whs pr symposium - management of adult obesity
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Management of Adul
ObesityDr. Margarita Ochoa-Maya, MD, CDE
Advanced Health and Wellbeing, C
!!!.AdvancedHealth"H.com
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OBESITY IS A DISEASE
Obesity afects 1 in three Americans
# out of $ adults in the %nited &tates are over!
The medical cost o OBESITY:
'et!een ()*+ 'O" to (#) 'O" /er year
Obesity is estimated to cause 111,! to deaths$yr
0une #)$1 American Medical Association and AAssociation of Clinical Endocrinologists 2AACE3reco%ni&ed OBESITY as a DISEASE
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T'E DE(I)ITIO) O( OBESIT
Obesity is:
A chronic disease
In*uenced by determinants such as:
4enetic and family history
Culture and both familial and /ersonal enviro
'ehavior and emotions Hormones
Body mass that e+ceeds a re-de.ned /
multifactorial
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OBESITY, A 0EA 20OBE3 (O0T'E )E4 3IE)I53
Obesity is a reality 6e are all acin% today, It DISEASE and it is an E2IDE3I78 5he World Health Organi6ation
5he "ational Heart, ung and 'lood nstitute of the "ational nstitutes of
5he American Medical Association
1 I) " Americans is afected by obesity, and 6
disorders #78 of Adult Americans have e9cess !eight and are obese
The re/alence o obesity has increased more9! in the ast decade
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OBESITY, A 0EA 20OBE3 (O0)E4 3IE)I53
It is estimated that more than " million Americans areby obesity
t is also estimated that this number 6ill climb to )# millionne9t 7 years
This eidemic needs to be addressed as it is a tic;bomb or the uture de/eloment o comlicationschronic illness:
m/act the biological, /sychological and s/iritual 6ellbein%individual
m/act the family unit and the community
m/act economy
m/act the utureof human:ind
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T'E I)< BET4EE) 4EI='T 3A)A=E3E=E)ETI7S, E)>I0O)3E)T A)D 'O03O)
=E)ETI7S
E)>I0O)3E)T
"5E;"A E"
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T'E I)< BET4EE) 4EI='T
3A)A=E3E)T A)D 'O03O)ES
'O03O)A DISO0DE0S I)s &yndrome
&lee/ Cycle Disorders1 &lee/ A/nea
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T'E I)< BET4EE) 4EI='T
3A)A=E3E)T A)D 'O03O)ES
'O03O)A BAA)7E IS )E7ESSA0Y (O0 'EAT'Y3AI)TE)A)7E:
7entral )er/ous System and the Brain
Cognitive choices in food
=astrointestinal System
?rom che!ing and the s/eed of eating to absor/tioelimination
0eroducti/e System
5he in@uence of E&5;O4E", ;O4E&5E;O"E and5E&5O&5E;O"E on !eight management, fertility a
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'ISTO0I7A, 75T50A A)DA0TISTI7 AS2E7TS O( OBESITY
5hroughout history of man:ind, food shortage and malnutrition habeen the recurrent theme
Ad/ances in ublic health, aired 6ith the increased amou?uality, and /ariety o ood, has had an imact on increaselon%e/ity and body si&e@
'eing under-nourished as !ell as obese has social im/lications andconnotations
7orulence and increased *esh ha/e been desirable acrothe centuries as a si%n o 6ealth
After the &econd World War, overabundance of easily accessible focou/led !ith reduced /hysical activity resulted in increased body !
Durin% the ost 6ar era, this ositi/e connotation on bein%or robustC 6as re*ected in the arts, literature, and medica
oinion o the times
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'ISTO0I7A, 75T50A A)DA0TISTI7 AS2E7TS O( OBESITY
Durin% the 1th
7entury, Dr@ Tobias >enner .rst used the termOBESITY in a study ublished in 1#9!
