HSS 1101 NOTES:

(Page 172-213)

CHAPTER 6: MANAGING YOUR WEIGHT: FINDING A HEALTHY BALANCE PART 1

VIDEO

SLIDE 4: HEALTHY RISKS OF OVERWEIGHT AND OBESITY

1.) Mental Health: Increased rates of depression and anxiety
2.) Cardiovascular System:
- High blood pressure
- High triglyceride levels and decreased HDL levels, both factors in the development of
cardiovascular disease.
3.) Endocrine System: A weight gain of 5—8 kg doubles a person’s risk of type 2 diabetes.
4.) Reproductive System:
- High rates of sexual dysfunction.
- Increased risks for prostate, endometrial, and uterine cancer.
- Increased risk of breast cancer in women.
- In pregnant women, increased risks of fetal and maternal death, labor and delivery
complications, and birth defects.
5.) Immune System:
- Tendency towards more infectious diseases.
- Reduced wound healing.
6.) Heart: Increased risk of sleep apnea and asthma.
7.) Digestive system:
- Increased risks for colon, gallbladder, and kidney cancers.
- Increased risk of gallbladder disease.
8.) Bone and Joints:
- For every 1 kg increase in weight, the risk of arthritis increases 9—13%.
- Increased risk of osteoarthritis, especially in weight-bearing joints, such as knees and hips.
 • This table shows the health conditions that is associated with overweight and obesity.
• Canadians are concerned about their body weight and shape, and should be since 54% of the
population over the age of 18 years is classified as overweight or obese according to the Body
Mass Index (BMI) calculations derived from self-reported height and weight (Statistics Canada
2014)
• Combined 61.8% of men and 46.2% of women are overweight and obese and at health risk.
• Even more alarming, these populations statistics regarding overweight are likely underestimated
given that BMI was calculated from self-reported height and weight.
• Men typically overestimate their height while women usually underestimate their weight. This
affects the calculations.
• Lowest rates of overweight and obesity are found in British Columbia (48%) while highest rates
of overweight and obesity are found in Newfoundland and Labrador.
• Equally alarming is the highest percentage of Canadian youth considered overweight or obese. In
2014, 23.1% of boys and girls age 12—17 years were classified as overweight and obese based
upon parent-reported data. This represented an increase from 20.4% in 2011.

SLIDE 5: OVERWEIGHT AND OBESITY (1 OF 5)

• Overweight: Weight Greater Than Expected for Specific Height

• Obesity: Excessive Accumulation of Body Fat
- Increases risk for health problems.
- Weight by itself or a combination with height cannot be a valid indicator related to
obesity and fatness.
• Health Risks Associated with Obesity
 - Atherosclerosis, coronary artery disease, and hypertension, colon cancer.
- Cancer, type 2 diabetes, gallbladder disease, and osteoarthritis, postmenopausal
breast cancer
- Equally important are the mental health risks of excessive fatness, including poor body
image and reduced self-esteem for both men and women from ages 20—80 years.
- A person can be overweight and not obese. Ex.) Male weightlifter or athlete can be
overweight according to height-weight level chart and BMI classification due to high level of
lean body or muscle mass even though he has a lower level of body fat.
- A person can be obese without being overweight Ex.) 160 cm woman who weighs 54 kg has
a BMI of 21, which is considered ‘weight appropriate’, but she can be ‘soft and squishy’.
Despite her BMI classification, more than 30% of her weight coming from body fat does little
physical activity most of her time and thus, has a low level of lean body or muscle mass.
- Physical health risks associated with obesity or an excessive accumulation of body fat,
include, but should not be limited to, an increased chance of developing atherosclerosis,
coronary artery disease, hypertension, colon cancer, postmenopausal breast cancer, type 2
diabetes, gall bladder disease, and osteoarthritis.

SLIDE 6: OVERWEIGHT AND OBESITY (2 OF 5)

Table 6.1 Body Fat Percentage Norms for Men and Women (1 OF 2)

Men
Age Very Lean Excellent Good Fair Poor Very Poor
20-29 <7% 7%-10% 11%-15% 16%-19% 20%-23% >23%
30-39 <11% 11%-14% 15%-18% 19%-21% 22%-25% >25%
40-49 <14% 14%-17% 18%-20% 21%-23% 24%-27% >27%
50-59 <15% 15%-19% 20%-22% 23%-24% 25%-28% >28%
60-69 <16% 16%-20% 21%-22% 23%-25% 26%-28% >28%
70-79 <16% 16-20% 21%-23% 24%-25% 26%-28% >28%

SLIDE 7: OVERWEIGHT AND OBESITY (3 OF 5)

Table 6.1: Body Fat Percentage Norms for Men and Women (2 OF 2)

Women
Age Very Lean Excellent Good Fair Poor Very Poor
20-29 <14% 14%-16% 17%-19% 20%-23% 24%-27% >27%
30-39 <15% 15%-17% 18%-21% 22%-25% 26%-29% >29%
40-49 <17% 17%-20% 21%-24% 25%-28% 29%-32% >32%
50-59 <18% 18%-22% 23%-27% 28%-30% 31%-34% >34%
60-69 <18% 18%-23% 24%-28% 29%-31% 32%-35% >35%
70-79 <18% 18%-24% 25%-29% 30%-32% 33%-36% >36%
SLIDE 8: OVERWEIGHT AND OBESITY (4 OF 5)

• Determining the Right Weight for You

- Body Mass Index (BMI): weight to height
o Weight should be taken without shoes or clothing, and height should be measured
without shoes.
- Adults’ BMI classification:
o <18.5 = underweight
o 18.5—24.9 = healthy weight
o >25 = overweight
o >30 = obese (three classes of obesity)
➢ 30.0—34.9 = Obese Class I with high health risk
➢ 35.0—39.9 = Obese Class II and is associated with a very high health risk.
➢ >40.0 is classified as Obese Class III with extremely high health risk.
- BMI values between 25.0 and 29.9 refer to overweight and are associated with increased
health risk.
- Women: higher fat than men (genetics)
- There are acceptable fat levels by gender in the tables.
- Body composition is most often broken down into two main components: Fat-free mass and
Fat mass.
- Fat-free mass is made up of all body’s components other than fat – that is, the structural and
functional elements in cells, body water, muscle, bones; and other body organs such as
heart, liver, and kidneys.
- Pubertal development leads to a substantive increase in fat-free mass in boys and in fat mass
in girls. Women also experience greater weight and fat fluctuation due to hormonal changes,
pregnancy, and menopause.
- Body Fat Percentage Norms for Men and Women (page 177)
- Body fat is composed of two types: essential fat and storage fat.
- Essential fat is necessary for normal physiological functioning, such as nerve conduction. It
makes up approximately 3—7% of total body weight in men and approximately 10—15% in
women.
- Storage fat, which serves to insulate, pad, and protect the body from cold and trauma,
makes up the remainder of our fat. It accounts for only a small percentage of total body
weight for very lean people and between 5—25% of body weight for mostly healthy
Canadian adults.
- Excessive low body fat in females may lead to amenorrhea or oligomenorrhea, a cessation or
disruption of menstrual cycle, respectively.
- Critical level of body fat necessary to maintain normal menstrual flow is believed to be
between 8—13% with exceptions to this rule given the many factors that affect menstrual
cycle.
- Under extreme circumstances, such as starvation diets and certain diseases, the body
exhausts available fat reserves, and begins breaking down muscle tissue in a last-ditch effort
to obtain sufficient nourishment.
SLIDE 9: OVERWEIGHT AND OBESITY (5 OF 5)

