Archive for the ‘Eating Disorders and Obesity’ Category

Eating Disorders and Autoimmune Disease

Thursday, April 18th, 2013

Autoimmune diseases afflict nearly 24 million Americans. Yet 90% of Americans cannot name a single one of these deadly and disabling diseases. If autoimmune diseases were grouped as a single category rather than more than 20 separate illnesses, they would be one of the ten most common causes of death for women under the age of 65.

According to News Medical, “autoimmune diseases arise from the overactive immune response of the body against substances and tissues normally present in the body. In other words, the body actually attacks its own cells. This may be restricted to certain organs (e.g. in thyroiditis [or Type 1 Diabetes]) or involve a particular tissue in different places (e.g. Goodpasture’s disease which may affect the basement membrane in both the lung and the kidney). There are more than 80 different autoimmune diseases”. The more commonly mentioned autoimmune diseases include Graves’ disease, Hashimoto’s disease, lupus, rheumatoid arthritis, Type 1 Diabetes, Multiple Sclerosis, Irritable Bowel Syndrome (IBS), and Celiac disease.

According to Dr. Alessio Fasano, there are three factors that must be present in order for an individual to develop an autoimmune disease:

  • the individual must be exposed to an environmental trigger
  • the individual must be genetically predisposed
  • the individual must have intestinal permeability (leaky gut)

Eating a diet that includes genetically engineered foods impacts the endocrine system in ways that increase the likelihood of autoimmune disorders. It also increases the likelihood of developing leaky gut. In other words, eating genetically engineered foods can expose us to two of the three factors listed by Dr. Fasano; they can be an environmental trigger and lead to leaky gut.

Leaky gut is very common in psychiatric diseases such as anorexia, bulimia, alzheimer’s and schizophrenia. You don’t have to have gut symptoms to have leaky gut; leaky gut can be completely asymptomatic. According to Dr. Jack Kruse, many individuals with eating disorders have a permeable gut barrier and brain barrier. This combination causes disruption in the hypothalamic-pituitary-adrenal axis (HPA) which leads to changes in cortisol (which is the stress hormone that tears things down in the body), dehydropiandrosterone (DHEA), which is an anabolic hormone that builds things back up, Insulin Growth Factor 1 (IGF1) which is a hormone that promotes growth and prevents cells from dying, and melatonin, known as the “sleep hormone” as it regulates sleep cycles. (Note: Altered circadian rhythm can affect sleep, hormones, and other functions within the body. Altered circadian cycles are also linked with obesity, diabetes, and psychiatric diseases such as depression.)

One small study in Sweden suggested that there could be a connection between autoimmune diseases and eating disorders. Researchers found that nearly three out of four women (74%) with an eating disorder also had antibodies that have a negative effect on the hypothalamus or pituitary. These antibodies were only found in 2 of 13 women without eating disorders. The hypothalamus plays a significant role in regulating how much food we eat. The researchers stated that more research would need to be completed before clinical applications of the findings can be considered. They are continuing to research the link between the nervous system and the immune system in individuals with eating disorders.

There are several measures that can be taken to reduce the risk of developing an autoimmune condition. We can eat clean, which will reduce our exposure to environmental triggers. In other words, eat organic foods that contain no additives, carcinogens, or GMO’s. We can avoid foods that cause an inflammatory response; these foods will vary from person to person, but usually involve grains or foods to which we are allergic. We can avoid foods that cause leaky gut, such as cereal grains, sugar, processed soy and industrial seed oils.

We can also take steps to help heal the gut. According to Chris Kresser we can promote the healing of the gut through:

  • Removing all food toxins from your diet
  • Eating plenty of fermentable fibers (starches like sweet potato, yam, yucca, etc.)
  • Eating fermented foods like kefir, yogurt, sauerkraut, kimchi etc. and/or take a high-quality, multi-species probiotic
  • Treat any intestinal pathogens (such as parasites) that may be present
  • Take steps to manage your stress in order to reduce cortisol

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2013, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2013, Dr J Renae Norton. http://www.eatingdisorderpro.com’

Sources:

Autoimmune diseases: a leading cause of death among young and middle-aged women in the United States.

What is Autoimmune Disease?