He lin:ed diet and dietary /atterns !ith obesity and disease
Durin% the 1th7entury, Dr@ 4illiam 4add I)
Durin% the year 1FG, Dr@ Burney stated that desite thesensation o hun%er 6as eltC in the stomach, it ori%inated B0AI)@
He se/arated the conce/ts of H%"4E; A"D AE55E
He stated that both doctors noted that dietary changes should be basedindividualBs uniue reuirements concerning age, gender, and activity le
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'ISTO0I7A, 75T50A A)DA0TISTI7 AS2E7TS O( OBESITY
Durin% the G!th7entury the incidence and re?uency o obe
be%an to increase and become 6idesread
4ei%ht issues in 6omen 6ere addressed seci.cally by Dr@ and e/enthal in 1"9
5hey described a syndrome s/ecic to !omen characteri6ed by obesityinfertility and named it olycystic Ovarian &yndrome 2CO&3
5hey claimed CO& !as one of the leading causes of anovulatory infert
5hey also re/orted the benecial eects of !eight loss as a treatment oillness
In the 1F!Hs, 3etroolitan ie Insurance, ublished a cha6here the ideal 6ei%hts or /arious hei%hts estimated an id
nsurance com/anies reali6ed the connection bet!een !eight and lifee9/ectancy and increased /remiums for the obese and the stigma arouobesity began.
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'ISTO0I7A, 75T50A A)DA0TISTI7 AS2E7TS O( OBES In une o 19# ate 2resident Eisenho6er
created the 2residentCs 7ouncil on Youth (itn t !as a /ublic a!areness cam/aign that brought to light the increasing
/roblem !ith obesity
t !as a /ioneer for further studies that !ould address the !orld of obevarious diet and e9ercise /rograms emerged
By 1#, researchers reco%ni&ed that 6ei%ht
needed to be addressed in the settin% o aersonCs hei%ht 5he 'ody Mass nde9 2'M3 !as created
'M is a statistical calculation and inde9 !hich !ould /redictably determ/erson is obese or not based on not only their !eight but in relation to height
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4EI='T 3A)A=E3E)T A)DOBESITY I) T'E G1ST7E)T50
Obesity is the eidemic o the G1st century Obesity oses a maJor ublic health issue@5here are
increased /ersonal, familial, social, and economic costsassociated !ith obesity.
obesity is no longer a problem of adults, the rate a!hich obesity is aecting children is e9/onential, and yand younger children are being aected by obesity
The 4orld 'ealth Or%ani&ation estimates th%lobally:
More than ) billion over!eight adults that have a 'M gthan #+
Of those that are obese, $ million have a 'M greater
$.
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T'E STI=3A O( OBESIT Indi/iduals afected by 6ei%ht roblem
obesity oten ha/e to ace obstacles behealth ris;s associated 6ith obesity its
Emotional suering is one of the most /ainfbeing obese
Today, e+cess 6ei%ht is re%arded as un
and oten associated 6ith ne%ati/e ste eo/le of all ages and cultures face social
stigmati6ation, may be targeted by bullies, oby their /eers
4ei%ht is a%ain ti%htly lin;ed to social and accetance and is considered a readiscrimination@
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T'E STI=3A O( OBESIT &tigmati6ation is /resent in elementary, high school, c
the !or:/lace Over!eight students are vie!ed as self-indulgent>, la
usually e9cluded from social activities
2eer /ictimi&ation is reorted in as many as #"and 9 o boys
At least $8 of over!eight girls and #*8 of over!eigre/ort being teasedby /eers at school
Teachers reort that students aected by obesity aras untidy, more emotional, less li:ely to succeed in scmore li:ely to have family /roblems
O/er6ei%ht children are less li;ely to be accetri/ate schools and colle%e desite e?ui/alent arates and academic achie/ement
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7O)SEK5E)7ES O( 'EATA)D OBESITY BIAS
2SY7'OO=I7A E((E7TS: &hame, An9iety, o! &eesteem, oor body image, oor inter-/ersonal relationDe/ression, ost-traumatic &tress Disorder
SO7IA E((E7TS: &ocial reFection by /eers, isolationcommunity involvement, /oor uality of inter/ersonalrelationshi/s, increased divorce rate and /otential neg
im/act on family life, /otential negative im/act on deand or /oor academic outcomes.
2'YSI7A 'EAT' E((E7TS: %nhealthy !eight con/ractices, binge eating, avoidance of /hysical activityrates of inFury during /hysical eorts, less endurance /hysical activity tolerance.