• Assessing Your Body Fat Content

- Cost and access are two factors to consider regarding techniques available, particularly since
some are relatively expensive and difficult to access. Another factor to consider is your
reason for wanting to know your body fat content and whether or not it is essential for you
to have precise measures.
- Consider what you will do with the value, once known, and if that value is actually needed
for you to make healthier choices that influence your body composition.
- Dual-Energy X-Ray Absorptiometry (DEXA)
o DEXA: A method of body composition assessment in which estimates are made of
bone mineral content and learn fat mass.
o Measures bone mineral content and lean and fat tissue.
o This technique requires a low radiation exposure from a low-energy and high-energy
photon beam. A strength of the DXA method is that total body fat can be
determined as well as regional body fat distribution.
o Given the technology and usefulness of the DXA, some consider it the most accurate
or “gold standard” assessment of body composition.
- Hydrostatic weighing
o Hydrostatic weighing: A method of determining body fat by estimating total body
volume from the amount of water displaced when a person is completely
submerged.
o It was previously considered the gold standard for measuring body composition.
o This method measures the amount of water a person displaces when completely
submerged.
o Because fat tissue has a lower density than muscle or bone tissue, body fat can be
computed using a person’s underwater and out-of-water weights once the density of
the body is determined.
- Air Displacement Plethysmography (ADP)
o ADP: A method determine body fat from estimate of total body volume from the
amount of air displaced.
o It is based on the same premises as hydrostatic weighing.
o Total body volume is measured – this time from air displacement – from which an
estimate of body fat can be made (either in water or air) using the formula density =
mass/volume.
o Majority assumption and limitation of these two methods is that the density of fat
and fat-free mass is considered constant.
- Skinfold Measurements
o It is a method of assessing body fat where folks of skin and the underlying fat tissue
are measured with skinfold calipers.
o A commonly used method to estimate body fat.
o In this procedure, a person grasps folds of skin and the underlying tissue with the
thumb and index finger and then a specially calibrated instrument called a “skinfold”
caliper is applied to take the measurement.
 o Eight sites most commonly measured on the right side of the body:
➢ Triceps > Front Thigh
➢ Biceps > Medical calf
➢ Subscapular
➢ Iliac crest (on the side of the body – near the “love handles”)
➢ Supraspinal
➢ Abdominal
o In the hands of trained technicians, the procedure can be fairly accurate. But, the
fatter the person is, the more likelihood of measurement error.
o Skinfold calipers don’t expand far enough to obtain measurement from moderately
obese (20—40% fat) or morbidly obese (>40% fat)
o Alternative to predicting percentage of body fat from skinfold measurements is to
simply total them. In this way a “sum of skinfolds” allows for comparison of “before”
and “after” measurements.
o Since approximately 50% of body fat lies below the skin (that is, as subcutaneous fat),
a loss in total sum of skinfolds indicates a loss of total body fat. Similarly, a gain in sum
of skinfolds indicates a gain in total body fat.

- Waist Circumference
o Abdominal body fat can be estimated from waist circumference.
o Simple measuring tape is used to take the girth, or circumference, measurement at
the superior border or top of the iliac crest or hip bones.
o Regardless of where measured, a large circumference is associated with greater
health risk.
o A waist circumference >102 cm in men and 88 cm in women indicates increased risk
of heart disease, type 2 diabetes, metabolic syndrome, hypertension, and
hyperlipidemia.
- Bioelectrical Impedance Analysis (BIA)
o BIA: A technique of body fat assessment in which the resistance to a weak electrical
current is measured.
o Another method of determining body fat percentage.
o Involves, sending a weak electric current through the body.
o The premise of this technique is based on the greater electrolyte and water content
of fat free mass vs fat mass.
o In recent years, this technique has increased in use, likely because of its
convenience, low cost, noninvasiveness, and quick estimate of body fat.
o It is important for the body to stay hydrated for more accurate measurements,
because even small fluctuations of body water content could alter assessment.

SLIDE 10: MANAGING YOUR WEIGHT (1 OF 8)

• Keeping Weight Loss in Perspective

- Long-term loss: difficult, requires support.  IN THE SLIDE
 - Lifelong approach: healthy eating, physical activity  IN THE SLIDE
- More specifically, to keep your weight and potential for weight loss in perspective, you need
a better understanding of how, where, why, what, and when you eat, and how, where, why,
what and when you are – or are not—physically active.
- Other factors are involved too – factors such as stress, food availability and accessibility,
depression, and sleep.
- To reach and maintain the weight that is right for you – the weight at which you will be
mostly healthy – you need to develop a lifelong approach to healthy eating, physical activity,
and sedentary behaviors.
- When sedentary, your metabolism slows, particularly when you watch TV. Thus, it is prudent
when sedentary, such as when studying or writing papers, to make the effort to get up and
move at least once each hour, even if it is just to stand up and stretch—though a 5–10-
minute walk break would be better.
- In regard to weight management, you should also manage the amount of sleep you get.
- Recent research indicates that people who are sleep deprived eat more than those who
sleep for longer periods of times.
- When sleep deprived, the regulation of these hormones is out of balance with a greater
release of ghrelin, the hormone that stimulates appetite, and reduced release of leptin, the
hormone that signals we are full or have eaten enough.
• What is a Calorie?
- A Calorie is a unit of measurement that indicates the amount of energy obtained from a
particular food.
- For example, half of a kg of body fat contains approximately 3500 calories. Each time you
consume 3500 calories more than your body needs, you gain 0.5 kg.
- Conversely, each time your body expends 3500 calories more than it takes in, you lose 0.5
kg.
- Measurement: energy from a food  IN THE SLIDE
- One kilogram of fat = approximately 7000 calories.  IN THE SLIDE

SLIDE 11: MANAGING YOUR WEIGHT (2 OF 8)

• Physical Activity
- Basal Metabolic Rate (BMR); Resting Metabolic Rate (RMR)
o BMR: The energy expenditure of the body under resting conditions at normal room
temperature.
o RMR: The energy expenditure of the body while at rest, which includes basal
metabolic rate (the metabolic rate of the body at complete rest) plus the energy
required by sedentary activities, such as food digestion, sitting, studying, or
standing.
o RMR > BMR (amount of energy your body requires at complete rest)
- Exercise Metabolic Rate (EMR)
o The energy expenditure of physical activity.
o 20—35% of our caloric needs.
 o Caloric expenditure comes in the form of light to moderate intensity physical
activities, such as walking to class, climbing stairs, doing the dishes, running the
vacuum, and doing laundry.
- Thermic Effect of Food (TEF)
o The energy required to digest, absorb, transport, metabolize, and store nutrients.
o Account for your remaining caloric needs.
o TEF refers to the energy expended eating and drinking.
o Digestion, absorption, transportation, metabolization, and storage of nutrients
require about 5—10% of the energy content of the food or drink consumed.
- Increasing BMR, RMR, or EMR levels lead to a greater caloric requirement for weight
maintenance.
- Increase in intensity, frequency, and time or duration of your daily physical activities will
have a significant impact on your total caloric expenditure and ability to manage your
weight.
• Recommendations
- 60 minutes of moderate-intensity activity daily (IN SLIDE)
- Cardiorespiratory, strength exercises; use large muscle groups. (IN SLIDE)
- To achieve weight loss, a higher level of physical activity is needed. For weight management,
emphasis should be placed on cardiorespiratory and strength-related physical activities.
- Cardiorespiratory activities such as brisk walking, swimming, cycling, jogging, and so on
elevate EMR and RMR during the activity and for several hours afterwards with a positive
impact on caloric requirements.
- Impact on EMR is considerably less than cardiorespiratory training; however, the impact on
RMR due to increased muscle mass is considerable.
- Energy spent on physical activity includes energy used to move the body’s muscles-- muscle
of the arms, back abdomen, legs and so on—and the extra energy required to increase
heartbeat.
- Number of calories expended depends on three factors:
1. Amount of muscle mass being moved.
2. Amount of weight being moved.
3. Amount of time the activity takes.

