Eating Disorder

What is anorexia nervosa?

Anorexia nervosa is a serious, occasionally chronic, and potentially life-threatening eating disorder defined by a refusal to maintain minimal body weight within 15 percent of an individual's normal weight. Other essential features of this disorder include an intense fear of gaining weight, a distorted body image, denial of the seriousness of the illness, and amenorrhea (absence of at least three consecutive menstrual cycles when they are otherwise expected to occur).

There are two subtypes of anorexia nervosa. In the restricting subtype, people maintain their low body weight purely by restricting their food intake and, possibly, by excessive exercise. Individuals with the binge eating/purging subtype also restrict their food intake, but also regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Many people move back and forth between subtypes during the course of their illness. Starvation, weight loss, and related medical complications are quite serious and can result in death. People who have an ongoing preoccupation with food and weight even when they are thin would benefit from exploring their thoughts and relationships with a therapist. The term anorexia literally means loss of appetite, but this is a misnomer. In fact, people with anorexia nervosa often ignore hunger signals and thus control their desire to eat. Often they may cook for others and be preoccupied with food and recipes, yet they will not eat themselves. Obsessive exercise that may accompany the starving behavior can cause others to assume falsely that the person must be healthy.


Who develops anorexia nervosa?

Like all eating disorders, anorexia nervosa tends to occur in pre- or post-puberty, but can develop at any time throughout the lifespan. Anorexia nervosa predominately affects adolescent girls and young adult women, although it also occurs in boys, men, older women and younger girls. One reason younger women are particularly vulnerable to eating disorders is their tendency to go on strict diets to achieve an "ideal" figure. This obsessive dieting behavior reflects today's societal pressure to be thin, which is seen in advertising and the media. Others especially at risk for eating disorders include athletes, actors, dancers, models, and TV personalities for whom thinness has become a professional requirement. People with anorexia nervosa will often mention that the sense of control they develop over eating and weight helps them feel as if other aspects of their life are under control. The presence of depression and anxiety disorders may increase the risk of developing anorexia nervosa.


How many people suffer from anorexia nervosa?

Conservative estimates suggest that one-half to one percent of females in the U.S. develop anorexia nervosa. Because more than 90 percent of all those who are affected are adolescent and young women, the disorder has been characterized as primarily a woman's illness. It should be noted, however, that males and children as young as seven years old have been diagnosed; and women 50, 60, 70, and even 80 years of age have fit the diagnosis. Some of these individuals will have struggled with eating, shape or weight in the past but new onset cases can also occur.


How is the weight lost?

People with anorexia nervosa usually lose weight by reducing their total food intake and exercising excessively. Many persons with this disorder restrict their intake to fewer than 1,000 calories per day. Most avoid fattening, high-calorie foods, and often eliminate meats. The diet of persons with anorexia nervosa may consist almost completely of low-calorie foods and or beverages like lettuce and carrots, popcorn, and diet soft drinks.


What are the common signs of anorexia nervosa?

The hallmark of anorexia nervosa is a preoccupation with food and a refusal to maintain minimally normal body weight. One of the most frightening aspects of the disorder is that people with anorexia nervosa continue to think they look fat even when they are bone-thin. Their nails and hair become brittle, and their skin may become dry and yellow. People with anorexia nervosa often complain of feeling cold (hypothermia) because their body temperature drops. They may develop lanugo (a term used to describe the fine hair on a new born) on their body.

Persons with anorexia nervosa develop odd and ritualistic eating habits such as cutting their food into tiny pieces, refusing to eat in front of others, or fixing elaborate meals for others that they themselves don't eat. Food and weight become obsessions as people with this disorder constantly think about their next encounter with food. Generally, if a person or their family fears he or she has anorexia nervosa, a doctor knowledgeable about eating disorders should make a diagnosis and rule out other physical disorders. Other psychiatric disorders can occur together with anorexia nervosa, such as depression, anxiety disorders and substance abuse disorders.


What are the causes of anorexia nervosa?

Although the precise causes of anorexia nervosa are unknown, we do know that it is caused by a combination of genetic and environmental factors. Scientists have studied the role of personality, genetics, environment, and biochemistry of people with these illnesses. Certain personality traits common in persons with anorexia nervosa are perfectionism, neuroticism (anxiety-proneness), low self-esteem, and social isolation (which usually occurs after the behavior associated with anorexia nervosa begins). Many people who develop anorexia nervosa had been good students and athletes.

Eating disorders also tend to run in families, with female relatives most often affected. Relatives of someone with anorexia nervosa are over 10 times more likely to have an eating disorder themselves than relatives of someone without anorexia nervosa. The heritability of anorexia nervosa has been estimated to be over 50%. Behavioral and environmental influences also play a role in vulnerability to the illness. Stressful life events or transitions may precipitate the illness. In studies of the biochemical functions of people with eating disorders, scientists have found that the neurotransmitters serotonin and norepinephrine are decreased in those with anorexia nervosa who are at a low weight. People with anorexia nervosa also tend to have higher than normal levels of cortisol (a brain hormone released in response to stress) and vasopressin (a brain chemical found to be abnormal in patients with obsessive-compulsive disorder).


Are there medical complications?

The starvation experienced by persons with anorexia nervosa can cause damage to vital organs such as the heart, kidneys, and brain. Pulse rate and blood pressure drop, and people suffering from this illness may experience irregular heart rhythms or heart failure. Nutritional deprivation along with purging causes electrolyte abnormalities such as low potassium and low sodium. Nutritional deprivation also leads to calcium loss from bones, which can become brittle and prone to breakage (osteoporosis). Nutritional deprivation also leads to decreased brain volume. In the worst-case scenario, people with anorexia can starve themselves to death. Anorexia nervosa has the highest mortality rate of any psychiatric illness. The most frequent causes of death are suicide and complications of the malnutrition associated with the disorder.