Autoantibodies against α-MSH, ACTH, and LHRH in anorexia and bulimia nervosa patients

Mechanisms of Disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases

The Leaky Gut Prescription

9 Steps to Perfect Health – #1: Don’t Eat Toxins

Bullying and Eating Disorders

Tuesday, April 2nd, 2013

As we noted in the “Childhood Obesity” infographic, 26% of sixth graders are bullied, teased, or rejected daily based on their size; this increases to 61% by high school. Additionally, obese children are 1.6 times more likely to be bullied by non-obese children.

Children that are bullied over their size are more likely to develop psychological issues, such as depression, anxiety, panic disorders, and eating disorders. In a study published in November 2012 by Beat, bullying was found to be responsible for eating disorders in more than 75% of participants; this is an increase of 67% since they carried out a similar study in 2010. More than 40% of participants reported that the bullying began before they were 10 years old.

Symptoms of eating disorders in children are similar to the symptoms that appear in teenagers and adults.Your child may have an eating disorder if they exhibit any combination of the following symptoms:

  • sudden weight loss
  • preoccupation with food
  • wearing extra layers of clothing or loose clothing
  • refusing to eat with other people
  • refusing to eat certain foods, certain food groups (such as meat), or particular macronutrients (such as carbs)
  • engaging in excessive exercise
  • expressing concerns that they are “too fat”
  • skipping meals and/or eating small portion sizes

If you are concerned your child has an eating disorder it’s important that you don’t try to deal with it on your own, oftentimes this can make the eating disorder worse. If you are in the Cincinnati area, you can contact me to discuss your concerns. If you are outside on the Cincinnati area, express your concerns to you child’s pediatrician or contact me, I may know someone in your area that I can refer you to.

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2013, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2013, Dr J Renae Norton. http://www.eatingdisorderpro.com’

Pregorexia

Monday, March 25th, 2013

Credit: Menno Hordijk (Used under a Creative Commons License)

Pregorexia is a term the media uses for women that have an eating disorder during the time they are pregnant and/or during early motherhood. Individuals affected by the disorder tend to be preoccupied with controlling pregnancy weight gain through food restriction, bingeing and purging, over-exercising, abusing laxatives. diuretics, or diet pills. It is estimated that 1 in 20 women suffer from an eating disorder while pregnant; 60-70% of eating disorder patients relapse during pregnancy.

According to the Mayo Clinic, warning signs of Pregorexia include:

  • talking about the pregnancy as if it wasn’t real
  • obsessiveness over calorie counting
  • eating alone or skipping meals
  • excessive exercise
  • pre-occupation with the scale and weight gain
  • minimal weight gain during pregnancy
  • dieting
  • signs of depression

Pregorexia puts the health of both the mother and the baby at risk. Disordered eating behaviors during pregnancy can affect the mother in a variety of way including malnutrition, dehydration, heart issues, premature birth, miscarriage, and depression. Gaining too little weight during pregnancy can affect the health of the baby in numerous ways including low birth weight, vitamin deficiencies, neurological problems, lower IQ, growth retardation, and other long-term health problems.

Psychologically speaking, pregorexia can be driven by a number of dynamics:

  • the media puts a lot of pressure on women to be thing, even during pregnancy
  • Some women associate motherhood with losing control of their bodies, losing control of their lives and/or losing their identity
  • gaining weight and bodily changes are difficult for most women during pregnancy, but it is especially difficult for those that have a history of disordered eating.
  • the idea of becoming a mother is frightening to some because they don’t believe they can take care of themselves, let alone a baby. They believe that if they keep their body small (like a child) this means that someone, usually parents, will have to take care of them.
  • sometimes the idea of becoming parents can cause relationship difficulties, making the mother-to-be feel out of control, she may try to regain control by controlling her food, weight, and exercise

Like all eating disorders, it is important to seek out treatment if you or a loved one struggles with pregorexia. Treatment often involves the obstetrician, psychological counselling, and nutritional support. A holistic approach that balances body, mind and spirit is the most successful form of treatment.

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2013, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2013, Dr J Renae Norton. http://www.eatingdisorderpro.com’

Sources:

Pregorexia – Anorexia that Endangers Pregnant Mothers and their Children

Pregorexia Starves Mom and Baby

Pregorexia: A legitimate problem during pregnancy?