SLIDE 12: MANAGING YOUR WEIGHT (3 OF 8)

• Is Dieting Healthy?
- Ultimate goal of a weight-loss program should be improved quality of life and lifetime weight
maintenance. Weight goals should be set to reduce health risks and address medical
problems and help you improve the ability to perform daily tasks without undue stress and
strain – rather than to achieve an “ideal” weight or shape.
- Concerns of dieting:
o More harmful than helpful to health
➢ Dieting to lose weight may be more harmful than helpful in promoting
physiological and psychological health.
 o Is rarely successful in the long term.
➢ Because dieting only rarely results in long-term weight loss, the physiological
and psychological stress, damage to self-esteem, and other emotional
disturbances are without purpose.
o Adverse health conditions (metabolism, cardiovascular)
➢ Dieting causes repeated cycles of weight loss and regain, changes in metabolic
rates, increased risk for cardiovascular problems, and other conditions adverse
to health.
o Contributes to the development of eating disorders.
➢ Dieting contributes to the development of eating disorders such as anorexia and
bulimia nervosa, and compulsive eating or binge eating disorder.

SLIDE 13: MANAGING YOUR WEIGHT (4 OF 8)

• Improving Your Eating Habits (1 OF 2)

- Individual determinants include our physiological state, food preferences, nutritional
knowledge, perceptions of healthy eating, and psychological factors.
- Environmental factors include the interpersonal environment, which determines food
accessibility and availability; the economic and social environment; and cultural milieu
surrounding food choices.
➔ Some of the suggestions to help maintain eating habits are below:
1. Turn off distractions while eating (Ex. TV, computer, radio, cellphone)
2. Include physical activity during breaks.
o Though not related to dietary intake, physical activity may take the place of “eating
for something to do”.
3. Chew food slowly
o Speak with those around you.
4. Only eat when hungry; eat frequently.
o The only meal that does not necessarily follow this rule is breakfast.
o It is important to break your fast each day to stimulate your metabolism or RMR.
o Eat frequently throughout the day – 3 smaller meals per day plus snacks – rather
than loading up at 1 meal and skipping others.

SLIDE 14: MANAGING YOUR WEIGHT (5 OF 8)

• Improving Your Eating Habits (2 OF 2)

5. Use smaller plates.
o Use smaller plates or serve smaller portions. Serve your plate at the counter/stove
rather than having pots/bowls on the table where you are eating. You then have to
consciously choose to have seconds and make more of an effort to get them.
6. Make favorite foods inconvenient to eat.
7. If you find that you are continually seeking your favorite foods, buy them in smaller
quantities, serve them in smaller portions, and store them in an inconvenient spot. It’s
 okay to have these ‘extras’ provided you have them in smaller quantities and preferably
not on a daily basis. (TEXTBOOK)
8. Eat breakfast every day.
9. Drink water instead of soft drinks.
o Replace soft drinks and other high-fat, high calorie fluids with water.

SLIDE 15: MANAGING YOUR WEIGHT (6 OF 8)

• Choosing to Eat Well

- Seek help from a reputable source.
o Registered Dietitians, holistic physicians, health educators, exercise physiologists
with nutritional backgrounds and other health professionals can provide reliable
information regarding dietary intake should you choose to seek an expert’s opinion.
- Avoid quick weight-loss programs. (that provide miracle results)
o Majority of these programs are expensive, and most people regain their lost weight
soon after completing them.
- Plans with choices (do not sacrifice enjoyment)
o Dietary plans that do not ask you to sacrifice what you enjoy and that allow you to
make choices are usually the most successful.
o A reliable, practical, and useful tool to help you choose to eat well is “Eating Well
with Canada’s Food Guide”.
• “Miracle” Diets
- Very Low-Calorie Diets (VLCDs): health risks
o Diets with caloric value of 400—700 calories per day.
o Typically, when you deprive your body of food for prolonged periods, it makes
adjustments to save you from inevitable organ shutdown.
o Only when available proteins are depleted, your body begins to use fat reserves.
o Powdered formulas are usually given to patients under medical supervision.
o Problems associated with fasting, VLCDs, and other forms of severe calorie
deprivation include blood sugar imbalances, cold intolerance, constipation,
decreased BMR, dehydration, diarrhea, emotional problems, fatigue headaches,
heart irregularity, ketosis, kidney infections and failure, loss of lean body tissue,
weakness, and potential weight gain due to yo-yo effect, and other problems.
- Ketosis: fat used as main fuel source.
o A condition in which the body adapts to prolonged fasting or carbohydrate
deprivation by converting body fat to ketones, which can be used as fuel for some
brain activity.

SLIDE 16: MANAGIN YOUR WEIGHT (7 OF 8)

• Low-Carbohydrate Diets
- Remember: different nutrient values amongst carbohydrates.
o Over the years, various forms of low-carbohydrate diets have attracted millions of
people with promises of quick, substantial weight loss.
o A major problem with low-carbohydrate diets is that they suggest that all
carbohydrates are bad for you. In other words, these low-carbohydrate diets do not
account for the vast difference in nutrient value among carbohydrate and their
glycemic index. Glycemic index provides a ranking of foods according to how quickly
their sugars are released into the bloodstream.
- Glycemic load guidelines:
➢ The amount of insulin a food triggers is referred to as glycemic load, which
considers both a food’s glycemic index and how much carbohydrate the food
delivers at one time in a single serving.
o Choose plants: beans, instead of meats.
➢ Pick the fruit rather than its sugar-laden juice counterpart. Eating the skin of
apples adds fibre and slows the entry of glucose into the bloodstream. If you eat
potatoes, eat them with the skin on and cut back on other starches. Instead of
potatoes and corn, try sweet potatoes and yams.
o Eat nuts:
➢ Almonds, hazelnuts, peanuts, pecans, and others are healthy low-carbohydrate
alternatives to snacking on chips and desserts made from white flour. They are
not calorie free, though, so manage your intake based on your calorie needs.
o Mix carbs with other foods.
➢ Eating carbohydrates with other foods such as monounsaturated oils (olive or
canola) can slow the rate of carbohydrate absorption. Milk or yogurt with cereal
is one example; bananas and cottage cheese in cereal is another.
o Choose whole grains.
➢ Make whole-grain breads a staple:
▪ Avoid white bread and look for brown breads with 100% whole wheat or
other grains. Consider options such as brown rice and whole-wheat
pizza dough and pasta. These are good choices for lowering your blood
sugar.
o Regular physical activity.
➢ Most people would be shocked if they ate a normal meal, measured their blood
sugar, then noted how dramatically their blood sugars go down after a 30-
minute walk. It may seem simple, but one of the best ways to keep yourself
healthy and still consume the carbs you want is through physical activity.
o Forgo meat in favor of beans. (TEXTBOOK)
➢ It is not necessary to cut all meat-based protein from your diet. However, when
you eat meat, opt for the leaner cuts and choose poultry over pork or beef.
Learn to cook and flavor beans; they are high in protein and other nutrients and
have very little effect on blood sugar insulin.
SLIDE 17: MANAGING YOUR WEIGHT (8 OF 8)

• Try to Gain Weight

- Identify reasons weight gain is difficult.
- Monitor your physical activity.
- Eat and drink more often:
o It is possible that you are not eating enough calories to support your body’s needs.
In addition to EMR, you may genetically have a higher RMR. Eat more frequently,
spend more time eating, and eat high-calorie, nutrient-dense foods first if you tend
to fill up fast. Take time to shop and to cook and eat slowly. Make your sandwiches
with extra-thick slices of bread and add more filling such as peanut butter, cream
cheese, or cheese. Eat second helpings whenever possible and eat high-calorie,
nutrient-dense snacks during the day.
o Nutrient-dense and high calorie foods.
- Drink more of your calories; instead of water, choose milk (chocolate and/or2%
white milk) or juice.
- Try to relax.
o Try to relax. Many people who struggle to gain weight tend to be fidgety and are
continuously on the go. Slow down and try to quiet your behavior.

