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9.NPA.3.2&3.3, page 1

Essential Standard Clarifying Objective 9.NPA.3

Analyze the relationship of nutrition, fitness, and healthy weight

management to the prevention of disease such as diabetes, obesity,

cardiovascular diseases, and eating disorders.

9.NPA.3.2 Classify the effects of eating

disorders as short-term or long-term. 9.NPA.3.3

Recall resources for seeking help for people with eating disorders.

Materials Needed: Smart Board File: Eating Disorders Matching Appendix 1 – Eating Disorders Matrix – Teacher Key Appendix 2a, b, c, d – Eating Disorders Matrix (cut apart and placed in envelopes for each group) Internet access 5 gift-‐wrapped packages I-‐Clickers Appendix 3a, b – copies of Guide to Eating Disorders Appendix 4a, b, c – copy of Teacher Key of Guide to Eating Disorders Appendix 5a, b – copies of Fictional Case Studies: Eating Disorders (directions for research) Appendix 6 – copies of Gone On Too Long Appendix 7 – copy of Gone On Too Long – Teacher Answer Key Appendix 8 – copies of Eating Disorders – An Adult Perspective Appendix 9a, b, c, d – Teacher Background Information Review: Option 1 Open the Eating Disorder Matching File on your smart board. Explain to students each of the terms or phrases below should fit into one of the columns. Have students come up and put each term in the correct location. You can do this 1 term at a time or all at once. Check and have them come up and move what they think should go somewhere else. Option 2 Eating Disorder Matrix: Divide students into small groups. (Each group will need one envelope with precut terms and category headings (Appendix 2a, b, c, d). The goal of this activity is to organize terms related to eating disorders with definitions into appropriate categories (Example: Anorexia Nervosa: Characterized by self-‐starvation and excessive weight loss). Groups will then match items and place in correct categories, thus reviewing Treatments, Signs/Symptoms, Dangerous Methods, and Medical Complications. After groups have finished, check for accuracy using the Eating Disorder Matrix Teacher Key (Appendix 1).

NC School Health Training Center NC Association for the Advancement of Health Education

9.NPA.3.2&3.3, page 2

Focus: Display five gift-‐wrapped packages in varying shapes and sizes. Each package should be decorated with a different style of wrapping paper and ribbons. Have each student vote* for the package he/she thinks is the prettiest. Present the results to the class. Discuss why the class did not all select the same package. If there was a package that was not chosen, do they think that someone else in another group might choose it? What defines their image of beauty? Is it necessary for every package to look the same? What would life be like if all packages looked the same? Then ask the class if they think it is necessary for all people to look identical. Ask them if they feel that they need to meet a particular standard to please themselves and others. If so, then what must they do if they do not meet that standard? What happens to a person who cannot meet that standard? * High Tech Option: use I-‐clickers to let students vote. They will not need to be assigned to a certain student since this is a non-‐graded assignment. Show the % only after all students have voted. Statement of Objective: We will be investigating the three most common eating disorders, anorexia nervosa, bulimia, and binge eating. By the end of today’s lesson, you will be able to predict the short and long-‐term effects of eating disorders on healthy growth and development, and identify resources for seeking help for people with eating disorders. Teacher Input: Option 1 Explain to students they will be assisting you today as Expert Teachers. They will be given an amount of time to read an article on a small area of today’s topic and will get to present their findings to the class. Provide students with copies of Guide to Eating Disorders (Appendix 3a, b) for note taking. Divide students into groups and assign each group one of the following articles relating to eating disorders (feel free to limit the number of articles to fit class time): http://kidshealth.org/teen/your_mind/mental_health/eat_disorder.html

1. Eat Disorders (This is a longer article-‐ may leave as one article, but breaking into an a and b on the work sheet). 2. Female Athlete Triad 3. Body Image and Self Esteem 4. A Guy’s Guide to Body Image 5. How Can I Improve My Self-‐Esteem

Using the PowerPoint, have students come up and present information and then use the PowerPoint to add or correct any information. Note: each article also has an Additional Resources tab at the bottom. These are great to show and go over when you reach the additional resources page on the PowerPoint. Notes are included in the PowerPoint, be sure to print if you would like to use them during class. [Use Appendix 4a, b, c as Teacher Key to check student presentations.]