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(A7TO0S TO BE 7O)SIDE0ED 4ADD0ESSI)= T'E OBESITY E2ID
4enetics
arenting and family life
sychological s:ills of theindividual and the family
Gno!ledge and education
about food, health andhealth /revention
&ocioeconomic status
&
hys
Cultural inchoices
?amilial inavailabi
Who /re/aresthe
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T'E 0OE O( 3O)EY A)DOBESITY o!er-cost foods ma:e u/ a greater /ro/ortio
diet of lo!er-income individuals In 5@S@ Deartment o A%riculture L5SDA
studies, emale reciients o ood assista
More energy-dense diets
Consumed fe!er vegetables and fruit Were more li:ely to be obese
2Darmon ", Dre!no!s:i A1 Does social class /redict diet uality AmI+1))+J)))+, #I3.
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7'ID'OOD OBESITY
The o/erall re/alence ochildhood obesity continued toincrease durin% the .rst hal othis decade:
in #1 )*8
in #*1 )+8
in #)#1 #)8
7hildho
)on-'
#8 in boys #
3e+ic
##8 in boys )
)on-'
)L8 average fo
2Harris GM, 4ordon-arsen , Chantala G, %dry ;1 ongitudinal trendsdis/arities in leading health indicators from adolescence to young ad
ediatr Adolesc Med )L1+*JI), #L3
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2'YSI7A A7TI>ITY A)DOBESITY
eo/le tend to model the /hysical activity of thei E9ercise habits follo! familial clusters
4ith increasin% a%e the trend demonstrateshysical acti/ity decreases
ncreased television, com/uter, and internet vi
times Decreased slee/ time is associated !ith increa
obesity rates
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BODY 7O32OSITIO): In order to measurebody, 6e need to understand its comon
The body is comosed o: Muscle tissue
?at tissue
Connective 5issue
&:eletal bones and teeth
'rain and nerves
Contents of digestive tract, including intestinal gas, air in thurine, lym/h, and blood.
3ost o the human body is made u o 6ater@ 5he cells arof L7-K8 !ater by !eight. 5herefore, it isnBt sur/rising that mhuman bodyBs !eight !ill have a tight re/resentation to their to!eight.
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T'E DI((E0E)T
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T'E B3I 7E)TE0ED DE(I)ITIO)O( 4EI='T A)D OBESITY
n the )Kth century the 'elgian statistician Dr. Adol/he Nuetelet
develo/ed the body mass inde9
'M-based denition is easy to use and it is /articularly conveniestatistical /ur/oses and use in research.
5he most commonly used denitions, established by the World HOrgani6ation 2WHO3 in )KK+ and /ublished in the year # /rovcurrent classication of obesity based on the 'M.
2OTE)TIA 2IT(AS: t considers !eight and height yet it does not consider &HAE
gnores EA" 'ODP MA&& as a measure of M%&CE MA&& and 'ODP ?A/ercentage as !ell as WA5E; WE4H5 and !ater retention
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BODY 3ASS I)DEN7ASSI(I7ATIO)BODY 3ASS I)DEN 7ASSI(I7ATIO)
Q)I.7 %nder!eight
)I.7 J #*.K "ormal !eight
#7. J #K.K 2#+3 Over!eight
$. J $*.K CA&& O'E&5P
$7. J $K.K CA&& O'E&5P
R *. CA&& O'E&5P
&ome modications to the WHO denitions have been made by /articsurgical literature brea:s do!n class obesity into further categoriesvalues are still dis/uted. 2&turm ; 20uly #+3. Sncreases in morbid ob#J#7S. ublic Health )#) 2+31 *K#JL.3
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BODY 7O32OSITIO) A)AYSISEssential Body (at The ercenta%e o essential at is G9 in men, and 1!1" in
There is no sin%le ideal ercenta%e o body at or e/eryone, it individuali6ed and the levels of body fat vary based on se9 and age as and :ind of /hysical activity
5he American Council on E9ercise 2not an oTcial government agency3 average /ercentages dier according to the s/ecied grou/s and categ
5he leanest athletes ty/ically com/ete at levels of about LJ)$8 for mefor !omen, the a/era%e erson has a at le/el o G or men an6omen
DES70I2TIO) 4O3E) 3E)