Is treatment available?

Recovery from anorexia nervosa is possible. In long term follow-up studies, about half of individuals fully recover from the illness, a small percentage continued to suffer from anorexia, and the remainder continue to have other eating disorders. For some, anorexia nervosa can be relatively short-lived, whereas for others it can become a chronic and debilitating illness. We do not yet know predictors of clinical course.

Luckily, most of the complications experienced by persons with anorexia nervosa are reversible when they restore their weight. People with this disorder should be diagnosed and treated as soon as possible because eating disorders are most successfully treated when diagnosed early. Some patients can be treated as outpatients, but some may need hospitalization to stabilize their dangerously low weight. Weight gain of one to three pounds per week is considered safe and desirable. The most effective strategies for treating a patient include weight restoration, individual, family, and group therapies along with psychiatric medications as needed.

To help people with anorexia nervosa overcome their disorder, a variety of approaches are used. Some form of psychotherapy is needed to deal with underlying emotional issues. Cognitive-behavioral therapy is sometimes used to change unhealthy thoughts and behaviors. Group therapy is often advised so people can share their experiences with others. Family therapy is important particularly if the individual is living at home and is a child or young adolescent. A physician or advanced-practice nurse is needed to prescribe medications that may be useful in treating the disorder or associated depression or anxiety. Be sure to check with your doctor before taking any psychiatric medications as they can impact weight and have varied risks and benefits. Finally, a nutritionist is necessary to advise the patient about proper diet and eating regimens. Where support groups are available, they can be beneficial to both patients and families. It is also important to realize that some people require a coordinated team of professionals from many disciplines to maximize their chance of recovery.


What about prevention?

New research findings are showing that some of the "traits" in individuals who develop anorexia nervosa are actual "risk factors" that might be treated early on. For example, anxiety, low self esteem, body dissatisfaction, and dieting may be identified and interventions instituted before an eating disorder develops. Advocacy groups have also been effective in reducing dangerous media stories, such as teen magazine articles on "being thin" and pro-anorexia (pro-ana) websites that may glamorize such risk factors as dieting.

What is Binge Eating Disorder (BED)?

Individuals with binge eating disorder (BED) engage in binge eating, but in contrast to people with bulimia nervosa (BN) they do not regularly use inappropriate compensatory weight control behaviors such as fasting or purging to lose weight. Binge eating, by definition, is eating that is characterized by rapid consumption of a large amount of food by social comparison and experiencing a sense of the eating being out of control. Binge eating is often accompanied by uncomfortable fullness after eating, and eating large amounts of food when not hungry, and distress about the binge eating. There is no specific caloric amount that qualifies an eating episode as a binge. A binge may be ended by abdominal discomfort, social interruption, or running out of food. Some who have placed strict restrictions on what and when it is OK to eat might feel like they have binged after only a small amount of food (like a cookie). Since this is not an objectively large amount of food by social comparison, it is called a subjective binge and is not part of binge eating disorder.

When the binge is over, the person often feels disgusted, guilty, and depressed about overeating. For some individuals, BED can occur together with other psychiatric disorders such as depression, substance abuse, anxiety disorders, or self-injurious behavior. The person suffering from BED often feels caught up in a vicious cycle of negative mood followed by binge eating, followed by more negative mood. Over time, individuals with BED tend to gain weight due to overeating; therefore, BED is often, but not always, associated with overweight and obesity. Previous terms used to describe these problems included compulsive overeating, emotional eating, or food addiction.

When identifying and diagnosing BED, doctors and mental health professionals refer to the criteria in the Diagnostic and statistical Manual IV (DSM-IV) which says, a person must have had, on average, a minimum of two binge-eating episodes a week for at least six months. Although this is a somewhat arbitrary criterion and any amount of binge eating should be attended to.

Who develops BED?

EDNOS is the most commonly diagnosed disorder among individuals seeking professional help for an eating disorder. Estimates vary about the prevalence of BED; however, recent statistics indicate that in the United States BED affects an estimated three and one-half percent of females and two percent of males at some point in their lifetime [compared to anorexia nervosa (AN), for example, which affects an estimated one-half to one percent of the population]. The prevalence of BED among obese individuals is even higher (approximately five percent to eight percent). The average age of onset for BED is in young adulthood (early 20’s) and slightly later in life compared to BN and AN. Although, recognition of binge eating in children is increasing.

How do people with BED control their weight?

Unlike people with anorexia nervosa and bulimia nervosa, people with BED do not engage in repeated attempts to control their weight by vomiting, using drugs to stimulate bowel movements and urination, and exercising excessively. As a result, many individuals who binge eat take in more calories than they burn for energy, and they become overweight and remain so as long as they continue to binge eat. Some individuals may attempt to overly restrict their food intake after a binge episode but this can backfire and lead to increased hunger and lead to more binge eating. Individuals with BED can get stuck in a vicious cycle of weight gain, depression, dieting, and binge eating.

What are the common signs of BED?

Most people who suffer from BED tend to do so in secret. They tend to limit their binge episodes to when they are alone, thus it is not easy to identify someone with BED. Weight gain is a common sign, but not everyone who gains weight does so because they binge eat. Many people with BED struggle with depressed and/or anxious mood. Some individuals with BED can develop strict rules about what foods are “good” vs. “bad” to eat. In turn, they become preoccupied with enforcing these rules as a means for distracting from their painful feelings, tension, and anxiety. In the end, this preoccupation only serves to perpetuate the need for these rigid rule-based behaviors.