NC School Health Training Center NC Association for the Advancement of Health Education

9.NPA.3.2&3.3, page 3

Option 2 Show the pod cast, http://www.pbs.org/wgbh/nova/thin/program.html. This hour-‐long program is divided into eight chapters. Topics include special populations (dancers, athletes), cultural pressures, history, treatment, and recovery options. QuickTime or Real Video is required for viewing. Guided Practice: Option 1 Case Studies: In groups or as individuals students should be given a situation card (Appendix 5a) and a situation response sheet (Appendix 5b). Using what they have learned from the class discussion students should complete an evaluation of their case study. When finished, come back together and discuss the answers with the group. Option 2 Students complete Gone Too Long (Appendix 6) to determine health consequences of anorexia nervosa, bulimia, and binge eating disorder. Access correct answers for assessment with Gone Too Long – Teacher Answer Key (Appendix 7). Independent Practice: Students are to complete Eating Disorders – An Adult Perspective (Appendix 8) with an adult and record adult’s responses. Closure: Today you learned the bad news about eating disorders: possible serious long-‐term effects. You also learned the good news: there are multiple resources for individuals and families to get help.

9.NPA.3.2&3.3, Appendix 1

Answers Eating Disorders – Definitions – Signs and Symptoms - Treatment

Eating Disorders and Definitions Anorexia Nervosa: Characterized by self-starvation and excessive weight loss

Bulimia Nervosa: Characterized by a cycle of binge eating followed by purging to try and rid the body of unwanted calories.

Binge Eating Disorder: Characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full.

While there is no purging, there may be sporadic fasts or repetitive diets. Female Athlete Triad: Defined as the combination of disordered eating,

amenorrhea and osteoporosis Treatments

Psychological Counseling Nutritional Counseling Outpatient Therapy Hospital Based Care

Psychiatric Medication Signs/Symptoms

Weight Fluctuations Becoming Withdrawn Excessive weight loss

Suicidal thoughts Feelings of guilt and shame

Obsession with food and calories Dangerous Methods

Ipecac Syrup Laxatives

Diuretics (water pills) Diet Pills

Medical Complications

Liver and kidney problems Cardiac arrest and/or death

Amenorrhea and Irregular menstruation Dehydration

Irregular heartbeats

9.NPA.3.2&3.3, Appendix 2a

Eating Disorders Matrix- Category Headings Directions: Cut headings into strips, student groups will organize terms according to appropriate category.

Eating Disorders Definitions Treatments

Signs/Symptoms Dangerous Methods

of Weight Control Medical

Complications

9.NPA.3.2&3.3, Appendix 2b

Anorexia Nervosa Bulimia Nervosa

Binge Eating Disorder Female Athlete Triad

Psychological Counseling Nutritional Counseling Outpatient Therapy Hospital Based Care

Psychiatric Medication Defined as the combination of disordered eating, amenorrhea

and osteoporosis Ipecac Syrup

Laxatives Diuretics (water pills)

Diet Pills

9.NPA.3.2&3.3, Appendix 2c

Characterized by a cycle of binge eating followed by purging

to try and rid the body of unwanted calories

Characterized by self-starvation and excessive weight loss

Weight Fluctuations Becoming Withdrawn

Characterized primarily by periods of uncontrolled, impulsive, or

continuous eating beyond the point of feeling comfortably full. While

there is no purging, there may be sporadic fasts or repetitive diets.

Excessive weight loss Suicidal thoughts

Feelings of guilt and shame Obsession with food and calories

9.NPA.3.2&3.3, Appendix 2d

Amenorrhea and Irregular menstruation Dehydration

Irregular heartbeats Shortness of Breath

Liver and kidney problems Cardiac arrest and/or death


Guide to Eating Disorders Directions: Using the Teen Health Website open your assigned article. With your group read your article and answer the questions for your section. Be prepared to present your information to the class. You will fill in other sections of this sheet as groups present. Eating Disorders: http://kidshealth.org/teen/your_mind/mental_health/eat_disorder.html Part A: 1. How many students are affected by eating disorders? 2. Give an example of an extreme behavior that would be a sign of

more than just dieting?

