Eating Disorders Affect All Ages

Eating Disorder

In conjunction with National Eating Disorders Awareness Week, February 26 through March 4, Arkansas Children's Hospital urges families to watch for signs of an eating disorder. This year the theme for the annual observation is "Be comfortable in your genes," emphasizing that a person's size and shape are genetic and poor eating habits can severely damage their health.
Millions of Americans are reading food labels these days; some are trying to eat healthier while others hope to avoid being overweight. Our society's obsession with weight stems from a number of factors; the growing number of obese Americans, images of celebrities who are unrealistically thin and the millions of people who fall in between those categories and suffer from a poor self-image or lack of self-esteem. While our attention on obesity can be helpful, the concern over body image also can get out of control, sometimes leading to unhealthy eating disorders that can be life-threatening. Eating disorders affect people of all ages, from children in kindergarten to their grandparents. Approximately 10 million girls and women struggle with some type of eating disorder, as do one million boys and men.
"An eating disorder develops as a result of a combination of several factors, some of which include genes, biochemical changes in the brain, specific personality traits such as obsessive compulsive tendencies and/or perfectionist tendencies, family dynamics and socio-cultural expectations regarding weight and appearance," says Maria Portilla, M.D., medical director of the Adolescent Eating Disorder Clinic at Arkansas Children's Hospital and associate professor of Pediatrics at the University of Arkansas for Medical Sciences College of Medicine. "Patients with eating disorders usually have an unrealistic view of themselves and focus a lot of their attention on their weight and appearance. Since this is a mental health illness, the patient needs treatment with a mental health professional."
Portilla says eating disorders diagnosed in the Adolescent Center at Arkansas Children's Hospital include anorexia nervosa, bulimia nervosa and other disorders that don't place the patient in either of the first two categories. Those who have an eating disorder may see themselves as overweight, when in reality they are dangerously thin and malnourished. The symptoms of anorexia nervosa, one of the more common eating disorders, include excessive weight loss, excessive exercise, avoiding fats and carbohydrates or avoiding meals altogether, fatigue, fainting or depression. Signs of bulimia nervosa include eating large amounts of food in a short time period followed by purging, excessive exercise after a meal, staying in the bathroom for long periods of time after a meal, a frequent sore throat or an obsession with food or weight.
"An adolescent or adult with an eating disorder needs treatment, preferably with a team of professionals that are communicating on a regular basis," says Portilla. "These professionals should include a mental health professional, such as a psychologist and psychiatrist, and a physician with expertise in eating disorders who can evaluate and follow the medical complications. Typically, these physicians are pediatricians, family practice physicians or internists." A healthy weight and body image can be achieved through proper diet and physical exercise, keeping in mind that adolescents and adults who are unrealistically thin are damaging their own psychological and physical health. It is estimated that 20 percent of those who have an eating disorder will die, secondary to medical complications, from malnutrition or due to suicide.
"An inadequate diet, low in carbohydrates, fats and protein, can lead to several complications," says Portilla. "Some of those include loss of muscle mass, loss of  bone mass (osteoporosis), loss of menstrual periods, which can lead to infertility, hair loss, abnormal sugar metabolism, which can lead to fainting or seizures and abnormal electrolytes which can also lead to seizures or irregular heartbeat that can result in death."
When a diet is low in calories, the patient is prone to being tired, weak, and dizzy. The person's metabolism becomes very low which causes other problems, such as being cold, tired, having problems concentrating, and ultimately dying. The most effective way of helping those with a suspected eating disorder is to encourage them to seek professional help, share information on organizations or Web sites that offer answers about eating disorders and avoid trying to force them to eat. Seeking help for a patient with an eating disorder must begin with a personal step. Treatment and rehabilitation may take months and in some cases years, to break through the psychological setbacks. Given the right medical treatment and social encouragement, those who have an eating disorder can return to a healthy, fulfilling life with high self-esteem and healthy eating habits.
Arkansas Children's Hospital is the only pediatric medical center in Arkansas and one of the largest in the United States serving children from birth to age 21. The campus spans 24 city blocks and houses 290 beds, a staff of approximately 500 physicians, 80 residents in pediatrics and pediatric specialties and more than 3,600 employees. The private, nonprofit healthcare facility boasts an internationally renowned reputation for medical breakthroughs and intensive treatments, unique surgical procedures and forward-thinking medical research - all dedicated to fulfilling our mission of enhancing, sustaining and restoring children's health and development.