Are there any serious medical complications?

The most common medical complications associated with BED are related to the weight gain and other metabolic disturbances that occur. In some cases, individuals can become obese and develop nutritional problems and type II diabetes. In rare instances, binge eating can cause the stomach to rupture. Studies suggest that there are medical and psychiatric correlates of binge BED hat are independent of obesity including insomnia, increased pain, and decreased quality of life.

Do we know what causes BED?

BED has been shown to aggregate in families and it is believed to be influenced by both genetic and environmental factors. Although no specific genetic variants have yet been identified, several studies are underway to identify genes that influence risk for binge eating.

BED is influenced by a combination of background factors that increase vulnerability to binge eating and by current triggers that are thought to play key roles in the initiation of binge episodes. For example, overweight individuals, particularly those with a high degree of body dissatisfaction, will often restrict food intake in an attempt to lose weight. Unfortunately, caloric deprivation only can increase the likelihood of subsequent binge eating. In addition, many individuals who suffer from binge eating experience marked increases in depressed and/or anxious mood prior to bingeing. Another key trigger seems to be cravings for sweets and simple carbohydrates, which are frequently found in patients with eating- and mood-related disorders. Some people with BED are highly reactive to food cues in the environment and have difficulty refraining from eating when confronted with high risk cues such as the sights and smells of potential binge foods.

Is treatment available for persons with BED?

Treatment for binge eating disorder targets both the elimination of binge eating and the development and maintenance of a healthy weight. Most people with BED can benefit from psychotherapy based on cognitive-behavioral principles and/or medication. Usually hospitalization is not required but admission to an eating disorders treatment program could be helpful in interrupting severe binge eating cycles.

Group therapy is especially effective for college-aged and young adult women because of the understanding of the group members. In group therapy they can talk with peers who have similar experiences. Additionally, support groups can be helpful as they can be attended for as long as necessary, have flexible schedules, and generally have no charge. Support groups, however, do not take the place of treatment. Sometimes a person with an eating disorder is unable to benefit from group therapy or support groups without the encouragement of a personal therapist.

Cognitive-behavioral therapy (CBT), either in a group setting or individual therapy session, has been shown to benefit many persons with BED. It focuses on self-monitoring of eating behaviors, identifying binge triggers, and changing distorted thinking patterns about food and negative thinking patterns about oneself. CBT can help reduce binge frequency and promote binge abstinence. Certain medications, particularly antidepressants, have been shown to help some individuals reduce binge behaviors, improve mood, and lose small amounts of weight. A comprehensive treatment strategy that combines CBT with medication and nutritional counseling may be recommended. Abstinence rates from binge eating across studies have ranged from 20-60%. When seeking this type of treatment it is important to remember to review the possible risks and benefits with your doctor and to never stop your medication without a doctor’s consultation.

Treatment plans should be adjusted to meet the needs of the individual concerned, but usually a comprehensive treatment plan involving a variety of experts and approaches is best. It is important to take an approach that involves developing support for the person with an eating disorder from the family environment or within the patient’s community environment (support groups or other socially supportive environments). Consultation with a dietician is a valuable component of treatment to help establish a healthy eating plan and appreciation of appropriate portion sizes.

What about prevention?

Because a history of repeated dieting, concerns about body shape, and negative mood, and self-esteem may be precursors the development of binge eating and BED, efforts are needed to reduce the media’s influence through its damaging articles from teen magazines on "dieting" and the importance of "being thin." In addition, creating more opportunities for young people to talk about their binge eating experiences in less judgmental/threatening environments may help bring BED out in the open. Using technology, such as web-based chat rooms for discussing BED and text messaging for monitoring binge eating behavior may prove helpful in bringing BED out of the shadows and reducing the shame and secrecy associated with this disorder.

What is bulimia nervosa?

Bulimia nervosa is a serious eating disorder marked by a destructive pattern of binge-eating and recurrent inappropriate compensatory behaviors to control one's weight. It can occur together with other psychiatric disorders such as depression, obsessive-compulsive disorder, substance dependence, or self-injurious behavior. Bulimia nervosa is an invisible eating disorder, because patients are of normal weight or overweight. Binge eating is the rapid consumption of an unusually large amount of food in a short period of time. Unlike simple overeating, the hallmark feature of a binge is feeling out of control. This means that one cannot stop the urge to binge once it has begun or that one has difficulty ending the eating episode even when far past being full. "Inappropriate compensatory behavior" to control one's weight may include purging behaviors (such as self-induced vomiting, abuse of laxatives, diuretics, or enemas) or non-purging behaviors (such as fasting or excessive exercise). Some people who have placed strict restrictions on what and when it is OK to eat might feel like they have binged after only a small amount of food (like a cookie). Since this is not an objectively large amount of food by social comparison, it is called a subjective binge.

There are two types of bulimia nervosa. In the purging type, the person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. In the nonpurging type, the individual uses fasting or excessive exercise to control weight, but does not regularly purge.

People with bulimia nervosa often feel a lack of control during their eating binges. Food is often eaten secretly and rapidly. A binge is usually ended by abdominal discomfort, social interruption, or running out of food. When the binge is over, the person with bulimia often feels guilty and purges to rid his or her body of the excess calories. To be diagnosed with bulimia nervosa, a person must have had, on average, a minimum of two binge-eating episodes a week for at least three months. However any amount of binge eating and purging is unhealthy and is worthy of an evaluation.

Who develops bulimia?