3. What are the 2 most common types of eating disorders? 4. What do people with anorexia fear? 5. What habits would a person with anorexia have? 6. What does habits of bulimia look like? 7. What is binging and purging? Where is usual done? 8. Can a person have both anorexia and bulimia? 9. Can guys develop eating disorders too? 10. Give 5 signs a person with anorexia may exhibit: 11. Give 5 signs a person with bulimia may exhibit:

Part B: 1. What causes eating disorders? 2. What age are most people who develop eating disorders? 3. What are some possible risk factors? 4. What role does puberty play? 5. Has “pop culture” played any role in how teens see themselves? 6. What other problems may exist with EDs? 7. Why are athletes and dancers vulnerable to EDs? 8. What serious health problems can come with EDs? 9. What problems can arise from the body going into starvation

mode?

10. What problems can arise from bulimia?

11. What emotional issues may arise? 12. List treatment options:

13. List people or places you may go for help? Female Athlete Triad: http://kidshealth.org/teen/food_fitness/sports/triad.html 1. What are the benefits of being an athlete? 2. Name the 3 parts of the female Triad:

3. Disordered Eating: 4. What is amenorrhea and what causes it? 5. What is osteoporosis? 6. Why is it important for a female to have her period during

adolescents?

7. Does losing weight always guarantee improved performance?


8. Signs and symptoms: 9. Name at least 5 people or places a person who may be of

help to a person with Female Athlete Triad?

Body Image and Self Esteem: http://kidshealth.org/teen/your_mind/mental_health/self_esteem.html?tracking=T_RelatedArticle 1. What is self esteem? 2. Why is self esteem important? 3. What is body image? 4. How does puberty influence self esteem? 5. How do the media influence self esteem? 6. How does family and school influence self esteem? 7. Why is a positive mental attitude important? 8. What does resilience mean? 9. Give 4 tips for improving Body Image:

10. What if it is too much for me to handle? Where can you go for help?

A Guy’s Guide to Body Image: http://kidshealth.org/teen/your_body/take_care/male_bodyimage.html?tracking=T_RelatedArticle 1. Do guys worry about their body image too? 2. Are guys more or less likely to talk about their fears? 3. Why is body image important to guys? 4. What is body dysmorphic disorder? 5. What changes during puberty may be hard to handle? 6. Do guys all grow and change at the same rate? 7. Who can guys go to for help or talk about their worries? 8. What are ways to deal with bullying from larger boys? 9. Name 4 things a guy can do to create a better body image:

How to Improve Self Esteem: http://kidshealth.org/teen/your_mind/mental_health/self_esteem.html?tracking=T_RelatedArticle 1. Define Self Esteem: 2. Define Self Image: 3. List 10 steps to improving self esteem and give a positive example for each step:


Guide to Eating Disorders: Answer Key Directions: Using the Teen Health Website open your assigned article. With your group read your article and answer the questions for your section. Be prepared to present your information to the class. You will fill in other sections of this sheet as groups present. Eating Disorders: http://kidshealth.org/teen/your_mind/mental_health/eat_disorder.html Part A:

1. How many students are affected by eating disorders? 1-2 out of every 100

2. Give an example of an extreme behavior that would be a sign of more than just dieting?

Not hanging out with friends to burn off a snack earlier

3. What are the 2 most common types of eating disorders? Anorexia and bulimia

4. What do people with anorexia fear? Weight gain, bod image 5. What habits would a person with anorexia have? Excessive exercise, dieting, purging

6. What does habits of bulimia look like? Eating in secret, usually junk food then purging, not always skinny

7. What is binging and purging? Where is usual done? Throwing up after eating a large amount of food, in private

8. Can a person have both anorexia and bulimia? Yes 9. Can guys develop eating disorders too? Yes

10. Give 5 signs a person with anorexia may exhibit: Very thin, obsessed with food, count food, feel fat, exercise a lot,