Diabulimia

Thursday, February 28th, 2013

Diabulimia is an eating disorder in which individuals with Type 1 Diabetes purposefully give themselves less insulin than they require, with the intention of losing weight. The eating disorder is most common in woman between the ages of 15 and 30. According to Dr. Ann E. Goebel-Fabbri, about 30% of diabetic woman restrict their insulin to induce weight loss at some point in their lives.

There are many serious short-term and long-term consequences associated with diabulimia:

According to Diabulimia Helpline, there are several telltale signs that an individual is suffering from diabulimia:

  • A1c of 9.0 or higher on a continuous basis.
  • Unexplained weight loss.
  • Persistent thirst/frequent urination.
  • Preoccupation with body image.
  • Blood sugar records that do not match HbA1c results.
  • Depression, mood swings and/or fatigue.
  • Secrecy about blood sugars, shots and or eating.
  • Repeated bladder and yeast infections.
  • Low sodium/potassium.
  • Increased appetite especially in sugary foods.
  • Cancelled doctors’ appointments.

Treatment for Diabulimia

The first step in Diabulimia is to break through the denial the individual may have that s/he is abusing insulin to manage weight.  Unlike many eating disorders, this one may start as an attempt to control the diabetes but end up as a way of controlling weight.   Those with Type I diabetes are at risk for addiction to empty carbs early in their disease as the first symptom is significant weight loss. Efforts to help the child regain the weight usually do not include clean eating, such that s/he may develop bad habits or even an addiction to carbs, fat and/or salt.

Treatment for Diabulimia resembles treatment for Bulimarexia, the combination of Anorexia and Bulimia, in as much as it often contains elements of each disorder.  To the degree that the individual uses insulin to “binge” on empty carbs, the first step is to teach him or her to eat clean foods that have a healing impact on the endocrine system rather than a damaging effect.

The other essential ingredient in the treatment of the individual suffering from Diabulimia is to help the individual deal with the fear of gaining weight.  As with many individual’s suffering from Anorexia, an excessively low weight seems like an accomplishment. The Diabetic is particularly at risk for having control issues, as so many things seem beyond his or her control, especially when it comes to the body’s reaction to food.

Interested in learning more about Diabulimia? We’ll be talking with Dr. Ann Goebel-Fabbri on next week’s podcast! We’ll be taking your questions live at 646-378-0494 or you can submit your questions HERE.

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2013, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2013, Dr J Renae Norton. http://www.eatingdisorderpro.com’.

DSM-5 Changes in the Diagnosis Eating Disorders

Saturday, December 29th, 2012

As of May 2013, several changes will be made to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in regards to the diagnosis of eating disorders.

Binge Eating Disorder (BED) will now be listed as a separate diagnosis. Previously, individuals with BEDs were diagnosed as Eating Disorders Not Otherwise Specified (EDNOS). BED is associated with major medical complications such as high cholesterol, heart disease, and obesity. By listing BED as a diagnosis that is separate from EDNOS, individuals will now receive a proper diagnosis and more effective treatment.

Individuals will no longer need to present with amenorrhea in order to receive a diagnosis of Anorexia Nervosa. There are also changes being made to the weight requirements. Previously, an individual had to present at 85% of their ideal body weight. In the upcoming edition of the DSM, the individual will present with a significantly low body weight due to restriction of energy (food) intake.

In the current edition of the DSM, the main criteria for diagnosis of Bulimia Nervosa is based on the number of binge/purge episodes that occur per week. Currently, to be diagnosed with Bulimia Nervosa, the individual must binge/purge more than two times every week for a period of three months; otherwise they are diagnosed with EDNOS. In the 2013 version of the DSM, the number of weekly binge/purge episodes has been reduced. The individual must binge/purge at least once per week for a three month period in order to be diagnosed with Bulimia Nervosa.