The typical age of onset for bulimia nervosa is late adolescence or early adulthood, but onset can and does occur at any time throughout the lifespan. Bulimia nervosa typically begins in adolescence or early adulthood although it can strike at any age. Like anorexia nervosa, bulimia nervosa mainly affects females. Ten percent to 15 percent of affected individuals are male although this may be an underestimate. An estimated two percent to three percent of young women develop bulimia nervosa, compared with the one-half to one percent that is estimated to suffer from anorexia. Bulimia strikes across racial and ethnic groups and across the socioeconomic spectrum. Studies indicate that about 50 percent of those who have anorexia nervosa later develop bulimia nervosa.

How do people with bulimia control their weight?

People with bulimia nervosa are overly concerned with body shape and weight. They make repeated attempts to control their weight by fasting and dieting, vomiting, using drugs to stimulate bowel movements and urination, and exercising excessively. Weight fluctuations are common because of alternating binges and fasts. Unlike people with anorexia, people with bulimia are usually within a normal weight range. However, many heavy people who lose weight begin vomiting to maintain the weight loss. Laxatives are dangerous and ineffective weight control measures. Laxatives work in the part of the intestine after the food has already been absorbed. They do not help you shed calories, only water and valuable electrolytes (like potassium and sodium).

What are the common signs of bulimia nervosa?

Constant concern about food and weight is a primary sign of bulimia. Common indicators of self-induced vomiting are the erosion of dental enamel (due to the acid in the vomit) and scarring on the backs of the hands (due to repeatedly pushing fingers down the throat to induce vomiting).

A small percentage of people with bulimia show swelling of the glands near the cheeks called parotid glands. People with bulimia may also experience irregular menstrual periods and a decrease in sexual interest. A depressed mood is also commonly observed as are frequent complaints of sore throats and abdominal pain. Despite these telltale signs, bulimia nervosa is difficult to catch early. Binge eating and purging are often done in secret and can be easily concealed by a normal-weight person who is ashamed of his or her behavior. Characteristically, these individuals have many rules about food -- e.g. good foods, bad foods -- and can be entrenched in these rules and particular thinking patterns. This preoccupation and these behaviors allow the person to shift their focus from painful feelings and reduce tension and anxiety perpetuating the need for these behaviors.

Are there any serious medical complications?

Persons with bulimia -- even those of normal weight -- can severely damage their bodies by frequent binging and purging. Electrolyte imbalance and dehydration can occur and may cause cardiac complications and, occasionally, sudden death. In rare instances, binge eating can cause the stomach to rupture, and purging can result in heart failure due to the loss of vital minerals like potassium.

Do we know what causes bulimia nervosa?

Although the precise causes of bulimia nervosa are unknown, we do know that it is caused by a combination of genetic and environmental factors. Ongoing research is poised to identify specific genes that might influence risk for the development of bulimia nervosa. Scientists have studied the role of personality, genetics, environment, and biochemistry of people with these illnesses. There is some evidence that obesity in adolescence or familial tendency toward obesity predisposes an individual to the development of the disorder. Some individuals with bulimia report feeling a "kind of high" when they vomit. People with bulimia are often impulsive and may also abuse alcohol, drugs, and engage in self-injurious behavior. Eating disorders like anorexia and bulimia tend to run in families, and girls are most susceptible. Recently, scientists have found certain neurotransmitters (serotonin and norepinephrine) to be altered in some persons with bulimia nervosa. We do not yet know whether these differences exist before bulimia develops or are a consequence of having the illness. Most likely, it is a combination of environmental and biological factors that contribute to the development and expression of this disorder. People with bulimia nervosa often say that binge eating and purging provide temporary relief from tension although after the binge and purge, negative feelings can be increased by the guilt and disgust over the behaviors they have engaged in.

Is treatment available for persons with bulimia nervosa?

Most people with bulimia can be treated through individual outpatient therapy because they aren't in danger of starving themselves as are persons with anorexia nervosa. However, if the binge purge cycle is out of control, admission to an eating disorders treatment program may help the individual interrupt their cycle to give them a head start on getting their symptoms under control.

Cognitive-behavioral therapy (CBT), either in a group setting or individual therapy session, the treatment of choice for bulimia nervosa can lead to complete abstinence from binge eating and purging in around 40% of patients. CBT focuses on self-monitoring of eating and purging behaviors as well as changing the distorted thinking patterns associated with the disorder. Cognitive-behavioral therapy is often combined with nutritional counseling. The only FDA approved medication for bulimia nervosa is fluoxetine (Prozac) showing 50-60% reduction in median binge eating and purging in the short term, although these behaviors often return when the drug is discontinued. It is good to remember that many psychiatric medications can impact weight and it is important to review with a doctor before starting any medication. Do not stop taking medication without consulting a doctor for the risks and benefits.

Group therapy is especially effective for college-aged and young adult women because of the understanding of the group members. In group therapy they can talk with peers who have similar experiences. Additionally, support groups can be helpful as they can be attended for as long as necessary, have flexible schedules, and generally have no charge. Support groups, however, do not take the place of treatment. Sometimes a person with an eating disorder is unable to benefit from group therapy or support groups without the encouragement of a personal therapist.

Treatment plans should be adjusted to meet the needs of the individual concerned, but usually a comprehensive treatment plan involving a variety of experts and approaches is best. It is important to take an approach that involves developing support for the person with an eating disorder from the family environment or within the patient’s community environment (support groups or other socially supportive environments).

What about prevention?