Employer-Based Weight Loss Programs Are Helpful

A little shove from the workplace may actually be the ticket to weight loss, a new review of studies from US show.
According to Michael Benedict, MD, and colleagues at UC, employer-based programs for weight loss are modestly effective at helping workers take off extra pounds.
“Worksite-based programs do tend to result in weight loss for the people that participate in them,” says Benedict, co-author of the study and researcher in the department of internal medicine.
The review appears in the July-August issue of the American Journal of Health Promotion.
Benedict and colleagues looked at 11 studies published since 1994 to determine their results.
Most of the programs involved education and counseling designed to improve diet and increase physical activity and lasted anywhere from two to 18 months. Forty-six percent of the studies involved low-intensity interventions, 18 percent were moderate intensity and 36 percent were high intensity.
Benedict says that intensity may be an important factor when it comes to weight loss. He added that programs incorporating face-to-face contact with subjects more than once a month appeared to be more effective than other programs.
In comparison, participants in higher intensity programs lost an average of 2.2 pounds to almost 14 pounds, while non-participants ranged from a loss of 1.5 pounds to a gain of 1.1 pounds.
“Most employed adults in the U.S. spend nearly half of their waking hours at their place of employment,” Benedict says. “Worksite based programs have great potential to positively impact our current obesity epidemic.
However, Benedict says it was difficult to draw conclusions about weight-loss maintenance.
“Participants in these programs may lose weight, but it is unclear what happens after the fact, as weight maintenance has not been studied,” he says.
There is also minimal data to show how much money employers could save if they start worksite weight-loss programs. Benedict says many employers want to know that implementing these programs will lead to a positive return on investment.
Studies have shown that other worksite health interventions targeting high risk employees, like smokers and people with hypertension, may benefit employers financially within only a few years.
“These programs have the potential to have a tremendous public health impact,” he says. “However, more high quality research is needed.”

Researcher Oversees Diet Sensation

Diet and High Carbs for Weight Loss

The Bread for Life Diet: The High-on-Carbs Weight Loss Plan, the diet phenomenon that has made nutrition researcher Olga Raz as famous in Israel as Atkins was in America, is scheduled to be released by U.S. publisher StewartTabori and Chang in September 2005.
"It's the diet other publishers didn't want to touch because it is so anti-Akins and South Beach," says Debora Yost, the book's editor, "but I have known all along that there were flaws in those diets and knew it was just a matter of time until carbohydrates would come back in vogue and be part of a sensible eating program."
Yost, a veteran health editor and an author herself, said she heard a loose translation of the diet was around and she tracked it to an advertising agency in Florida with the help of an industry colleague. "As soon as I saw it I could see that it made perfect sense. I contacted Olga Raz and had several e-mail conversations with her. She was very impressive and has an outstanding scientific background. The diet is not like anything I have ever seen, and I have seen them all."
The diet features bread, and lots of it, up to 12 slices a day for women and 16 slices a day for men, plus lots of other wholesome carbohydrates and is a two-part program. "The bread is not a gimmick. Rather it is a real weight loss mechanism because it is eaten in such a way that it corrects the biological processes that make dieting difficult for so many people, and it prevents the cravings and hunger that lead to diet failure," says Debora Yost. Raz has already guided thousands of people in Israel to successful weight loss through the "It's All in You Head" weight loss program at Tel Aviv Sourasky Medical Center, Israel's second largest hospital where Raz is the director of the nutrition and dietetic unit; her own private clinic; and through her book Eat Bread and Get Slim, which became an instant best-seller. The Raz Diet, as it is called in Israel, also became the basis of a hit reality program in which Raz coached 20 obese people, and helped them lose a combined total of 880 pounds over a six-to-eight month period.
Ironically, Raz developed her diet as a result of a scientific experiment she did to help come up with an explanation for her patients who complained that they could not sustain low-carbohydrate diets and did not like the way they made them feel. Raz's experiment involved measuring the levels of serotonin in the blood. Serotonin is a brain chemical that, in addition to other things, controls the hunger and satiety centers in the brain (Meguid, M. et al., 2000). When Raz fed patients a high-protein meal, there serotonin level rose but quickly plummeted. However, when she fed them whole grain carbohydrate-based bread their serotonin level went up and stayed up, meaning they felt satisfied and stayed satisfied.
"She took that finding and developed it into the diet that became The Bread for Life Diet," said Yost. "Subsequent research also found that it has big health benefits as well, including the ability to lower cholesterol, triglycerides and blood sugar. It also eliminates mood swings, so you don't get the cravings and hunger that makes people abandon their diets. She even found it helps relieve headaches."