11. Give 5 signs a person with bulimia may exhibit:

Fear weight gain, unhappy with body, only eat diet foods, buy laxatives, work out

Part B: 1. What causes eating disorders? Not sure

2. What age are most people who develop eating disorders? 13-17

3. What are some possible risk factors? Academic pressure, puberty, hormonal changes, peer pressure

4. What role does puberty play? Gain body fat, hips widen, breast become larger

5. Has “pop culture” played any role in how teens see themselves?

Hollywood airbrushed, petite skinny, guys perfectly muscular

6. What other problems may exist with EDs? May also be depressed, anxious, OCD, genetics

7. Why are athletes and dancers vulnerable to EDs?

May want to suppress growth or weight gain, encouragement from others to fit a certain mold of athlete,

8. What serious health problems can come with EDs? Heart conditions, kidney failure

9. What problems can arise from the body going into starvation mode?

Drop in blood pressure, hair loss, anemia, swollen joints, brittle bones

10. What problems can arise from bulimia? Stomach pain, damage to stomach and kidneys, tooth decay, loss of periods, chipmunk cheeks, loss of periods

11. What emotional issues may arise? Become withdrawn, depression, social stress

12. List treatment options:

Medical Dr., mental health professions, dietitians, therapy, counseling,

13. List people or places you may go for help? Dr, counselor, teacher, coach, school nurse, adult


Female Athlete Triad: http://kidshealth.org/teen/food_fitness/sports/triad.html

1. What are the benefits of being an athlete? Healthier, better grades, lower depression rates and drug use

2. Name the 3 parts of the female Triad: Disordered eating, amenorrhea, osteoporosis

3. Disordered Eating: Simple as avoiding “bad” foods to full blown anorexia

4. What is amenorrhea and what causes it? Loss of menarche, exercising intensely lowers estrogen

5. What is osteoporosis? Weakening of the bones

6. Why is it important for a female to have her period during adolescents? Peak bone mass is formed during adolescents

7. Does losing weight always guarantee improved performance?

No, it can actually break down muscle that makes us stronger.

8. Signs and symptoms: Weight loss, no periods, fatigue, inability to concentrate, stress fractures, muscle injuries and signs of eating disorders

9. Name at least 5 people or places a person who may be of help to a person with Female Athlete Triad?

Dr, coach, parent, physical therapists, nutritionist, dietitian, mental health specialist, teacher

Body Image and Self Esteem: http://kidshealth.org/teen/your_mind/mental_health/self_esteem.html?tracking=T_RelatedArticle 1. What is self esteem? How much we feel loved, valued by others 2. Why is self esteem important? 3. What is self image? Picture we have of ourselves 4. How does puberty influence self esteem? b/c there are so many changes so fast 5. How do the media influence self esteem? See so many airbrushed images

6. How does family and school influence self esteem?

Family members may have own issues, coaches worried about performance

7. Why is a positive mental attitude important? People who believe in themselves and know where they are going are more successful

8. What does resilience mean? Ability to get back up again and keep going

9. Give 4 tips for improving Body Image:

Accomplishment rather than perfection, view mistakes as learning opportunities, try new things, set goals, exercise, have fun

10. What if it is too much for me to handle? Where can you go for help? Parent, teacher, coach, guidance, NC text line

A Guy’s Guide to Body Image: http://kidshealth.org/teen/your_body/take_care/male_bodyimage.html?tracking=T_RelatedArticle 1. Do guys worry about their body image too? Yes

2. Are guys more or less likely to talk about their fears? Yes

3. Why is body image important to guys? Appear strong, tough

4. What is body dysmorphic disorder? Preoccupation with how someone looks, spends lots of time looking and flexing to find flaws

5. What changes during puberty may be hard to handle? Voice, hair, too small, too short

6. Do guys all grow and change at the same rate?

No genetics can make it earlier or later, look at parents history

7. Who can guys go to for help or talk about their worries?

Teachers, coaches, Dr., pastor, mental health, counselor


8. What are ways to deal with bullying from larger boys?

Use humor, wit, tell someone if too severe or frequent.