SLIDE 18: RISK FACTORS FOR OBESITY (1 OF 7)

• Heredity and Genetic Factors

- More than 250 gene markers have been identified as related to obesity in more than 400
studies.
- Body type and genes
o Heredity plays a more subtle role than most think. It is argued that obesity has a
strong genetic determinant with 40% of children with one obese parent and 80% of
children with two obese parents likely to also be obese.
o However, it is difficult to distinguish between the genetic and environmental
contributors to obesity in these children.
o Endomorphy, mesomorphy, and ectomorphy
o Children of obese parents: increased risk of obesity.
- Obesity genes?
o For some individuals, a variation in this gene increases the production of a chemical
that boosts appetite and signals a person to eat.
o Genetic predisposition: satiety, feeding behaviors.
➢ Our genes predispose us toward certain satiety and feeding behaviours.
o Obesity gene: “thrifty gene”.
➢ Another gene getting a lot of attention is Ob gene (for obesity) that is believed to
disrupt the body’s “I’ve had enough to eat” signaling system and may prompt
individuals to keep eating past the point of being comfortably full.
 ➢ Research on Pima Indians, a group with an estimated 75% obesity rate and 90%
rate of overweight, points to Ob gene as “thrifty gene”.

SLIDE 19: RISK FACTORS FOR OBESTIY (2 OF 7)

• Endocrine Influences: The Hungry Hormones

- <2% of obesity caused by endocrine problems.
- Adaptive thermogenesis: calories = no weight gain.
➢ Adaptive Thermogenesis: Theoretical mechanism by which the brain regulates
metabolic activity according to caloric intake.
o States that some people can consume extra calories without gaining weight because
the appetite centre of their brains speeds up metabolic activity to compensate for
the increased consumption.
- Hormones ghrelin, leptin, and GLP-1.
o Recognizing the roles of the hormones (acylated ghrelin, leptin, and insulin) involved
in energy regulation can help you to better understand your hunger, satiety, and
eating behaviors.
o Ghrelin is believed to be involved in appetite stimulation. They are classified as
episodic given its influence on appetite.
o Leptin is believed to be involved with the satiety signal from the brain, which tell us
to stop eating because we are full. Leptin and insulin are tonics in that they regulate
overall energy balance over days and weeks rather than from meal to meal.
o Leptin and ghrelin are believed to be influenced by lack of sleep.
o GLP-1 is another hormone involved in slowing the passage of food through the
intestines. It may stimulate insulin production, a key factor in preventing and
controlling type 2 diabetes and obesity.
o It is further speculated that leptin and GLP-1 play complementary roles in weight
control, where leptin regulates body weight and fat levels over the long term, calling
on the fast-acting appetite suppressant GLP-1 when needed.
• Hunger, Appetite, and Satiety
- Hunger, physiological response; appetite, learned response.
o Hunger: An inborn physiological response to nutrient needs.
o Appetite: A learned response tied to an emotional or psychological craving for food
often unrelated to nutritional need.
- Satiety: feeling of fullness
o Satiety: The feeling of fullness or satisfaction after eating.

SLIDE 20: RISK FACTORS FOR OBESITY (3 OF 7)

• Developmental Factors
- Hyperplasia, an increase in cell number
o Usually only infancy and puberty
 ➢ Fat cells normally only increase in number during infancy and the rapid growth
period of puberty.
o Increase, with chronic positive energy balance.
➢ It may also increase in number when individuals are under chronic positive
energy balance and their current fat cells are “full”.
- Hypertrophy, an increase in cell size.
o May increase in size at any time.
➢ It can occur any time in childhood, adolescence, and adulthood – if calorie intake
exceeds calorie output.
➢ People who are obese and have a large number of fat cells may have difficulty
attaining long-term fat loss because there may be a trigger released once they
have substantially decreased the size of each fat cell, resulting in an increase in
appetite.

SLIDE 21: RISK FACTORS FOR OBESTIY (4 OF 7)

• Metabolic Rates and Weight

- Influences on BMR
o Age; infancy, puberty, pregnancy.
➢ BMR is the amount of energy your body requires at complete rest.
➢ In physically active individuals, about 60—70% of all the calories consumed
support basal metabolism, which provides the energy (that is, calories) needed
for bodily functions such as heartbeat, breathing, maintaining body
temperature, and so on.
➢ BMR fluctuates considerably. BMR is greatest when we are younger, partly
because cells undergo rapid subdivision in young people, which requires a good
deal of energy.
o Body composition
➢ BMR is influenced by body composition. Muscle tissue is highly active– even at
rest— compared to fat tissue. The more muscle tissue you have, the greater the
BMR.
➢ Thus, men usually have higher BMR than women because they have greater
muscle mass.
o Self-protective situations (Ex. fever, yo-yo dieting)
➢ Age is another factor affecting BMR. After the age of 30, BMR slows down by
about 1—2% per year. Therefore, people commonly find that they either have to
eat less or do more physical activity to maintain their body weight.
➢ “Middle-aged spread”, a reference to the tendency to gain weight or fat after the
age of 30, is partly related to this change.
➢ A slower BMR, coupled with an inclination to be physically less active, puts many
middle-aged people’s weight over healthy limits.
➢ Yo-yo Dieting: Cycles in which people repeatedly gain and lose weight. This
lowers their BMR, and typically leads to weight gain.
 - Setpoint theory: body has a weight at which it is comfortable.
o It is a theory that suggests that fat storage is determined by a thermostatic
mechanism in the body that acts to maintain a specific amount of body fat.
o Ex.) If your setpoint is 70 kg, you will gain and lose weight fairly easily within a given
range (usually within 1—2 kg) around that setpoint.
o Proponents of this theory argue that it is possible to raise your setpoint over time by
continually gaining weight and failing to engage in regular physical activity.
o Conversely, reducing caloric intake and being physically active over a long period of
time may slowly decrease your setpoint.

SLIDE 22: RISK FACTORS FOR OBESITY (5 OF 7)

• Psychosocial Factors
- Relationship: emotional needs and weight problem.
o Uncertain
➢ The relationship of weight problems to deeply rooted emotional insecurities,
needs, and wants remains uncertain.
- Eating: focal point of people’s lives.
o Major part of our socialization.
➢ What is certain is that in Canada, eating tends to be a focal point of our lives – a
major part of our socialization; a social ritual associated with companionship,
celebration, and enjoyment.

SLIDE 23: RISKS FACTORS FOR OBESITY (6 OF 7)

• Eating Cues
- Problems associated with fast food:
o High fat, calories, sodium, and carbohydrates.
o Oversized portions, eaten completely.
o Eating quickly, no recognition of satiety.
• Dietary Myth and Misperception
- People eat more than they think.
- Obese individuals: less active.
o Underestimate their dietary intake and overestimates their calorie output.
o Many studies indicate that individuals who are obese do not eat more than their
counterparts at a healthy weight.
o However, the majority of individuals who are obese are less physically active than
people at a healthy weight. Further, if these individuals are not able to accurately
assess what they eat and how much they do for physical activity, it should not be
surprising that they do not know how to alter their behaviours to better manage
their weight.
SLIDE 24: RISK FACTORS FOR OBESITY (7 OF 7)

• Lifestyle
➢ Lifestyle is the critical factor affecting obesity.
- >85% of Canadians classified as sedentary.
o 85% of Canadians do not meet the recommendation to obtain at least 150 minutes
of moderate or more intense physical activity per week. One of the reasons for low
levels of physical activity participation may relate to poor or inadequate experiences
in physical education classes.
- Cultural aspects: education system, work life.
o Another cultural issue regarding our level of physical activity relates to how we
perceive it.
- Labor-saving devices, reduces activity levels.
o A major cause of low physical activity levels is the abundance of labour-saving
devices in the modern household, as well as inactive modes of transportation.
- Exercise viewed as “work”.
o Many believe that they have to ‘exercise’ and exercise is viewed as work, not as
something to be enjoyed.
- Need to increase active living.