Daily Weighing and Quick Action Keeps Pounds Off

Successful Diet and Maintaining Weight Loss
Stepping on the scale every day, then cutting calories and boosting exercise if the numbers run too high, can significantly help dieters maintain weight loss, according to results of the first program designed specifically for weight loss maintenance. Study results are published in the New England Journal of Medicine.
Unlike other obesity studies, which focus on how to lose weight, the "STOP Regain" trial tested a method that taught participants how to keep those pounds from coming back - regardless of the method they used to lose the weight in the first place.
Led by Rena Wing, professor of psychiatry and human behavior at Brown Medical School and director of the Weight Control and Diabetes Research Center at The Miriam Hospital, the study taught successful dieters a technique called "self-regulation." With the goal of maintaining their weight within five pounds, participants were taught to weigh themselves daily and use the information from the scale to determine if they needed to adjust their diet or exercise routine.
The intervention worked: Significantly fewer participants regained five or more pounds during the 18-month-long program. The program was most successful when delivered in face-to-face meetings, although the Internet also proved a viable way to help participants maintain their weight loss.
"If you want to keep lost pounds off, daily weighing is critical," Wing said. "But stepping on the scale isn't enough. You have to use that information to change your behavior, whether that means eating healthier or walking more. Paying attention to weight - and taking quick action if it creeps up seems to be the secret to success."
"We know that losing weight and keeping weight off is very tough for many people," said Robert J. Kuczmarski, director of the Obesity Prevention and Treatment Program at the National Institutes of Health. "However, the results of STOP Regain show that there are definite actions that people can take before their weight begins to creep upward. Weight control and better health are not one-shot deals and this study will help people see that."
In the study, Wing and her team enrolled 314 participants who'd lost at least 10 percent of their body weight - averaging nearly 20 percent of their body weight or 42 pounds - within the last two years. A third of participants were assigned to a control group and received quarterly newsletters about eating and exercise in the mail for the duration of the study period.
The other two-thirds were assigned to groups that would test the weight maintenance program. One third received the intervention over the Internet, the final third in face-to-face group meetings. Whether delivered over the computer, or in person, the education and support program was virtually identical.
Participants were taught strategies specific to prevent weight regain, many gleaned from Wing's National Weight Control Registry, a database of more than 5,000 people who have successfully lost weight and kept it off for at least one year. Strategies taught in the trial included eating breakfast, getting an hour of physical activity each day and regular weighing - participants were given a scale and urged to use it daily. They also reported their weight weekly, either over the Internet or by phone, depending on the study group.
Participants were also introduced to a weight-monitoring system based on color zones. If they were within three pounds of their starting weight after the weekly check-in, they were in the "green zone" - and received encouraging phone messages and green rewards, from mint gum to a dollar bill. If they'd gained between three and four pounds, they landed in the "yellow zone" and were instructed to tweak their eating habits or exercise routine.
If they gained five pounds or more, they were in the "red zone" and encouraged to restart active weight-loss efforts. They were urged to pull out a red toolbox they received at the start of the program that included items such as a meal replacement shake, a pedometer, a diet diary and their own weight success loss story. "Red zone" residents also had the chance to get one-on-one counseling by phone, email or in person.
Both groups attended weekly meetings for the first month of the study period, then monthly meetings either in groups or via a computer chat room. Internet participants received a laptop computer, an Internet connection and technical support.
Results were resounding: In the control group, 72 percent of participants gained five or more pounds during the year and a half study period. But only 55 percent of Internet participants and 46 percent of meeting participants gained back that much weight.
"The Internet intervention worked, but the face-to-face format produced the best outcomes," Wing said. "Both were successful because the message that people got pay attention to your weight, then take action to maintain it was effective. People were told to take personal control of their health and were given the tools to do it. And they kept off the weight."
The authors note that daily weighing was strongly associated with prevention of weight gain, but only in the Internet and face-to-face groups. Intervention participants who weighed themselves daily had an 82 percent reduction in the odds of regaining five or more pounds. However, daily weighing in the control group had little to no effect on the amount of weight regained.
"This suggests that participants in the two intervention groups were able to use the information from the scale to make constructive changes in their eating and exercise behaviors," says Wing. "It's further evidence that getting on the scale each day is only part of the solution."
Wing and her team conclude that the concept of an intervention exclusively designed for weight-loss maintenance is an important approach to the successful treatment of obesity. Future studies should examine ways to refine the Internet format, as well as test interventions designed to last longer than 18 months.

