homophobia and binge eating in lesbian and bisexual women.

There is limited research evidence about the specific factors influencing disordered eating for lesbian and bisexual women. Therefore, this study investigated relationships among binge eating, internalized homophobia, shame, depression, and distress tolerance in a sample of lesbian (n=72) and bisexual women (n=66). Two hypotheses were tested. First, it was hypothesized that shame and depression would mediate the relationship between internalized homophobia and binge eating. Second, it was hypothesized that distress tolerance would moderate the relationship between shame and binge eating and the relationship between depression and binge eating in the mediation relationships proposed in the first hypothesis. Results indicated that shame was a significant mediator for the relationship between internalized homophobia and binge eating, that depression was not a significant mediator, and that distress tolerance did not moderate the significant mediation relationship between shame and binge eating. The data in this study also indicated that the proportions of lesbian and bisexual participants who reported binge eating and compensatory behavior did not differ significantly, but that bisexual participants reported significantly more depression and shame than lesbian participants.

Omega-3 fatty acids in obesity and metabolic syndrome: a mechanistic update

Strategies to reduce obesity have become public health priorities as the prevalence of obesity has risen in the United States and around the world. While the anti-inflammatory and hypotriglyceridemic properties of long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) are well known, their antiobesity effects and efficacy against metabolic syndrome, especially in humans, are still under debate. In animal models, evidence consistently suggests a role for n-3 PUFAs in reducing fat mass, particularly in the retroperitoneal and epididymal regions. In humans, however, published research suggests that though n-3 PUFAs may not aid weight loss, they may attenuate further weight gain and could be useful in the diet or as a supplement to help maintain weight loss. Proposed mechanisms by which n-3 PUFAs may work to improve body composition and counteract obesity-related metabolic changes include modulating lipid metabolism; regulating adipokines, such as adiponectin and leptin; alleviating adipose tissue inflammation; promoting adipogenesis and altering epigenetic mechanisms.

Sound Traditional and Nontraditional Prepartum Exercise for Good Health

There has been a progressive evolution in the concept of exercise for prepartum women. Per contra, screening guidelines have not changed. All women should have a thorough clinical evaluation by the health care team before an exercise program is recommended. This is true for previously sedentary women or women who have been active before their pregnancy. The consensus today is that given no medical contraindications to exercise during pregnancy women with uncomplicated pregnancies should participate in moderate exercise, such as brisk walking, 30 min a day or more. The use of heart rate to guide intensity is not valid for prepartum women because of the large variability of heart rate during pregnancy. Rather, metabolic equivalents (METS), the Rating of Perceived Exertion Scale (RPE) or methods such as the talk test should be used to monitor exercise intensity. The recommendation is 3-5 METS, an RPE of 12-14 (somewhat hard) on the 6-20 scale, or women should be able to maintain a conversation while exercising. Strength-conditioning activites are also advocated in uncomplicated pregnancies. However, there is less evidence on strength conditioning and weight training in pregnancy. The research on yoga and Plates on gravid women is too limited to make a position stand on these activities. Regardless of the type of activity, all goals should be reasonable. Furthermore, pregnancy it is not a time to reach peak fitness levels or train for an athletic competition. Elite athletes who train during pregnancy require supervision by an obstetric care provider with knowledge of the impact of strenuous exercise on fetal outcomes.

Screening for Disordered Eating and Eating Disorders in Female Athletes

Low energy availability appears to be the key etiologic abnormality central to the pathologies seen in the Female Athlete Triad. The energy deficit comes from either increased exertion or inadequate intake of nutrition, either through disordered eating (inadvertent or purposeful) or one of the pathologic eating disorders. It is important to educate female athletes about this concerning scenario as early intervention can limit morbidity and mortality from it. It is important for those interacting with female athletes, both recreational and competitive, to screen for disordered eating/eating disorders (DE/ED) which could lead to low energy availability. With proper education, screening can be done informally by virtually anyone who interacts with female athletes. In the formal setting, question-based tools are available to facilitate the process. Several of these tools are discussed in this chapter. Any athlete who screens positively for possible DE/ED should be referred to a physician and/or mental health provider for further evaluation.

The Physiology of Anorexia Nervosa and Bulimia Nervosa

Eating disorders (ED) are psychological disorders that are characterized by abnormal eating, dysfunctional relationships with food, and a preoccupation with one’s weight and shape. The incidence of EDs in women ranges from 0.5 to 3 % with the incidence increasing from 1963 to 2013. Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) recognizes two specific EDs: anorexia nervosa (AN) and bulimia nervosa (BN), although there are subtypes associated with each. The DSM-IV-TR and the International Classification of Diseases (ICD-10) have different criteria for diagnosing AN and BN. Early identification of an ED is associated with shorter duration and fewer medical complications. Yet, it is estimated that only about 33 % of AN patients and 6 % of BN are receiving proper treatment for their illnesses. Gastrointestinal upset, fluid and electrolyte imbalances are common in AN in the short term and can eventually lead to long-term complications such as, pernicious anemia, osteoporosis, and heart disease. On the other hand, BN can cause short-term adverse effects like erosion of the teeth, enlargement of the parotid salivary glands, and acidic stomachs leading to heartburn. Long-term adverse effects caused by BN are gynecological problems, hormonal disturbances, hypercholesterolemia, and hypertension. Successful treatment of EDs should be managed with a team-based approach including the physician, psychologist, and registered dietitian.

Nutritional Guidelines, Energy Balance, and Weight Control: Issues for the Aging Active Female

During aging total energy expenditure (TEE) decreases by 6 % per decade in women, parallel to the reduction in physical activity. Resting metabolic rate (RMR) decreases 1–2 % per decade and increases from 50 years (3 % per decade). There is a change in body composition not associated with the reduction in RMR or loss of fat-free mass (FFM). This change in body composition produces an increase in fat mass, and it is higher in women than in men. The change in body composition does not always imply a change in body weight (or body mass index). As the caloric intake requirements decrease with aging, the right quality of food and adequate portions become more important. Energy imbalances complicate health and quality of life in both malnutrition and overweight. The 7th edition of the Dietary Guidelines for the USA published in 2010 and incorporating MyPlate in 2011 are available resources to advise people and help improve nutrition, serving as a guide for adults and older active women also. Adequate calorie intakes should be matched to physical activity level in each, providing the required amount of macronutrients, vitamins, and minerals, and possible food supplements for active women to achieve proper weight control, energy balance, and heath.

The Active Female

Due to the rising rates of eating disorders and obesity, increasingly more attention is being paid to body image and body image diffi culties. Body dissatisfaction, which is ubiquitous among girls and women, can be defi ned by the difference between one’s perceived body size and ideal body, particularly with regard to the desire to be thin. Body dissatisfaction has become so commonplace that it has been described as “normative discontent.” It is also considered one of the most robust risk and maintenance factors for clinical eating disorders. A wide range of risk factors contribute to the development of body dissatisfaction, including biological and physical factors, sociocultural infl uences, and individual characteristics. In addition, females who place a strong emphasis on thinness and physical appearance and routinely engage in body comparison are especially vulnerable to experiencing body dissatisfaction. Body image problems and disordered eating behaviors know no boundaries; they impact females across age groups, ethnicities, cultures, and socioeconomic levels. Therefore, it is essential for health professionals to understand the development of body image diffi culties and be knowledgeable about body image assessment techniques and effective prevention and intervention programs. Armed with this insight, health professionals will be in position to foster healthy body image and enhance quality of life among females across the lifespan.