Prevention research is increasing as scientists study the known "risk factors" for these disorders. Given that bulimia and other eating disorders are multi-determined and affect young women, there is preliminary information on the role and extent such factors as self esteem, resilience, family interactions, peer pressure, the media and dieting might play in its development. Advocacy groups are also engaged in prevention through efforts such as removing damaging articles from teen magazines on dieting and the importance of being thin and destructive web-sites that promote anorexia nervosa (pro-ana) and bulimia nervosa (pro-mia) as a lifestyle rather than a debilitating disorder.

What is Eating Disorder Not Otherwise Specified (EDNOS)?

The Diagnostic and Statistical Manual – 4th Edition (DSM-IV) recognizes two distinct eating disorder types, anorexia nervosa and bulimia nervosa. If a person is struggling with eating disorder thoughts, feelings or behaviors, but does not have all the symptoms of anorexia or bulimia, that person may be diagnosed with eating disorder not otherwise specified (EDNOS). The following section lists examples of how an individual may have a profound eating problem and not have anorexia nervosa or bulimia nervosa.

A female patient could meet all of the diagnostic criteria for anorexia nervosa except she is still having her periods
A person could meet all of the diagnostic criteria for anorexia nervosa are met except that, despite significant weight loss the individual's current weight is in the normal range.
A person could meet all of the diagnostic criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for duration of less than 3 months.
The person could use inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies). This variant is often called purging disorder.
The person could repeatedly chewing and spitting out, but not swallowing, large amounts of food.
Binge-eating disorder is also officially an EDNOS category (see separate fact sheet for BED): recurrent episodes of binge eating in the absence if the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.
The examples provided above illustrate the variety of ways in which disordered eating can look when a person has EDNOS, but this list of examples does not provide a complete picture of the many different ways that eating disorder symptoms can occur.

The “not otherwise specified” label often suggests to people that these disorders are not as important, as serious, or as common as anorexia or bulimia nervosa. This is not true. Far more individuals suffer from EDNOS than from bulimia and anorexia combined, and the risks associated with having EDNOS are often just as profound as with anorexia or bulimia because many people with EDNOS engage in the same risky, damaging behaviors seen in other eating disorders.

Individuals with EDNOS who are losing weight and restricting their caloric intake often report the same fears and obsessions as patients with anorexia. They may be overly driven to be thin, have very disturbed body image, restrict their caloric intake to unnatural and unhealthy limits, and may eventually suffer the same psychological, physiological and social consequences of anorexic people. Those who binge, purge, or binge and purge typically report the same concerns as people with bulimia, namely, that they feel they need to purge to control their weight, that they are afraid of getting out of control with their eating, and that binging and/or purging often turn into a very addictive, yet ineffective coping strategy that they feel they can not do without. In all meaningful ways, people with EDNOS are very similar to those with anorexia or bulimia, and are just as likely to require extensive, specialized, multidisciplinary treatment.

Who develops EDNOS?

Eating Disorder NOS typically begin in adolescence or early adulthood although they can occur at any time throughout the lifespan. Like anorexia nervosa and bulimia, EDNOS is far more common in females; however, among those individuals whose primary symptom is binge eating, the number of males and females is more even. Because EDNOS has not been studied as extensively as anorexia and bulimia, it is harder to gauge an exact prevalence, but estimates suggest that EDNOS accounts for almost three quarters of all community treated eating disorder cases.

What are the common signs of EDNOS?

Signs of EDNOS are the same signs you would look for in anorexia and bulimia nervosa. Constant concern about food and weight is a primary sign, as are behaviors designed to restrict eating or compensate for eating (such as exercise or purging). For individuals who binge, most notable is the disappearance of large amounts of food, long periods of eating, or noticeable blocks of time when the individual is alone. Individuals who restrict often find the need to eat by the end of the day and the urge is so strong that it results in a binge. This binge can lead to guilt and shame the leads to purging, which may prompt the individual to promise to “do better tomorrow” by restricting. Cycles like this are consistent with EDNOS and bulimia, and can become very intractable if not addressed. Characteristically, these individuals have many rules about food -- e.g. good foods, bad foods -- and can be entrenched in these rules and particular thinking patterns. This preoccupation and these behaviors allow the person to shift their focus from painful feelings and reduce tension and anxiety perpetuating the need for these behaviors appropriately.

Are there any serious medical complications?

Individuals with EDNOS are at risk for many of the medical complications of anorexia or bulimia, depending on the symptoms they have. Those who binge and purge run risks similar to bulimia in that they can severely damage their bodies. Electrolyte imbalance and dehydration can occur and may cause cardiac complications and, occasionally, sudden death. In rare instances, binge eating can cause the stomach to rupture, and purging can result in heart failure due to the loss of vital minerals like potassium. Persons with EDNOS who are restricting may have low blood pressure, slower heart rate, disruption of hormones, bone growth, and significant mental, and emotional disturbance.

Do we know what causes EDNOS?

As with other eating disorders that have been more widely studied, the cause of EDNOS is most likely a combination of environmental and biological factors that contribute to the development and expression of these disorders. While each individual may feel that they developed these behaviors “on their own” they are often amazed to find that other people have the same obsessions, irrational fears, and self-loathing. They are not alone, and they are not to blame for having this problem.

Is treatment available for persons with EDNOS?

Unfortunately, treatment studies specifically for EDNOS are rare. Cognitive-behavioral therapy, either in a group setting or individual therapy session, has been shown to benefit many people with bulimia and would logically be applicable to those with EDNOS who binge or purge. It focuses on self-monitoring of eating and purging behaviors as well as changing the distorted thinking patterns associated with the disorder. Cognitive-behavioral therapy is often combined with nutritional counseling and/or antidepressant medications such as fluoxetine (Prozac).