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2012, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2012, Dr J Renae Norton. http://www.eatingdisorderpro.com’

Female Athlete Triad Syndrome

Monday, December 17th, 2012

photo used under a creative commons license

Female Athlete Triad Syndrome is a condition that combines energy deficit created through restricting food intake or over-exercising, irregular menstruation, and bone loss. According to the Female Athlete Triad Coalition, the most common symptoms of Female Athlete Triad Syndrome include:

  • irregular or absent menstrual cycles
  • always feeling tired and fatigued
  • disrupted sleep
  • stress fractures and frequent or recurring injuriesrestricting food intake
  • obsessed with being thin
  • eating less than needed in an effort to improve performance or physical appearance
  • cold hands and feet

As with all eating disorders, some individuals are more at risk of developing Female Athlete Triad Syndrome. Athletes involved in sports that emphasize being “lean” (such as gymnastics, figure skating, ballet, long distance running, swimming, diving) are most commonly affected by Female Athlete Triad Syndrome. Other risk factors include: participating in sports that require weight checks, over-exercising, playing “high-pressure” sports, participating in sports that look down upon weight gain, working with controlling parents or coaches.

Psychologically speaking this syndrome can be driven by a number of dynamics.  For different reasons, some young women associate motherhood with losing control of their bodies and/or their lives.  The obvious one is the weight gain.  But it may also be that they do not want to give up their devotion to their Eating Disorder, especially if they suffer from Anorexia or Bulimarexia.  For others, it may have to do with giving up or modifying career or athletic success. This often stems from a fundamental belief that they “cannot have it  or cannot do it all” and so they sacrifice the role of motherhood.  For others, the mature or womanly body is frightening because they do not believe that they can take care of themselves. Thus keeping a child’s body means that someone, usually parents, will have to care for them. At the end of the day, the number of reasons for engaging in behaviors that are so detrimental to one’s health and future are as different and varied as the people suffering from them. Which is why all treatment has to take the individual where she is and not use a One Size Fits All Approach.

There are several steps that active women can take to prevent Female Triad Syndrome. The Female Athlete Triad Coalition suggests:

  • monitoring your menstrual cycle by using a diary or calendar
  • consult your physician if you have menstrual irregularities, having recurrent injuries or stress fractures
  • seek counseling if you suspect you are overly concerned about your body image
  • consult a sport nutritionist to help you design an appropriate diet that is specific to your sport and to your body’s energy needs
  • seek emotional support from parents, coaches and teammates

It is also important to make sure you are taking in enough calories to support normal body function. If you are a 120 pound woman, it takes 1600 calories per day to have a normal menstrual cycle. If you burn an additional 500 calories at the gym or in your sport, you would need to eat 2100 calories per day.

For more information for Female Athlete Triad Syndrome, be sure to visit the Female Athlete Triad Coalition.

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2012, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2012, Dr J Renae Norton. http://www.eatingdisorderpro.com’

Anorexia Nervosa & Body Dysmorphia

Thursday, November 1st, 2012

photo used under a creative commons license, flickr user Ken Doerr

Many patients with anorexia nervosa experience body dysmorphia; they feel that they are much larger than they actually are. Recently, a study was published that investigated whether this overestimation of body size is a symptom of the eating disorder or if it is a general impairment in perception.

The study involved fifty participants; 25 of the participants had anorexia nervosa, 25 participants were control participants. Participants were well-matched based on age and level of education. Within a test room, each participant was presented with a door. The participant had to judge whether the door was wide enough for them to pass through. Presented with the same door, the participant then had to judge whether the door was wide enough for another person in the test room to pass through.

The participants with anorexia nervosa significantly overestimated their ability to pass through the door in comparison to the control group, suggesting that overestimation of the passability ratios in participants with anorexia nervosa are likely to be caused by an overestimation of their own body size and shape.

The study concluded that the overestimation in participants with anorexia nervosa occurred because the central nervous system had not yet registered that the participants body was emaciated; the central nervous system had an outdated image of the participants body in it’s pre-anorexic state.


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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2012, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2012, Dr J Renae Norton. http://www.eatingdisorderpro.com’

Source: Guardia D, Conversy L, Jardri R, Lafargue G, Thomas P, et al. (2012) Imagining One’s Own and Someone Else’s Body Actions: Dissociation in Anorexia Nervosa. PLoS ONE 7(8): e43241. doi:10.1371/journal.pone.0043241

Yoga in the Treatment of Eating Disorders

Thursday, October 11th, 2012

photo used under a creative commons license

In 2010, Newman’s Own funded a pilot program at the Seattle Children’s outpatient Adolescent Medicine Department. The pilot program was implemented to evaluate the effect of yoga on eating disorder treatment outcomes among teenagers receiving outpatient treatment for anorexia nervosa, bulimia nervosa, and Eating Disorder Not Otherwise Specified (EDNOS).