Atheletes )*-#8 L-)$8
?itness #)-#*8 )*-)+8
Obese $#8 U #78 U
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4AIST TO 'I2 0ATIO (AT DIST0IB5TIO): the !ay in !hich the fat is distributed in
has an in@uence on the ris: of disease
4AIST TO 'I2 0ATIO: Measurements of the !aist and of the observing their relationshi/ is an anthro/ometric measuremendetermine central obesity - fat in the abdominal region and the
5his measure has been !idely used in research and has been sho!com/arable and sometime better than 'M in its /o!er to /redict tmetabolic abnormalities such as ty/e diabetes and cardiovascula
5he !aist to hi/ ratio is commonly used in clinical /ractice and
used to /redict future medical /roblems and com/lications of o 3easurements that ha/e increased ris; o diabetes, car
disease, and $ or other serious illness in men and 6ome
3E) 4O3E)
Waist Circumference R* inches R$7 inches
Waist to Hi/ ;atio R). R.I
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T'E I)< BET4EE) OBESITY A)=E)ES 4ei%ht roblems and obesity are a conse?uence o
interlay bet6een a ersonCs o6n %enetic redisositand the en/ironment in 6hich it li/es@ These actorsafect multile %enes@
5o loo: at genes associated !ith being or becoming obes4enes that regulate a//etite, genes res/onsible for
metabolism and energy balance
As o G!!#, more than F1 sites on the human%enetic code 6ere lin;ed to the de/eloment oobesity
articularly if the environment !as conducive to activa
the genetic /redis/osition. En/ironment has beenassociated 6ith a F!-! in/ol/ement in the
de/eloment o obesity@
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T'E I)< BET4EE) OBESITY A)=E)ES I)'E0ITA)7E 2ATTE0)S:5o identify genetic abnormalities th
/resent in the form of obesity
4E"E5C C%&5E;& A;5C%A; 4E"E A'"O;MA5E&
The Pthrity %ene hyothesisQ: t /ostulates that humanevolution has had /eriods of famine, alternating !ith /eriods ofabundance.
5his may ma:e /eo/le /rone to obesity. During /eriods ofabundance, there is a /redis/osition to store energy and
/romote obesity, and this !ould /rove advantageous in/re/aring for the times to come.
Once a society or culture established a stable food su//ly, !create an e/idemic in obesity.
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=E)ETI7 SY)D0O3ES O(OBESITY 4E ESTABIS'ED =E)ETI7 SY)D0O3ES: Early onset of se
obesity, !hen a child younger than ) years of age has a 'M grethan 5H;EE standard deviations above normal
+8 harbor single locus mutation
SY)D0O3I7 OBESITY1 obesity associated !ith a genetic disord
Do6n Syndrome 2Do!n syndrome is not al!ays associated !obesity, yet it increases the ris: for obesity3
2rader-4illi syndrome
'ardet-'iedl syndrome
Cohen syndrome
Aya6i syndrome
MOMO syndrome
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=E)ETI7 SY)D0O3ES O(OBESITY Other %enes associated 6ith obesity include:
etin De.ciency 2OMM )L*)L ocus +$).$3
etin 0ecetor De.ciency 2OMM L)+ ocus )/$)3
2ro-hormone 7on/ertase-1 De.ciency 2OMM LK77 ocus 7
2ro-oio-melanocortin De.ciency 2OMM LK+$* ocus #/#$.$3
3elanocortin -F 0ecetor L37F0M 2olymorhism 2OMM )777*)I##3
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3ETABOIS3: T'E I)< BET4E'O03O)ES A)D 4EI='T 3etabolism is the act o maintainin% lie throu%h the u
ener%y t is a collection of chemical reactions that allo! organism
re/roduce, and maintain its structure and relate to their e
Anabolism: creation and /roduction of energy sources tand used later
7atabolism: brea:ing do!n and using u/ energy
3etabolic rate:5he heat that is liberated during metabolicreactions
7alorieLsM: A unit of measure that denes the uantity of enfrom dierent foods or e9/anded by dierent functions of the
Ener%y balance: the dierence bet!een the amount of caloand the amount of calories the body uses
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3ETABOIS3: T'E I)< BET4E'O03O)ES A)D 4EI='T