Treatment plans should be adjusted to meet the needs of the individual concerned, but usually a comprehensive treatment plan involving a variety of experts and approaches is best. It is important to take an approach that involves developing support for the person with an eating disorder from the family environment or within the patient’s community environment (support groups or other socially supportive environments).

What about prevention?

Prevention research is increasing as scientists study the known "risk factors" for these disorders. Given that EDNOS and other eating disorders are multi-determined and often affect young people, there is preliminary information on the role and extent such factors as self esteem, resilience, family interactions, peer pressure, the media and dieting might play in its development. Eating disorders and body image is commonly seen as a problem affecting women, but men are also touched by media influence. Steroid abuse and body image to create the strong, cut male physic results in many short and long term effects, but falls off under the radar in terms of indicating distorted body image and eating disorders. Advocacy groups are also engaged in prevention through efforts such as removing damaging articles from teen magazines on "dieting" and the importance of "being thin.

EAT-26

The Eating Attitudes Test (EAT) is a commonly used method used to standardized the measure of symptoms and behaviors that are characteristic of eating disorders. The original EAT had 40 items, but this is the latest updated and shortened version designed to be self-administered or administered by health-professionals, school counselors, coaches and others.

This test alone does not diagnose an eating disorder and should not be thought of as the sole means of identification. Only a qualified health care professional can provide a diagnosis. The EAT-26 is used to assess “eating disorder risk.” All self-report measures require open and honest responses in order to provide accurate information. The test usually provides useful information about the eating symptoms and concerns that are common in eating disorders.

http://testing.river-centre.org:591/fmi/iwp/cgi?-db=EAT&-loadframes

Definition of a Healthy Body Weight

Dieting is not healthy eating.

Close to a third of the population are overweight, and in addition eating disorders are on the rise especially among young women. The preoccupation of body image and the pursuit to be thin has professionals looking at weight as they affect the physical and mental health of those involved. The concept of a healthy weight emerged from the recognition that we needed to shift our attention away from only body weight and focus on healthy living in general. Healthy living involves eating well, being active, and feeling good about oneself.

A healthy body weight is a weight range appropriate for a particular height and body build. It should not be confused with a thin weight. A healthy weight is the point at which you feel: fit and flexible, healthy and energetic, and are at a lower risk for weight-related health problems. The healthiness of your weight can be measured using the Body Mass Index (BMI) calculator Calculate your BMI. The calculator uses a person’s body weight and in relation of their height to define normal, overweight, and obesity.

To achieve a healthy body weight regular physical activity in combination with healthy eating promises the best hope. The type of physical activity one chooses can range from walking, riding a bike, dancing, gardening, running with your dog…but joining an expensive gym or sport club is not the only option or an excuse.

Healthy Eating Guidelines

Many people eat for emotional reasons. It is typically triggered by stress and anxiety too often leads to overeating and/or making poor food choices. In a study done by the International Journal of Eating Disorders compares the daily journals kept by a group of normal-weight women, half of whom were binge-eaters. The key influence on emotional eating, however, is not just negative or stressful events, but rather its people’s response to them. People who are less thrown off by stress tend to focus on how they want to constructively deal with a negative situation or they simply put it aside and move on. These who tend to experience more disruption due to negative situations are more inclined to stay focused on the problem, mentally replaying a distressing situation over and over again.

Those whose healthy-eating goals, are often disrupted by emotions can benefit from finding new strategies to help them respond more effectively to stressful situations. A study found that people gave in to eating temptations every time they didn’t have a strategy to deal with stressful situations. Individuals who respond to a negative situation with both positive and negative thoughts and constructive action are able to avoid emotion-based eating. Action responses might include attempts to fix a problem by asking a friend, family member, or associate for their advice, or through claming and soothing yourself by taking a walk, listening to music or deep breathing. Examples of positive thinking include reminding yourself that the problem is not really as big as it seems, or that brainstorming different approaches to the problem to find the most effective solution.

It has been observed that many people use food as a means to distract themselves from emotions ranging from simple boredom to frustration to elevated anxiety. Differentiating between biological hunger and other urges to eat, and trying to identify the feelings and needs behind non-hunger urges is the baseline for understanding what is behind the hunger. When a rest or distraction or refreshing relief from routine is needed simply learning to acknowledge it is appropriate to take a break can be freeing. If you’re not hungry, use breaks to read, nap or take a walk.

It is shown that emotional eating can be a significant source of excess of calories. This can result in overweight or obesity, which can increase problems. The American Institute for Cancer Research emphasizes the need to choose portions appropriate to our individual needs and to avoid popular super-sized foods. Emotional eating is controlled with healthier foods or smaller portions, and by getting whatever help and support you need to learn how to handle non-hunger urges without actually turning to food for temporary solace.

For more information on food and nutrition guidelines visit the American Dietetic Association.

Nutritional Requirements

Men are from Mars and Women are from Venus, but other than origin the genders also see differences in their nutritional requirements. What does everyone need to be concerned about and what health concerns do men and women specifically need to be aware about?

1. Calcium

Women: Calcium is important in lowering a woman’s risk of osteoporosis. A diet high in calcium and Vitamin D has been proven to lower the risk of bone fractures and regulate blood pressure. Women under 50 years of age the recommended amount of daily calcium is 1,000 milligrams and 1,200 mg for women over 50 years.

Men: Calcium is important in lowering the risk of osteoporosis in men, but can be harmful in large doses. Studies have shown that men who consumed high levels of calcium saw an increased risk in prostate cancer. For all ages the recommended amount is 800mg or 3 servings of dairy per day.