The study involved 50 girls and 4 boys between the ages of 11-21; 29 participants were diagnosed with anorexia nervosa, 9 participants were diagnosed with bulimia nervosa, 15 participants were diagnosed with EDNOS. Participants were randomly divided into two groups. One group received standard care; standard care involved appointments with a physician and dietician every other week which monitored weight/height, vital signs, body mass index, nutritional habits, and menstruation status. The second group of participants received yoga instruction plus standard care; yoga instruction involved one hour of one-to-one individualized viniyoga, semi-weekly. Participants were evaluated at the beginning of the study, at the end of the study, and one month after the study via Eating Disorder Examination (EDE), Body Mass Index (BMI), Beck Depression Inventory, State Trait Anxiety Inventory, and Food Preoccupation questionnaire.

Immediately after yoga sessions, participants experienced a significant decrease in their preoccupation with food; this was evaluated using the Food Preoccupation questionnaire.  Although both groups experienced a decrease in EDE scores, the group that received yoga plus standard of care exhibited greater decreases in symptoms of their eating disorders. At the 12-week follow-up, the EDE scores non-yoga group had returned to baseline; this was not the case with the yoga group. BMI remained stable for both the yoga and non-yoga group; participants with anorexia nervosa did not lose weight, participants with bulimia nervosa did not experience rapid weight fluctuations. Based upon the results of the study, the researchers concluded that individualized yoga does hold promise as adjunctive therapy to standard care. The full results of the study can be viewed HERE.

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2012, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2012, Dr J Renae Norton. http://www.eatingdisorderpro.com’

Eating Disorders in Older Women

Wednesday, September 19th, 2012

 

photo used under a creative commons license

Recently, there has been an increase in the number of older women that display symptoms of disordered eating.  Although this segment of the population appears to be having issues that are very similar to those seen in younger women (body dysmorphia, seemingly uncontrollable eating, yoyo dieting, etc.) they may not be showing up for treatment.  In my practice, I usually see them “indirectly” or in the role as parent rather than a patient.  It is becoming all too common to have a patient describe her mother’s issues with food as being a part of her problem.  From parents that engage in bingeing to moms that are obviously restricting, the problems run the gamut.  The problem is that they are not there to address their own disorder, but that of their child.

An eating disorder is always a very serious problem, but it may be even more serious in older women because eating disorders can be particularly harmful to older populations since their bodies are less resilient. Eating disorders can have devastating effects on cardiovascular health, musculoskeletal health, and gastrointestinal health; these effects are amplified in older populations. Oftentimes eating disorders in older populations are left undiagnosed since symptoms that would be telltale signs of an eating disorder in younger populations, such as amenorrhea, are chalked up to menopause.

This year, the International Journal of Eating Disorders published a study which examined body image and the prevalence of eating disorders in older women. 1,849 women participated in the study; the average age of participants was 59 years old. The body weight of participants varied; 56% were overweight or obese, 42% were normal weight, 2% were underweight. The study determined that:

  • 71% of the women said their weight or body shape affected their self-perception
  • 41% of the women reported checking their body daily
  • 36% of the women reported spending at least half of the last five years dieting
  • 13.3% of the women reported symptoms of an eating disorder
  • 8% of the women reported purging without bingeing within the past five years
  • There was a high incidence of the use of unhealthy methods aimed at weight loss; 7.5% reported using diet pills, 7% reported exercising in excess, 2.5% reported using diuretics, 2% reported using laxatives, 1% reported vomiting.

An Australian study was published that also examined eating behaviors, weight history, and body image in older women. 475 women participated in the study; their ages ranged from 60-70 years old. The majority of women in the study were slightly overweight with a BMI of 25. The study determined:

  • 90% of the women reported feeling very fat or moderately fat
  • 60% of the women reported feeling dissatisfied with their body; many reported wanting to obtain a BMI of 23
  • More than 80% of them women reported making efforts to manage their weight
  • 4% (18 participants) met diagnostic criteria for an eating disorder; one participant had anorexia nervosa, one participant had bulimia nervosa, fifteen participants had an eating disorder not otherwise specified (EDNOS)
  • An additional 4% of participants reported a single symptom of an eating disorder such as abusing laxatives or diuretics, purging or binge eating.