SLIDE 25: SOCIAL BIAS AGAINST THE OVERWEIGHT

• Weight Bias
- Negative attitudes harmful to obese individuals interpersonal interactions and
activities with people who are obese.
- Can lead to social isolation.
o Bias and stigmatization can lead to social isolation and a host of other problems for
individuals who are obese.
- Associated with higher rates of:
o Depression, suicide, and disordered eating
➢ People who experience bias and stigma have higher rates of depression, poorer
psychological adjustment, and higher rates of suicide.
o Poorer psychological adjustment
➢ They may feel that they are “unlovable” and have difficulties in relationships.
They also may have higher rates of disordered eating, issues with self-esteem,
more difficulties in obtaining health care, and a host of other problems.

SLIDE 26: THINKING THIN: BODY IMAGE DISORDERS

• Obsession with thinness is not a recent phenomenon.

 • Women, pressured for generations to be thin.
- During the Victorian era, corsets were used to achieve unrealistically tiny waists.
• Media reinforces thinness as beauty ideal.
- As a female, you are expected to believe that if you are thin, with shapely curves or well-
defined muscles, you will be more desirable.
- Beautiful female models and underweight beauty pageant contestants typically range in size
from 0—2, delivering the subtle message that thin is in, desirable and successful.

CHAPTER 6: MANAGING YOUR WEIGHT: FINDING A HEALTHY BALANCE PART 2

VIDEO

SLIDE 4: EATING DISORDERS (1 OF 7)

• Eating Disorders
- Abnormal eating, efforts to control weight
- Abnormal attitudes: body weight and shape
- Occurs more frequently in females with 95% of all diagnosed cases occurring in women.
Further, it tends to be younger women who are most often diagnosed – the majority of
diagnoses occurring between the ages 13—18 years, although diagnosis can occur in the
early 20s and 30s too.
- Eating disorders are not restricted to middle-class white females with overprotective or over
perfectionist parents.
- They occur with similar frequencies in most industrialized countries, including Canada, the
United States, Europe, Australia, Japan, New Zealand, and South Africa.
- Emigrants from cultures where eating disorders are rare and who come to cultures where
they are more prevalent can develop eating disorders as they assimilate to the sociocultural
pressures surrounding body weight and shape in their adopted culture.
• Anorexia Nervosa
➢ Anorexia Nervosa is an eating disorder characterized by excessive preoccupation
with food, self-starvation, and/or extreme exercising to achieve weight loss.
- Obsessed with food, self-starvation, and extreme exercising.
- Many medical problems:
o Damage to bones, muscles, and body systems.
- When anorexia nervosa develops in childhood or early adolescence, one of the first signs can
be the failure to gain weight associated with normal growth rather than actual weight loss.
- About 1% of females in late adolescence or early adulthood meet the diagnostic criteria of
anorexia nervosa while only about 0.3% of men are affected.
- The medical problems associated with anorexia nervosa are many. Starvation damages the
bones, the muscles, and the organs; as well as the immune, nervous, and digestive systems.
 - People with anorexia nervosa often lose their hair or develop excessive fine facial and body
hair. A woman’s menstrual cycle usually stops as well (that is, amenorrhea occurs)
- Between 10—15% of individuals with anorexia nervosa die as a result of the disorder.

SLIDE 5: EATING DISORDERS (2 OF 7)

• Bulimia Nervosa
- Binge eating then purging.
o Self-induced, vomiting, laxatives, enemas, or diuretics, excessive exercising,
or fasting; prevent calorie absorption.
- 1—3% of adolescent and young females.
o Rate among men is about 10% of that among females.
- One frequent health issue often experienced relates to the acid in vomit, which causes tooth
enamel to dissolve.
- Calluses may appear on outer fingers/knuckles from frequent scraping along the teeth when
inducing vomiting by putting one or more fingers down the throat.
• Binge Eating Disorder (BED)
➢ Binge Eating Disorder (BED) is an eating disorder characterized by recurrent
binge eating without any purging behavior.
- Binge eat but do not purge.
o Occurs in about 1—4% of the population and in about 30% of individuals who are
obese and in a weight management program.
o People with BED binge because they are very hungry as a result of restrictive eating
or dieting or to comfort themselves, avoid uncomfortable situations, or numb their
feelings.
- No abnormal attitudes: dieting; body weight, shape.
o BED is often referred to as “compulsive overeating”.

SLIDE 6: EATING DISORDERS (3 OF 7)

• Eating Disorder Not Otherwise Specified (ED-NOS)

- Unclear diagnosis; eating, body image problems.
o Purge after normal eating.
o Chew food repeatedly then spit out.
o Binge eating and purging (not regularly)
➔ When individuals cannot be clearly diagnosed with one of the eating disorders previously
described yet still have obvious problems with their eating and body image, they are said to have
an Eating Disorder Not Otherwise Specified (ED-NOS).
• Disordered Eating
- Abnormal eating behaviors not diagnosed clinically.  IN SLIDE
 - Disordered eating refers to a wide range of abnormal eating behaviors including various
actions seen in individuals with anorexia nervosa, bulimia nervosa, and BED.
- These behaviors include the following:
o Compulsive eating, habitual dieting.  IN SLIDE
o And irregular chaotic eating patterns where hunger and satiety are ignored.
- Similar to other eating disorders, disordered eating has negative health implications for
overall and emotional, spiritual, social, and physical health.

SLIDE 7: EATING DISORDERS (4 OF 7)

• Anorexia Athletica
➢ Similar to disordered eating, anorexia athletica is not a recognized psychiatric
diagnosis. Many people preoccupied with food and weight exercise compulsively
to control their weight in misguided attempts to gain a sense of power, control,
and self-respect.
- Not a recognized diagnosis; compulsive exercising.
- Control weight = power, control, and self-respect
- Symptoms include:
o Exercise taking time from work, school, and relationships.
o Self-worth based on performance.
o Excessive exercise (fanatic about weight, diet)
o Always pushing on to the next physical challenge.
o Justifying excessive behaviors by defining oneself as an athlete or insisting that
current exercising behaviors are healthy.
o Stealing time from work, school, and relationships to exercise.

SLIDE 8: EATING DISORDERS (5 OF 7)

• Who is at Risk?
- Many factors: no simple explanation
- Potential factors:
o Win social approval.
o Gain control of life
- Often suffer from other problems.
o Clinical depression, alcohol abuse, compulsive stealing, gambling or other
addictions.
o Some studies using identical twins have shown a possible association between
heredity and eating disorders, as have others that point to the proportionally large
number of persons with an eating disorder who have a mother or sister similarly
affected.
SLIDE 9: EATING DISORDERS (6 OF 7)

• Treating Eating Disorders

- Early diagnosis, treatment: best predictors (success)
- Multidimensional approach involving family and friends.
o The most effective treatments combine different approaches, are individualized, and
involve the patient and his or her family and friends.
- Attention: usually from someone showing concern.
- May require hospitalization and psychotherapy.
o Concurrently, individual and group psychotherapy provide an opportunity to
enhance self-confidence, self-esteem, and feelings of power and control.
- New ways: handle stress, control life.
o At this time, the person learns new, more effective ways to handle stress and gain a
measure of control over her or his life, so that it is no longer necessary to turn to or
away from food as the solution.