2. Iron

Women: Women require more iron then men because of their monthly menstrual cycles. Signs of iron-deficiency anemia include fatigue, inability to concentrate and difficulty breathing. If these symptoms appear, speak to a doctor. The recommended amounts of daily iron are 18mg and eight milligrams for postmenopausal women. The difference is one of the reasons why it’s important to choose an age-appropriate formula if you are taking multi-vitamin supplements.

Men: The recommended amount is 8mg for men of all ages. Studies have shown that men with high iron stores were associated with increased risk of heart attacks. It is important to choose an age-appropriate as well as gender-appropriate formula if taking a multi-vitamin supplement.

3. Omega 3 fatty acids

Women: Omega 3 fatty acids are a type of polyunsaturated fatty acids, which have been shown to help lower triglycerides and increase the good HDL cholesterol. They may also act as an anticoagulant to prevent blood from clotting. Omega 3 fatty acids can be found in almost all fish, but they are particularly high in fatty fish such as mackerel, salmon, sardines and herring. They can also be found in nuts and seeds as well as vegetable cooking oils. There is no official recommendation on how much omega 3 fatty acids women should eat, but the American Heart Association recommends eating fish at least two times a week.

Men: Omega 3 fatty acids benefit men, but only the marine kind from fish oil. Vegetable omega 3, also known as alpha-linolenic acid (ALA) may not be good for men. Still controversial a high intake of ALA has been linked to higher risk of prostate cancer. Until more is known, men should avoid taking concentrated ALA supplements such as flaxseed oil pills.

4. Protein

Women: Protein provides energy and it is also important in growth and repair. As a result of the high-protein diet hype, many people eat more protein than required. Excess protein accelerates calcium loss in urine, therefore, women with a high risk of osteoporosis should be careful not to eat too much protein. The average requirement is based on 0.8 grams of protein per kilogram of body weight. For example, a 130 pound woman would need 47 grams of protein daily.

Men: Men weigh more and therefore need more protein. Excess protein accelerates calcium loss in urine, even in men. Thus, men with a high risk of kidney stones should watch their intake. The same calculation is applied to men when determining an individual’s average requirement of daily protein. Based on 0.8 grams of protein per kg of body weight a 165 pound man would need 60 grams of protein daily.

In general healthy men and women will do fine with a daily 60 grams (8oz) of protein. If you are an athlete, however, your needs and requirements will increase.

5. Fiber

Women: Fiber prevents constipation, hemorrhoids, diverticulosis and can help reduce the risk for some chronic diseases such as colon and breast cancer. In addition, it may help lower bad LDL cholesterol and total cholesterol reducing the risk of heart disease. Fiber can also help lower the blood sugar to help manage diabetes. Women under 50 require 25 grams of fiber, while those over 50 require 21 grams. This is equivalent to at least two cups of vegetables and 1.5 cups of fruit.

Men: In a brief statement, men require more fiber than women. Men in general need more calories and in turn they need more fiber. Fiber requirements are calculated to provide the greatest protection against heart disease and are based on energy intake. Men under 5 require 38 grams of fiber, while those over 50 require 30 grams of fiber. This is equivalent to at least three cups of vegetables and two cups of fruit.

Understanding Food Labels and Nutrition Facts

Food labels have become synonymous with cryptic ingredients, hidden macronutrients and undecipherable content amounts. Grocery shopping for some can be a real headache and stressful experience, but it doesn’t have to be. Determining whether or not a product fits into your healthy lifestyle has become easier with the addition to listing the amounts of macronutrients and vitamin and mineral contents. The food label provides good information to help a consumer determine if a particular food product meets his or her nutritional needs.

In 1990, the Nutrition Labeling and Education Act went into effect with the intention that food labels are designed to help consumers make healthy food choices. The USDA and the FDA developed these guidelines so that consumers would have access to useful nutritional information. According to this act all packaged food MUST contain the following information:

• Common name of the product

• Name and address of the product’s manufacturer

• Net contents in terms of weight, measure or count, and;

• Ingredient list and Nutrition Facts

The most frustrating and yet most sought after component is the Nutrition Facts panel. Required fields include components of common nutrients, such as total fat, cholesterol, and sodium. Each package must identify the quantities of specified nutrients and food constituents per serving. Note the following measurements:

* 1 gram of fat = 9kcal

* 1g of protein = 4kcal

* 1g of carbohydrate = 4kcal

* 1g of alcohol = 7kcal

Nutrients Listed, Serving Size, Calories (kcal)

Total fat, saturated fats, cholesterol, total carbohydrate, protein, vitamins A and C, calcium and iron, are required on the label. Other nutrients are optional and may be listed at the discretion of the manufacturer. The percent daily values provide an estimate of the percentage of a nutrient from one serving in a typical 2000kcal diet. Also included is the daily reference values footnote. This reminds consumers of the daily intake of different foods depending on their own nutritional needs. In addition, a few other nutrients relevant to heart health are important to pay attention to when reading a label. At the beginning of January 2006 all labels will also include trans fatty acids.

Serving sizes are standardized to make for easier comparison among similar products. They are expresses in common household and metric measures. It is always important to pay attention to a serving size. For example, if you eat four pieces and the serving size is two then you need to double the amount of nutrition content listed on the label.

It is important to find out the total amount of calories. Calories provide a measure of how much energy you obtain after eating a portion of food. Many consumers are surprised to find out that fat-free is not synonymous with low calorie. Just as sugar-free is not always low in Calories or fat. See a comparison of low-fat or fat-free with regular food products.