The relationshi bet6een metabolic rates, ener%y ba6ei%ht chan%es is /ery comle+@
Hormones are inherently attached to the !ord metabolism
metabolism is tightly lin:ed to body !eight, body function a/erformance
'ormones, roteins, and other chemicals are crucial
controllin% ener%y e+enditure, ood inta;e, and bod 5he brain centers regulate energy e9/enditure and tissues t
the body by communicating !ith the gastrointestinal systemtissue, and muscles to control energy e9/enditure and ener
6e cannot redict the efect o alterin% only one oactors on body 6ei%ht as a 6hole
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(A7TO0S T'AT I)(5E)7E E)EEN2E)DIT50E
0estin% 3etabolic 0ate: contributes V+8 of daily energy e9/en/hysical activity contributes 7-)83 J 5his means that a signicant energy usage and consum/tion is 9ed3
The ener%y cost of metaboli6ing and storing food
The temerature efect of the body during rest, illness and e9erc
Adati/e thermo%enesis:5he ada/tation of tem/erature and enregulation ha//ens in the bro!n fat>
'ro!n fat uses stored energy to create heat and therefore /romotes !e
White fat stores energy in the form of li/ids 2fat molecules3
5he balance bet!een !hite fat and bro!n fat is being actively investiga
We do :no! that bro!n fat decreases !ith age, and the balance bet!eeres/onse to chronic caloric inta:e as !ell as genetic /redis/osition
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I)(5E)7ES I) (OOD 7'OI7ES
Indi/idual 2reerence: e9/osure, /ast e9/eriences, tradition
Social In*uences: cultural shared beliefs and values, mar:et 7ultural 2reerenceand identity !ithin a grou/
0eli%ious 2reerences and Holidays
Economic In*uences on aordability and allocation of mone
En/ironmental in*uences:
Social: /arental, school and !or: environment
Internal: emotions and feelings, boredom
Biolo%ical en/ironment: llness, /uberty, menstrual cycleaging
2olitical In*uences: ta9ation, industriali6ed farming, subsidilabeling
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)O50IS'3E)T A)D T'EDI((E0E)7ES 4'E) DIS75SSI)
OBESITY "ourishment is the food or other substances needed for grhealth and /revention of disease. 3alnutrition is 6hen a erson does not ha/e a diet t
contains the ri%ht amount o nutrients or is unable tabsorb them rom the %astrointestinal tract@
oor nutrition can also refer to under-nutrition> !hich mea
/erson is not getting enough nutrients, des/ite adeuate inof calories.
5his ha//ens !hen a /erson consumes a lot of em/ty calories!ithout good nutritional value.
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)O50IS'3E)T A)D T'EDI((E0E)7ES 4'E) DIS75SSI)
OBESITYSI=)S O( 5)DE0-)5T0ITIO) I)75DE: Wea: muscles, decreased muscle mass
Chronic fatigue, chronic muscle soreness
o! mood, de/ression, @at aect, and the o//osite suddenirritability and mood changes
ncrease in illnesses and infections due to an altered immustate
Decreased healing of s:in
Changes in hair te9ture, uality and color
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)O50IS'3E)T A)D T'EDI((E0E)7ES 4'E) DIS75SSI)
OBESITY(A7TS: $ /ercent of American diets fall short of such common /lant-derived nutrmagnesium,
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4%5 "5E4;5P A"D O'E&5P
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=5T I)TE=0ITY A)D OBESITY
Disru/tion of gut lining
m/ro/er absor/tion
n@ammation
ermeable gut- "D'
?ood ntolerances
?ood Allergies
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T'E I)< BET4EE) 'O03O)ES4EI='T Body 6ei%ht is re%ulated by hormones and the ner/ous sys
6hich to%ether they orchestrate a balance bet6een ener%y
ener%y e+enditure 5nder normal circumstances:
When a /erson is overfed, a//etite !ould fall and energy e9/enditure
When a /erson is food de/rived, a//etite increases and energy e9/end
f this e9uisite balance is disturbed, !eight imbalance and obesity ensues.