9. Name 4 things a guy can do to create a better body image:

Recognize strengths, good body doesn’t mean athletic, strength training program, don’t trash your body, be yourself

How to Improve Self Esteem: http://kidshealth.org/teen/your_mind/mental_health/self_esteem.html?tracking=T_RelatedArticle 1. Define Self Esteem: See above 2. Define Self Image: See above 3. List 10 steps to improving self esteem and give a positive example for each step: see article


Case Study Situations

Case Study #1: Megan

Shelly is concerned about her friend Megan. No matter what they talk about the conversation always turns to food. Megan

has gone from working out 3-4 days a week to working out 7 days a week,

sometimes even twice a day. Megan is always talking about how fat she is even

though it seems she has lost a lot of weight. It is hard to tell how much since

she wears baggy clothes; she says she is always cold. Shelly has noticed Megan keeps a bottle of laxatives in her locker. Yesterday, Megan fainted in Chemistry.

Case Study #2: Melissa

Melissa is a 14 year old who has always been thin but her recent weight loss has

brought her BMI down to 18 and her mother says her grades are falling and she is

showing little interest in food. Melissa says her weight loss is from starting cross country

running with her father on weekends. She denies having little interest in food – rather she is simply careful about what she eats.

She reports recently becoming a vegetarian for health reasons. The only symptom of

concern to Melissa is that she reports feeling constantly cold. She states that her mother “drives me crazy at meal times”. She does not understand what all the fuss is about.

Case Study #3: John

As a freshman John has made the Varsity Wrestling Team. His coach wants him to wrestle another weight class down which

means he will need to lose another 15 pounds. The 1st 15 he lost in less than 2 weeks. He is not allowing himself to eat

more than 500 calories a day and he only sucks on ice instead of drinking water. At school he wears 2 sweat shirts and during lunch he sneaks into the gym to run laps.

His girlfriend has noticed that he falls asleep in class and at night when they try to talk on the phone. If they do go out to

dinner he always gets up and goes to the bathroom after he finishes eating and his

face is red and his eyes are watering when he gets back.

Case Study #4: Sara

Sara is a freshman cheerleader and had always been a stunt person up until this

year when her coach switched her to base. Her friends have noticed that she will not eat food in front of them and she will only drink 2 sweet teas from McDonalds a day.

If she can’t get tea, she will drink a Monster to help her stay awake. She is

always complaining that she was replaced because she was fatter than the other girl. Her teachers have noticed she is having trouble staying awake in class and her

grades are falling. She has also developed dark circles under her eyes and she is

wearing her once thick long hair up to hide that it is thinning.


Teen Case Studies: Eating Disorders Directions: Your group will need 1 case study card from your teacher. Using the information on your card please answer the questions below. Use details from the card to strengthen your answers. Situation :

1. What disorder is this an example of:

2. What are the symptoms?

3. What pressures are present or could be inferred from the card?

4. Are there present medical complications? If so what are they?

5.

Name 3 things that can be done to help this person:

6. What complications could develop if this condition is not treated?

7.

Name at least 5 people or places this person could receive help?

8. What are possible treatment options?


Gone On Too Long…

Individuals who suffer from eating disorders often are suffering in silence. Directions: Place an A next to those health consequences related to Anorexia, a B next to those health consequences related to Bulimia and an O next to those health consequences related to Binge Eating. You may have more than one indicator per answer.

1. Slow heart rate and low blood pressure

2. Heart Failure due to dehydration and lack of potassium and sodium

3. Secondary Diabetes

4. Tooth decay and staining of the teeth from stomach acids

5. Rupture of the esophagus

6. Death

7. Heart Disease

8. Gallbladder Disease

9. Depression

10. Ulcers

11. Constipation and irregular bowel movements

12. Loss of muscle tone and weakness

13. Electrolyte Imbalances

14. Fainting

15. Dry hair and hair loss

16. Growth of a downy layer of hair in an attempt to keep the body warm

17. Kidney Failure

18. High Blood Pressure

19. Gastric rupture

20. Low self esteem

21. Anxiety

22. Reduction in bone density

23. Irregular or ceasing of menstrual cycle

24. High Cholesterol


TEACHER KEY-Gone On Too Long… Individuals who suffer from eating disorders often are suffering in silence.