The Bottom Line: regarding food labels

Food labels and Nutrition Facts enable consumers to compare products based on key ingredients. When comparing foods, focus on the ingredients that are most important to you. Tips to consider when comparing food labels.

• If you are concerned about you weight, compare products based on BOTH their calories and fat.

• If you have heart disease or high blood pressure, focus on the amount of total fat, saturated fat, trans fat, cholesterol and sodium. Then choose products that contain less than 20 percent Daily Values for fat, cholesterol and sodium.

• If you have diabetes, focus on the amount of carbohydrate, sugar added as well as fiber.

Nutrition Myths

Good fats, bad fats, low-fat, fat-free, low-calorie. These are just some of the many terms that get thrown at us as consumers daily by food manufacturers. They are enticing and intriguing especially with Americans’ preoccupation with body image. The fact is that we need fats, and reduced fat items have more sugar added to them to enhance the flavor. What you may think is a conscious effort to be healthy may result in the unintended outcomes and sabotage. Fats get a bad reputation and are one of the first nutrients monitored when people begin their quest for health. It is true that all fats are not equal and some promote health while others increase the risk of heart disease, it is also true that fats help nutrient absorption, nerve transmission, and maintaining cell membrane integrity. The key is to replace the bad fats with good fats in our diet.

Good fats include monounsaturated fats (MUFAs) and polyunsaturated fats. They lower total cholesterol and LDL cholesterol (bad cholesterol). MUFAs aid in increasing HDL cholesterol and have been found to help weight loss, especially in body fat. Food stuffs that supply MUFAs include nuts such as peanuts, walnuts, almonds, and pistachios, avocado, canola and olive oil. Polyunsaturated fats include the well-known group omega 3 fatty acids. Seafood such as salmon and fish oil, corn, soy, safflower and sunflower oils are high of this type of fat.

Bad fats include saturated fats and the highly talked about trans fats. Saturated fats raise total blood cholesterol and LDL cholesterol. They are mainly found in animal products such as meat, dairy, eggs and seafood. Some plant foods such as coconut oil, palm oil and palm kernel oil are also high in saturated fats. Trans fats are not found in nature, but were invented as scientists began to "hydrogenate" liquid oils so that they can withstand better in food production process and provide a better shelf life. Trans fatty acids are found in many commercially packaged foods, commercially fried food, other packaged snacks as well as in vegetable shortening and hard stick margarine.

To reduce your intake of bad fats consider these simple changes. Avoid using cooking oils that are high in saturated fats and/or trans fats such as coconut oil, palm oil or vegetable shortening. Instead, use oils that are low in saturated fats and high in monounsaturated and polyunsaturated fats such as canola oil, olive oil and flax seed oil. Minimize using commercially packaged foods which are high in trans fats, and read labels to look for trans-fat free alternatives. Use lower-fat dairy products such as 1% or skim milk instead of whole milk and trim visible fats and skins from meat products to reduce saturated fats.

The truth about fats and calories is not the only myth surrounding nutrition. Other common myths seen in the dieting and the nutrition world are brown eggs are more nutritious than white, avoid carbohydrates to lose weight, avoid nuts because they are fattening, eating for two is necessary during pregnancy, and red meat is bad for health. All of these “truths” can easily be debunked with the knowledge of dietitians and their work.

1. Brown Eggs are more nutritious than White Eggs

This widely believed myth that the color of the eggshell has an affect on the eggs overall nutritional value has no scientific support. The color has nothing to do with the nutritional value, quality, flavor, cooking characteristics, or shell thickness. It only tells you what breed of hen produced the egg. The white shelled eggs are produced by hens with white feathers and white earlobes whereas the brown shelled eggs are produced by hens with red feathers and red earlobes.

2. Avoid carbohydrates to lose weight

Many low-carb diets convey the message that carbohydrates promote insulin production, which in turn results in weight gain. The problem is many low-carb diets do not provide sufficient carbohydrates to your body for daily maintenance. This means the body will begin to burn stored carbohydrates (glycogen) for energy, and when your body starts burning glycogen, water is released. This water release is the reason for the initial weight loss of a low-carb diet. These diets are often calorie-restricted allowing an average of1000 - 1400 calories, compared to 1800 - 2200 calories needed for most people. Carbohydrates are not the pinnacle of successful weight loss. You can lose weight by healthfully reducing your caloric intake by 500 calories per day in respect to your normal diet.

3. Avoid Nuts because they are fattening

Nuts are caloric and it is easy to overeat them, but when properly portioned nuts can be part of a healthy diet. Nuts are high in good fats, monounsaturated and polyunsaturated fats, as well as plant sterols, which have all been shown to lower bad LDL cholesterol. Instead of simply adding nuts to your diet, the best approach is to eat them in replacement of foods high in saturated fats.

4. Eating for two is necessary during pregnancy

The idea that pregnancy allows for women to eat double and ice cream is a free-for-all is a nutrition myth. Generally it is recommended that pregnant women increase their daily intake by 100 kcal in the first trimester and 300 kcal in the second and third trimesters. A daily prenatal multivitamin supplement is recommended and an extra snack before bedtime such as a piece of fruit, a serving of milk or yogurt, and a few biscuits is enough.

5. Red Meat is bad for health

Some studies have linked red meat with increased risk of heart disease due to the saturated fat content, but even chicken can contain as much saturated fat as a cut of lean pork or beef. Poultry is naturally lower in saturated fats but only if you do not eat the skin. Red meat altogether is not bad for your health. Instead of excluding red meat altogether, choose leaner cuts. For beef, choose eye of round, top round roast, top sirloin and flank; for pork, choose tenderloin and loin chops.