SLIDE 10: EATING DISORDERS (7 OF 7)

• Helping Someone with an Eating Disorder

o Be patient and knowledgeable.
➢ Be Patient: When you first approach the individual, do not be surprised if your
expression of concern is rejected and treated with anger and denial. Shame and
pain tend to go along with an eating disorder. It is also important not to rush and
to accept that it will take time for the person to recognize that he or she has an
eating disorder and needs to change.
➢ Be Knowledgeable: It is important to understand that an eating disorder results
from a misguided coping strategy to deal with deeper issues around control. In
other words, eating disorders are about more than just not eating or being thin!
Learn more about eating disorders and in particular the eating disorder you
think this individual has.
o Be compassionate and encouraging.
➢ Be compassionate: Eating disorders are complex problems where issues with
food and body weight and shape result. It is important to understand that the
person might prefer to use healthier coping mechanisms, but simply does not
know how.
➢ Be encouraging: Encourage the person to define himself or herself in ways that
do not involve the eating disorder. Do this by talking about other aspects of his
or her life, and of life more generally. Affirm strengths and interests unrelated to
food or physical appearance.
o Be nonjudgmental.
 ➢ It is important to express your needs in the relationship, without blaming or
shaming the other person. Remember that the individual with the eating
disorder will have to decide on when and how to get help, and what kind.
Provide support by validating healthy changes, no matter how small they may
be.
o Take care of yourself.
➢ Seeing someone you care about struggling with an eating disorder might make
you scared, angry, frustrated, and helpless. Still, be careful not to blame this
person for his or her condition. Try to understand that eating disorders result
from the behaviours used to deal with painful emotions or experiences and are
a result of an attempt to gain control. The person with an eating disorder may
know that his or her condition is upsetting other people but may not be ready
for or capable of change.
o Do not take on the role of therapist.
➢ Do only what you feel capable of. Get support for yourself. You need to take care
of yourself while dealing with your friend or family member. Remember, you
need to put on your own oxygen mask before helping others with theirs. Also
remember that this person can only get better at his or her own pace. You can
be supportive and gently share information. You can help this person to see and
consider alternatives to his or her current behaviours. You cannot make the
person get better; you cannot even force him or her to seek treatment.
- Conversation Guide: Focus on feelings and relationships.
o Express concern about the person’s health, yet respect his or her privacy.
o Do not comment on how the person or any others look, how fat or thin they are,
how much they eat, and so on. The person is already aware of his/her body, eating
habits, and likely has a distorted view of his/her body, exercise, and eating
behaviors. Even if you use the compliments, comments about weight or appearance
reinforce the obsession with body image and weight.
o Be positive. Find neutral, comfortable places and times to talk.
o Keep calm, focused, and respectful during different conversations. Set caring and
reasonable limits. Be firm and consistent. Ex.) know how you will respond when the
person wants to skip meals or eat alone, or when the person gets angry if someone
eat his/her “special” food.
o Avoid power struggles about eating. Do not demand change. Do not criticize eating
habits. People with eating disorders are trying to gain control because they do not
feel in control of other aspects of their life. Trying to trick or force them to eat can
make things worse.
o Examine your attitudes about food, weight, body image, and body size. Think about
the way you personally are affected by body-image pressures, and how it is that you
speak about your body, your eating, and the pressures you experience.
o Do not convey any fat prejudice or reinforce the desire to be thin. If the person says
he or she feels fat or wants to lose weight, do not say, “You are not fat.” Instead,
suggest that the person explore his or her reasons for dieting, and what he or she
 thinks weight loss can achieve. Encourage him or her to reflect on the pressure to
look a certain way in society, and how this makes us feel about ourselves.

SLIDE 11: CREATING A PERSONALIZED PLAN FOR ACHIEVING YOUR HEALTHY WEIGHT (1 OF 2)

• The Following Suggestions may Help (1 OF 2)

- Design plan to meet your needs.
o Plan must fit your personality, priorities, and your study, work, and recreation
schedules. It should also allow for sufficient rest and relaxation.
- Chart your progress.
o For many people, the daily “weigh-in” is a critical factor in maintaining their
program. However, for others, the daily monitoring of weight negatively influences
self-esteem. If you choose to weigh yourself daily, keep in mind that body weight
normally fluctuates throughout the week and a once per week “weigh-in” is more
appropriate.
- Chart your eating setbacks.
o Rather than thinking in terms of failure and punishment, think in terms of temporary
setbacks or relapses and how to accommodate them. Carefully record your
emotional states when eating, eating habits, environmental cues, and feelings
regarding what and how much you eat. Better understanding your attitudes and
behaviours toward food will help you to manage them effectively. Successful weight
maintenance accommodates hormonal fluctuations and their potential influence on
dietary habits.
- Be physically active.
o Different people benefit from different types of physical activities. Select physical
activities for fun and not a daily form of punishment for overreacting.
- Chart your physical activity (or lack thereof)
o Similar to monitoring your setbacks in dietary intake, you should keep track of your
challenges in regard to your physical activity behaviors.

SLIDE 12: CREATING A PERSONALIZED PLAN FOR ACHIEVING YOUR HEALTHY WEIGHT (2 OF 2)

• The Following Suggestions may Help (2 OF 2)

- Be aware of hunger and fullness.
- Accept yourself.
- Develop stress-management skills.
- Get enough sleep.
- Try not to get too hungry.

SLIDE 14: WHAT IS BODY IMAGE? (1 OF 3)

 • Body Image
- Body Image: The picture you have of yourself in your mind, how you see yourself when you
look in a mirror or and how you feel about your body.
- Most adults, children, and adolescents too, are dissatisfied with their bodies. One study
found that 93% of the women reported that they had negative thoughts about their
appearance during the past week.
- How you see yourself, your appearance?
- How comfortable you feel about your body?
• Negative Body Image
- Distorted perception: discomfort, shame, and anxiety.
o Distorted perception of your shape, or feelings of discomfort, shame, or anxiety
about your body.
• Positive Body Image
- True perception of appearance: celebrating uniqueness.
o You celebrate your uniqueness including your “flaws,” which you know have nothing
to do with your value as a person.
- You see yourself as who you are and what you look like.

SLIDE 15: WHAT IS BODY IMAGE? (2 OF 3)

• Many Factors Influence Body Image

- The media and popular culture.
o Disconnect between idealized images and typical body.
➢ More than 52% of Canadians are overweight or obese due to this disconnect.
➢ A significantly positive association was found between body weight ideals and
body dissatisfactions in a study with more than 7400 participants from 26
countries.
- Family, community, and cultural groups.  They strongly influence the way we see
ourselves.
o Parents: enhance or disrupt children’s body image.
➢ Interactions with your peers, teachers, co-workers, and others can also influence
body image development.
➢ Associations within your cultural group appear to influence your body image.
➢ Peer harassment (teasing and bullying) is widely acknowledged to contribute to
a negative body image.
- Physiological and psychological factors
o Possible link: brain’s ability to regulate neurotransmitters.
➢ Poor regulation of neurotransmitters is also involved in depression and anxiety
disorders, including obsessive-compulsive disorder.