Researchers attribute the majority of mid and late-life eating disorders to major life changes such as divorce, loss of a parent, having children leave home for university or jobs, having children return home upon graduating university, and adapting to the role of having to take care of both children/grandchildren and aging parents. During these stressful life changes, many women turn to food to help gain a sense of control and to regulate their mood. Additionally, aging women may feel even more pressure to lose weight because they feel they are losing their “youthful beauty” which today’s pop culture values so highly.

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

© 2012, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2012, Dr J Renae Norton. http://www.eatingdisorderpro.com’

Why Rapid Weight Gain Decreases Treatment Success Rates

Friday, August 24th, 2012

At many inpatient eating disorder treatment centers patients with anorexia nervosa are required to restore their weight quickly; I’ve had patients that were forced to gain 20 pounds in 21 days! Not coincidentally, 21 days was the amount of time that managed care would cover.  There are numerous reasons as to why gaining weight this quickly actually sets the patient up for relapse. Let’s look at what gaining weight at a rapid rate does to leptin levels.

In the malnourished, underweight anorexic, leptin levels are typically very low, due to low fat reserves. Usually, leptin levels reach normal levels during weight restoration. However, when weight is gained too quickly, leptin levels rise too quickly and may exceed the normal range. Of course this has the opposite effect needed for refeeding and individuals experience suppressed appetite and suppressed energy expenditure. As a result, it becomes increasingly difficult for the patient to eat, often interfering with the refeeding process.  Many of the patients who have had this experience, were told, in effect, that they were at fault, or “not trying”. The reason that this happens is that not enough practitioners know about Leptin and the role that it plays in re-feeding. For someone who already has control issues, this is an extremely painful and often damaging experience.

At the Norton Center, our anorexic patients are helped to restore their weight slowly, but steadily. This, along with other important nutritional factors, plays a major role in our high success. It is important to note that many treatment programs use weight gain at the conclusion of treatment as the measure of success.  This is a distortion in as much as the 20 pound weight gain is often gone in a matter or months, and sometimes in a matter of weeks. We measure success as weight gain that is maintained for a at least one year post treatment.  Currently, our success rates  for those patients that remain in treatment is about 90%; in comparison, many inpatient treatment centers experience a much lower success rate, or about 30 to 40%.

How Low Leptin Effects the Physical Complications and Behaviors Typical of Anorexia Nervosa

Low leptin plays a significant role in many of the physical complications and behaviors that are typically associated with anorexia nervosa; amenorrhea, hypothyroidism, hypercortisolism, osteopenia, immune changes, and increased physical activity.

Leptin levels of less than 1.85 µg suggests amenorrhea and subnormal luteinizing hormone (a hormone that stimulates ovulation) in women with anorexia nervosa. As leptin levels normalize through weight restoration, the hypothalamic-pituitary-gonadal axis may be activated. Not all patients with anorexia nervosa resume menses upon weight restoration.

The majority of women with anorexia nervosa exhibit osteopenia. Low leptin levels are also associated with a reduction in bone formation rate. Although there are other endocrine changes that contribute to osteopenia, low leptin levels appear to play a significant role.

Individuals with anorexia nervosa, often experience a compromised immune system. This could also be due, in part to low leptin levels although most of the compromised immunity is due to increased cortisol levels.  Cortisol is the hormone that we associate with stress.  Patients who are gaining weight too rapidly, are under considerably more stress, and may also be experiencing increased cortisol levels

Finally, up to 80% of patients with Anorexia Nervosa tend to engage in excessive physical activity. It is believed that there is an inverse correlation between food intake and physical activity during the weight loss phase. In other words, the lower the leptin levels, the more drive there is to exercise excessively, which causes more weight loss or less weight gain. One study demonstrated that patients reported a decreased feeling of restlessness or hyperactivity (need to exercise) as leptin increased during the refeeding/weight restoration phase of treatment.

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© 2012, Dr J Renae Norton. This information is intellectual property of Dr J Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2012, Dr J Renae Norton. http://www.eatingdisorderpro.com’

Sources: Monteleone P. Di Lieto A. Castaldo E, et al. Leptin functioning in eating disorders. CNS Spectrums. 2004;9:523–529. [PubMed]