Aetite is in*uenced by sycholo%ical actors, cultural ac
amilial beha/iors 'ormones that ha/e efects on the brain, the %astrointestin
the ancreas, the li/er and the adrenal %lands include:
A22ETITE STI35ATO0S: le/tin, insulin, glucose, :etones, cortisol, gP, cholecysto:inin, neuro/e/tide P, MCH, Ag;, Ore9in, Endocannabino
A22ETITE 7O)T0OE0S: M&H, CA;5, 4-), and &erotonin
T'E I)< BET4EE) T'E B0AI) (OOD
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T'E I)< BET4EE) T'E B0AI), (OOD'EAT': hormones that ma;e the con
Si%ht , smell, te+ture and en/ironment are all sensed by the brain .rst
The brain reares the body or ood, anticiate and desire ood "otice the dierence bet!een H%"4E;, AE55E A"D &A5E5P and MOOD
?ood stimulates the /leasure and re!ard centers of the brain
Ener%y balance re?uires an ability o the brain to detect the status oener%y stores and match ener%y inta;e 6ith e+enditure
T'E =57OSE BAA)7I)= 'Y2OT'ESIS: nsulin and 4lucagon
T'E (AT BAA7I)= 3ODE: e/tin, 4hrelin, Adi/onectin,
T'E )5T0IE)T 3ODE: 4astrointestinal absor/tion, hormones and function oindividual organs1 4astrin, Cholecysto:inin,
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=AST0OI)TESTI)A 'O03O)E
5he gastrointestinal tract secretes hormones that control of feeding athey have a direct access to the brain
7'OE7YSTO
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'O03O)ES (0O3 T'E ADI2OSETISS5E E2TI):
3ade by the Adiocyte to communicate to the brain abo
ener%y stores crosses the blood-brain barrier Eects on the hy/othalamus, brain stem, and feeding and
centers 2
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'O03O)ES (0O3 T'E ADI2OSETISS5E ADI2O)E7TI): adiocyte comlement-related roteinC
5he adi/onectin gene 2AM)3 has been ma//ed to chromosome $#+
3ade by the Adiocyte to communicate to the brain aboener%y stores DOES )OT cross the blood-brain barrier
&5M%A5E& E"E;4P E=E"D5%;E
;ED%CE& ?OOD "5AGE
E"HA"CE& "&%" &E"&5
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SEE2 OBESITY A)D 7'0O)I)ESS Slee deri/ation has a direct and ne%ati/e imact on a er
health, their 6or;, and 6or; erormance
Decreases the ability to concentrate
m/acts inter/ersonal relationshi/s and limit social interactions and acti
5here are more than + slee/ disorders described in the medical literatu
(acts about Slee related Disease:
&lee/ /roblems account for an estimated ()L billion in medical costs eacause lost /roductivity at !or: Jarge indirect costs
At least * million Americans suer from chronic, long-term slee/ disord
) in $ /eo/le in the %nited &tates has used some :ind of a slee/ aid
roblems li:e stro:e and asthma attac:s tend to occur more freuently dnight and early morning, /erha/s due to changes in hormones, heart rathormonal shifts of the circadian rhythm.
"eurons that control slee/ interact closely !ith the immune system, thude/rivation is associated !ith immune /roblems.
2SY7'OO=I7A 7A5SES O( 4
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2SY7'OO=I7A 7A5SES O( 4DISO0DE0S
Obesity is one of the nationBs fastest-gro!ing and most troubling h/roblems today
Emotions are tightly lin:ed to eating, and for that matter, under-eand overeating
What !e do and donBt do often results from ho! !e thin: and feel- strean9iety
%nless a /erson is able to ma:e the reali6ation that their emotions
lin:ed to their a//etite and !hat they eat, and address these emo!ith healthy co/ing s:ills, serious health /roblems may be aconseuence of emotional eating.