SLIDE 16: WHAT IS BODY IMAGE (3 OF 3)

 Body Distorted Body Body Body
hate/dissociation body image preoccupied/obsessed Acceptance ownership
I often feel I spend a I spend a significant I base my My body is
separated and significant amount of time body image beautiful to
distant from my amount of viewing my body in equally on me
body as it time the mirror. social norms
belongs to exercising and and my own My feelings
someone else. dieting to I spend a significant self-concept. about my
change my amount of time body are not
I don’t see body. comparing my body to I pay attention influenced by
anything positive others. to my body society’s
or even neutral My body and my concept of an
about my body shape and size I have days when I feel appearance ideal body
shape and size. keep me from fat. because it is shape.
dating or important to
I don’t believe finding I am preoccupied with me, but it only I know that
others when they someone who my body. occupies a the significant
tell me I look OK. will treat me small part of others in my
the way I I accept society’s ideal my day. life will always
I hate the way I wanted to be body shape and size as find me
look in the mirror treated. the best body shape I nourish my attractive.
and often isolate and size. body so it has
myself from I have the strength
others. considered and energy to
changing or achieve my
have changed physical goals.
my body
shape and size
through
surgical
means so I
can accept
myself.

SLIDE 17: HOW CAN YOU DEVELOP A MORE POSITIVE BODY IMAGE? (1 OF 2)

• Challenge Commonly Held Attitudes in Society

• The Four Myths (Page 203)
- How you look is most important thing
- Anyone can be slender and attractive (willpower)
- Extreme dieting: effective weight-loss strategy.
- Appearance is more important than health.
 • The National Eating Disorder Foundation recommends the following 10 steps for
developing positive body image.

SLIDE 18: HOW CAN YOU DEVELOP A MORE POSITIVE BODY IMAGE? (2 OF 2)

• Some People Develop Body Image Disorders

- Body Dysmorphic Disorder (BDD)
➢ Affects a small percent of the population; 1% of people in the U.S is affected by
BDD.
➢ Precise rates are currently not known in Canada; however, a 2002 survey did find
that approximately 1.5% of Canadian women between the ages of 15 and 24 did
suffer from an eating disorder.
o Obsessively concerned with appearance (distorted view)
o Perceived lack of muscles, facial blemishes, Size of body parts etc.
➢ Also linked to OCD (obsessive-compulsive disorder)
➢ Cause can be linked to genetic susceptibility, childhood teasing, physical/sexual
abuse, low-self-esteem, and sociocultural expectations for beauty.
➢ People with BDD may try to fix it by exercising excessively, repeated cosmetic
surgery, extreme tattooing, or other appearance-altering behaviors.
➢ 7—15% of people seeking dermatology or cosmetics treatments have BDD.
- Social Physique Anxiety (SPA)
➢ Social Physique Anxiety (SPA): Refers to the nervousness or anxiety experienced
at the real or perceived evaluation of your body by others.
o Disproportionate time fixating on body.
➢ Exercising; ego-centered, self-directed activities. (IN THE SLIDE)
➢ SPA refers to the anxiety experienced at the real or perceived evaluation of your
body by others.
➢ People with SPA spend disproportionate time fixating on their bodies, working
out, and performing tasks that are ego centered and self-directed in attempts to
present their body favorably.

SLIDE 19: WHAT IS DISORDERED EATING? (1 OF 9)

• Some People Develop Eating Disorders (1 OF 6)

- Disordered eating:
➢ A pattern of atypical and less healthy eating behaviors used to achieve or
maintain a lower body weight.
➢ Behaviors associated with Disordered eating include chronic dieting, use of diet
pills, self-induced vomiting, and others.
o Atypical behaviors to achieve lower weight. (Not diagnosed clinically)
- Eating disorder:
 ➢ A term used to describe a collection of psychiatric diseases that involve severe
disturbances in eating behaviors, unhealthy efforts to control body fat and
weight, and abnormal attitudes toward one’s body weight and shape.
➢ The diagnostic criteria for eating disorders are defined by the American
Psychiatric Association (APA) and include anorexia nervosa, bulimia nervosa,
binge-eating disorder, and a cluster of less distinct conditions collectively
referred to as eating disorders not otherwise specified (ED-NOS).
➢ Eating disorders are psychiatric diseases that are clinically diagnosed.
➢ Have lower self-esteem or excessive concern with body image.
➢ Occurs mostly in women (95% of cases) specifically in teen to young adult
women.
➢ It was further reported by the Public Health Agency of Canada (2011) that
anorexia nervosa and bulimia nervosa are most predominant among adolescent
girls and young women (5—15%). Binge eating disorder affects about 2% of the
population.
➢ Disordered eating and eating disorders are also common among athletes,
affecting up to 62% of college and university athletes in sports such as
gymnastics, wrestling, swimming, figure skating, and others with an emphasis on
body weight and shape or aesthetics in performance.
➢ Many men suffering from eating disorders fail to seek treatment, perhaps
because these disorders have traditionally been thought of as a women’s issue.
o Severe disturbances in body image, eating. (PAGE 205)
➢ Eating disorders are complex and, despite scientific research to try to understand
them, their biological, behavioural, and social underpinnings remain elusive.
➢ When you have an eating disorder, you often feel disempowered in other
aspects of your life and try to gain a sense of control through food—what, how
much, where, with whom, and so on, you eat.
➢ You may also be clinically depressed, suffer from obsessive-compulsive disorder,
or have other psychiatric problems. Further, you are at greater risk for an eating
disorder when you have low self-esteem, negative body image, and a high
tendency for perfectionism.

SLIDE 20: WHAT IS DISORDERED EATING? (2 OF 9)

Eating Disruptive Food Concerned Food is not an

Disorder Eating Patterns preoccupied/obsessed well issue
I regularly stuff I have tried I think about food a I pay attention I am not
myself and diet pills, lot. to what I eat in concerned
then exercise, laxatives, order to about what
vomit, or use vomiting, or I feel I don’t eat well maintain a others think
diet pills or extra time most of the time. healthy body. regarding what
laxatives to get exercising in
 rid of the food order to lose It’s hard for me to I may weigh and how much
or calories. or maintain my enjoy eating with more than I I eat.
weight. others. would like, but
My friends and I enjoy eating When I am
family tell me I I have fasted or I feel ashamed when I and balance upset or
am too thin. avoided eating eat more than others my pleasure depressed, I
for long or more than what I with eating eat whatever I
I am terrified periods of time feel I should be eating. with my am hungry for
of eating fatty in order to lose concern for a without any
foods. or maintain my I am afraid of getting healthy body. guilt or shame.
weight. fat.
When I let I am moderate Food is an
myself eat, I I feel strong I wish I could change and flexible in important part
have a hard when I can how much I want to goals for eating of my life but
time restrict how eat and what I am well. only occupies a
controlling the much I eat. hungry for. small part of
amount of I try to follow my time.
food that I eat. Eating more the guidelines
than I wanted in Eating Well
I am afraid to to make me with Canada’s
eat in front of feel out of Food Guide for
others. control. healthy eating.

SLIDE 21: WHAT IS DISORDERED EATING? (3 OF 9)

• Some People Develop Eating Disorders (2 OF 6)

- Anorexia Nervosa, criteria:
➢ Anorexia Nervosa: Eating disorder characterized by excessive preoccupation with
food, self-starvation, or extreme exercising to achieve weight loss.
➢ 0.5% and 3.7% of females in Canada will suffer from anorexia nervosa in their
lifetime.
o Body weight: not normal for age, height.
o Fear of gaining weight, becoming fat.
o Disturbance in body weight and shape.
➢ Disturbance in body weight and shape is experienced, undue influence of body
weight or shape on self-evaluation, or denial of the seriousness of the current
low body weight.