Fad Diets May Not Deliver What They Promise

Fals Diet Promises

Anyone who reads the newspaper, reads magazines, watches television or listens to the radio knows that dieting is big business. Consumers are bombarded with messages about fad diets that seem to come and go. Spending on weight loss products reached $43 billion in recent years. Some may help you lose weight in the short term, but most are a waste of hard-earned money. If they worked, the majority of Americans would not be overweight. For National Nutrition Month 2007, the American Dietetic Association says the most effective long-term way to achieve a healthful lifestyle is to be 100% Fad Free?.
As easy as it is to be lured by promises of a quick fix, the reality is that there isn't one. There is no super food, super pill or super diet that will make us thin. How can we spot fads?
If it sounds too good to be true, it probably is. Beware of offers promising a quick fix.
Watch out for gimmicks asking you to buy additional products such as 'supplements'.
If a diet plans asks you to avoid an entire group of foods, such as carbohydrates, beware. It is extremely difficult and maybe dangerous to exclude an entire food group.
If the plan offers proof that it works based on personal experiences rather than science, forget it. Words like miraculous, breakthrough, revitalize, detoxify, cure, quick or secret formula are red flags.
If fad diets aren't the answer, what is a desperate, discouraged dieter to do? Very simply, eat a little less and move a little more. A very small 100-calorie per day margin can swing your weight by 10 pounds per year! This means that if you take in 100 calories more than you need every day for a year, you will gain about 10 pounds in that year.
Conversely, if you take in 100 calories less than you need every day for a year, you will lose about 10 pounds in a year. This 100-calorie margin change can be accomplished painlessly and without your even noticing. What does 100 calories look like?
4 Hershey kisses
5 tablespoons of coffee creamer
14 potato chips
8 ounces of soda
1 tablespoon of mayonnaise
2 tablespoons of cream cheese
8 ounces of lemonade
10 French fries
Cutting out any of these items is certainly possible and won't make you feel deprived. In fact, cutting 200 or even 300 calories per day will likely go unnoticed. As you can see drastic measures aren?t necessary to manage weight.
The Marion County Health Department promotes healthy nutrition through a variety of educational programs. Health department Registered Dieticians (RD) specialize in personalizing weight management. Registered Dietitians excel in understanding the causes of weight gain and are prepared to help individuals incorporate a healthy diet and physical activity into a daily routine. The health department also provides counseling support to families with children who have been identified as being at risk for being overweight or underweight. Local elementary schools incorporate healthy nutrition information in their curriculums to encourage children to try new fruits and vegetables with support from the health department.
The Nutrition Services program also administers the Women, Infants and Children (WIC) program to eligible participants in Marion County. Through WIC, individuals are identified as 'nutritionally at risk' and are provided with nutrition education and healthy supplemental foods. WIC participation continues to grow in Marion County; therefore more families are reached with healthy nutrition and physical activity information.