EATI)= DISO0DE0S
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EATI)= DISO0DE0S Hormones are closely lin:ed to a//etite, mood, and im/ulse control, !hic
all altered in /eo/le !ith eating disorders
A)O0ENIA )E0>OSA: eo/le !ith anore9ia nervosa have a distorted boimage that causes them to see themselves as over!eight even !hen thedangerously thin.
5hey tend to be /erfectionistic, and often refuse to eat, e9ercise com/ulsivelydevelo/ unusual habits such as refusal to eat in /ublic or in front of others. Annervosa is usually associated !ith signicant !eight loss, and can even cause from starvation.
B5I3IA )E0>OSA: eo/le !ith bulimia nervosa eat e9cessive uantitielater /urge their bodies of the food and calories they Fust consumed and
5hey use /rolonged fasting, la9atives, enemas, or diuretics, thro! u/ 2vomit3 oe9cessively e9ercise. 5hese acts are often done in secrecy and are associated feelings of disgust and shame as they binge, soon to be relieved of the tensionnegative emotions once their stomachs are em/ty again or /urge.
EATI)= DISO0DE0S
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EATI)= DISO0DE0S
BI)=E EATI)= DISO0DE0: eo/le !ith binge eating disorder e9/erience fre/isodes of out-of-control eating.
5he dierence bet!een bulimia and binge eating is that binge eaters do not /urgebodies of the e9cess calories consumed.
eo/le !ith bulimia are often im/ulsive and eat to overcome /sychic /ain and esca/roblems in their day-to-day lives.
A study of obese /eo/le !ith binge eating /roblems found that more than half alsohistory of maFor de/ression.
Additional research sho!s that obese !omen !ith binge-eating disorder !ho e9/eteasing about their a//earance later develo/ed body dissatisfaction and de/ressio
Bin%e eatin% is characteri&ed by:
;ecurrent e/isodes of eating during a discrete /eriod of time 2at least # days a !eea L month /eriod
Eating uantities of food that are larger than most /eo/le !ould eat during a similaamount of time
A sense of lac: of control during the e/isodes of e9cessive eating
Emotions of guilt or distress follo!ing the e/isodes of e9cessive eating
(EE =OOD A)D ST0ESS
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(EE =OOD A)D ST0ESS'O03O)ES Brain chemicals can rimarily in*uence emotions 5hese hormones are the :ey /layers that control a//etite a
hunger- f out of balance, they may get triggered to stimulae9cessive eating
'ormones that hel us eel %ood:
&erotonin, Do/amine, 4amma-amino butyric acid 24A'A
Endor/hins, Acetylcholine, 5yrosine, "itric o9ide
'ormones associated 6ith stress: Adrenaline, E/ine/hrine, "ore/ine/hrine
Cortisol1 corticosterone
nsulin
"euro/e/tide P
(OOD OBSESSIO) A)D (OOD
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(OOD OBSESSIO) A)D (OODADDI7TIO) 7omulsi/e o/ereatin% is real, it haens and it is /ery hard t
f a /erson is overtly /reoccu/ied !ith food and feels that sometimes out of control, :no!ing that there is a light at the end of the tunnel is
As hysician, identiyin% this roblem is /ery diRcult
5here is a lot of shame and denial around this /roblem and it is very hard the /erson does not ac:no!ledge this is ha//ening
An unhealthy relationshi/ !ith food hard to diagnose, it lac:s diagnostic c
n fact, there are guidelines that a//ly for substance addiction, /rocess addisordered eating in general, yet a!areness and the ability to start a conv
diTcult 5al:ing about it /romotes education about healthier eating, /romotes hea
those !ho choose unhealthy lifestyles and at high ris: for obesity, and thofor their obesity /roblems.
?ood addiction is one of the /ro/osed causes of the obesity e/idemic &tates, and around the !orld.
3EDI7ATIO)S A)D S50=E0Y 5S
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T0EAT OBESITY 20ES70I2TIO) 3EDI7ATIO) (O0 T'E T0EAT3E)T O( OBESI
ME5?O;M"
D-* "H'5O;& A"D 4-) A"AO4&
HE"5E;M"E
HE"5E;M"E A"D 5OAMA=- N&MA
O;CA&E;"- 'E
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N%E&5O"&
5HA"G PO%Margarita Ochoa-Maya, MD
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