SLIDE 22: WHAT IS DISORDERED EATING? (4 OF 9)

  What anorexia nervosa can do to your body.
1) Altered levels of neurotransmitters can lead to
depression, anxiety, fatigue, poor sleep, dizziness,
fainting, and impaired functioning.
2) Blood levels of iron and electrolytes fall
dangerously low.
3) Kidney failure can lead to dehydration and
death.
4) Decreased digestive activity can cause
constipation, abdominal pain, and bloating.
5) Bones lose density and fracture more easily.
6) Muscle tissue is lost.
7) Hair thins and becomes dry and brittle.
8) Skin becomes dry, discolored, easily bruised;
fine, downy hair may grow.
9) Decreased immune function makes infections
more likely.
10) Heart disturbances include low blood pressure, irregular heartbeats, and potential sudden death
from cardiac arrest.
11) Reproductive hormone decrease and menstruation and fertility cease in women.
12) Nails turn brittle.

SLIDE 23: WHAT IS DISORDERED EATING? (5 OF 9)

• Some People Develop Eating Disorders (3 OF 6)

- Bulimia Nervosa, criteria:
➢ Bulimia Nervosa: Eating disorder characterized by binge eating followed by
inappropriate measures such as vomiting, laxative use, or excessive exercise to
prevent calorie absorption.
➢ Occurs in private and is accompanied by lack of control.
o Binge eating; behavior to prevent weight gain.
▪ Then engage in some kind of purging, or compensatory behavior, such as
vomiting, taking laxatives, or exercising excessively to lose the calories they
consumed.
▪ Weight is maintained, but the acid in the vomit causes tooth enamel to
dissolve (not noticeable if someone has bulimia unlike anorexia)
➢ At least once a week for 3 months
o Body shape and weight influence self-evaluation.
o Inappropriate compensatory behavior.
- Affects 1—3% of adolescents and young females (between 1.1% and 4.2% of women will
experience bulimia nervosa in their lifetime)
o The revised APA (2010) diagnostic criteria for bulimia nervosa are as follows:
 ➢ Recurrent episodes of binge eating (defined as eating, in a discrete period of
time, an amount of food that is larger than most people would eat during a
similar period of time and under similar circumstances, and experiencing a sense
of lack of control overeating during the episode)
➢ Recurrent inappropriate compensatory behaviour to prevent weight gain, such
as self-induced vomiting; misuse of laxatives, diuretics, or other medications;
fasting; or excessive exercise.
➢ Binge eating and inappropriate compensatory behaviour occurs on average at
least once a week for 3 months.
➢ Body shape and weight unduly influence self evaluation.
➢ The disturbance does not occur exclusively during episodes of anorexia nervosa.
- Calluses may appear on fingers/knuckles due to scraping them on teeth when purging.
- Cause: Combination of genetic and environmental factors, family history of obesity,
underlying anxiety, and an imbalance in neurotransmitters can all be contributing factors.

SLIDE 24: WHAT IS DISORDERED EATING? (6 OF 9)

 What Bulimia Nervosa can do to your body?
1) Throat can become inflamed and glands in
the face, neck, and jaw become swollen and
sore.
2) Tooth enamel erodes, leading to pain and
sensitivity; cavities, gum disease, and tooth loss
can occur.
3) Blood levels of electrolyte fall dangerously
low; anemia and low blood pressure can
develop.
4) Kidney malfunction and dehydration can
result from diuretic abuse and vomiting.
5) Laxative abuse can cause rebound
constipation.
6) Altered brain chemistry can cause depression, anxiety, dizziness, impaired functioning,
and seizures; use of diet pills or stimulant appetite suppressants may cause addiction.
7) Esophagus can become inflamed or rupture; backflow of stomach acid causes heartburn.
8) Electrolyte imbalances can lead to arrhythmia and sudden cardiac arrest and death.
9) Stomach can enlarge and even rupture; ulcers and bleeding may occur.
10) Pain, diarrhea, and bloating result from digestive dysfunction.

SLIDE 25: WHAT IS DISORDERED EATING? (7 OF 9)

 • Some People Develop Eating Disorders (4 OF 6)
- BED, criteria: (1 OF 2)
➢ Binge-eating disorder: A type of eating disorder characterized by binge eating
once a week or more, but not typically followed by a purge.
➢ Binge eating, but no purging.
➢ Individuals with BED are often clinically obese.
➢ No abnormal attitudes about dieting, body weight, shape.
➢ 2% of population in Canada are affected by BED.
o Associated with 3+ of the following:
➢ Eating much more rapidly than normal.
➢ Eating until feeling uncomfortably full.
➢ Eating large amounts, when not hungry.
➢ Eating alone due to embarrassment (quantity)
➢ Feeling disgusted, depressed, and guilty after overeating.
o Marked distress regarding binge eating.
o Binge eating 1 times a week (for 3 months)
o Binge eating is not associated with compensatory behavior (e.g., purging) and does
not occur exclusively during bulimia nervosa or anorexia nervosa.

SLIDE 26: WHAT IS DISORDERED EATING? (8 OF 9)

• Some People Develop Eating Disorders (5 OF 6)

- BED, criteria: (2 OF 2)
o Marked distress regarding binge eating.
o Binge eating, 1+ times a week.
o Binge eating, not associate with compensatory behavior.

SLIDE 27: WHAT IS DISORDERED EATING? (9 OF 9)

• Some People Develop Eating Disorders (6 OF 6)

- Some eating disorders are not easily classified.
o No diagnostic criteria but psychiatric illness.
o Eating Disorders Not Otherwise Specified (ED-NOS)
➢ ED-NOS: Eating disorders that are psychiatric illness but do not fit the diagnostic
criteria for anorexia nervosa, bulimia nervosa, or binge-eating disorder.
➢ This group of disorders can include night eating syndrome and recurrent purging
in the absence of binge eating.
- Treatment for eating disorders.
o Without treatment, about 20% will die.
o With treatment, recovery rates from 44—76% for anorexia, nervosa, and
from 50—70% for bulimia nervosa.
 o Therapy: psychological, social, environmental, and physiological.
➢ Therapy allows the patient to work on adopting new eating attitudes and
behaviors, building self-confidence, and finding other ways to deal with life’s
problems.
➢ Support groups can help the family and individual learn to foster positive actions
and interactions.

SLIDE 28: SOME PEOPLE DEVELOP EXERCISE DISORDERS

• Compulsive Exercise, Called “Anorexia Athletica”

➢ Compulsive exercise: Disorder characterized by a compulsion to engage in
excessive exercise, and feelings of guilt and anxiety if the level of exercise is
perceived as inadequate.
➢ 18% of almost 600 college students met the criteria for compulsive exercise.
➢ People who exercise with compulsion similar to people with eating disorders,
often define their self-worth externally.
- Compulsion: guilt, anxiety if no exercise.
o Compulsive exercise is characterized by a compulsion to exercise rather than a desire to
do so.
- Injuries: joints, connective tissues, bones, and heart.
o It can also put significant stress on the heart, especially if combined with disordered
eating.
- Often: anxiety and/or depression.
• Muscle Dysmorphia
➢ Body Image disorder in which men believe that their body is not lean or
muscular enough.
➢ Referred to as “reverse anorexia”.
- Man believes body insufficiency lean (muscular)
o Men with muscle dysmorphia believe that they look “puny” when in reality they look
normal or may even be considered muscular.
- Comparing to others; checking mirror; camouflaging.
o As a result of their adherence to a meticulous diet, their time-consuming workout
schedule and their shame over their perceived appearance flaws, they may neglect
important social or occupational activities.
o Other behaviours characteristic of muscle dysmorphia includes comparing oneself
unfavourably to others, checking one’s appearance in the mirror, and camouflaging one’s
appearance.
- Individuals are likely to use steroids, supplements.
o Men with muscle dysmorphia are also likely to abuse anabolic steroids and dietary
supplements.