Directions: Place an A next to those health consequences related to Anorexia, a B next to those health consequences related to Bulimia and an O next to those health consequences related to Binge Eating. You may have more than one indicator per answer.

1. Slow heart rate and low blood pressure A

2. Heart Failure due to dehydration and lack of potassium and sodium A, B

3. Secondary Diabetes O

4. Tooth decay and staining of the teeth from stomach acids B

5. Rupture of the esophagus B

6. Death A, B

7. Heart Disease O

8. Gallbladder Disease O

9. Depression A, B, O

10. Ulcers B

11. Constipation and irregular bowel movements A, B

12. Loss of muscle tone and weakness A

13. Electrolyte Imbalances B

14. Fainting A, B

15. Thin dull hair and hair loss A, B

16. Growth of a downy layer of hair in an attempt to keep the body warm A

17. Kidney Failure A

18. High Blood Pressure O

19. Gastric rupture B

20. Low self esteem A, B,O

21. Anxiety A, B, O

22. Reduction in bone density A, B

23. Irregular or ceasing of menstrual cycle A, B, O

24. High Cholesterol O


Eating Disorders – An Adult Perspective

Ask an adult to discuss eating disorders with you. Record their responses below.

1. Have you ever felt pressure to look a certain way or fit into a certain size? What do you do when you have those feelings?

2. What kinds of messages did you get from the media about your body when you were my age? What can I do to speak up about media messages that bother me?

3. I hear adults making comments about dieting and wanting to lose weight. Can we talk about how these comments affect me?

4. Have you ever known anyone who has suffered from an eating disorder? If so, what happened to this person?

5. Why do you think people develop eating disorders?

6. What advice can you give me about how I can have a positive body image and healthy self-esteem?

7. Grab some magazines and think about some of your favorite celebrities. Sit down with an adult and look at the pictures on the pages. Talk about the differences between what you see in the media and what your real life is like. Do these images look like people you know?


TEACHER BACKGROUND INFORMATION How and why you eat is affected by many factors:

• appetite • food availability • family • friends • cultural practices • your own efforts to control your eating

Excessive dieting - dieting to the extent that you lose more weight than is healthy - is seen by some as "trendy" or even necessary to be slim and fashionable. From belly-baring fashions, to gaunt, skeletal runway models; women have taken the idea that "thin is in" to new extremes in the new millenium. Eating disorders represent a mental health effect of this preoccupation with body weight, shape and diet. Typically, if you have an eating disorder, you'll have unhealthy eating behavior. This may include extreme and unhealthy reduction of the amount of food you eat. Or, you may severely overeat. If you have an eating disorder, you almost always will feel bad about your eating, body shape, weight -- or all three. Mental health professionals still doesn't know exactly whey some people move beyond normal eating behavior, like cutting back on how much you eat in order to stay healthy, and at some point become out of control, evolving into a full-blown eating disorder. We do know that this is a complex process, and no one factor is the cause or reason. We also know that eating disorders are not due to a failure of will or behavior. They are, on the other hand, real medical illnesses that are diagnosable and treatable. What Are The Main Types of Eating Disorders? The main types of eating disorders are anorexia nervosa and bulimia nervosa. A third type, called binge-eating disorder, is not yet a formal psychiatric diagnosis, but it's increasingly recognized as another major category of eating disorder. Who Gets Eating Disorders, and When? Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorder are male. Most often, eating disorders develop during the teenage years, or as a young adult. More and more, there are reports of eating disorders developing even in elementary school-age children, and adults. Eating Disorders and Health Eating disorders frequently show up along side of other mental health issues, such as depression, alcohol or drug abuse, and anxiety disorders. People who suffer from eating disorders also risk serious -- and sometimes fatal -- health complications, including serious heart conditions and kidney failure. This is why it's particularly important for eating disorders to be recognized, diagnosed and treated. Anorexia nervosa Anorexia nervosa is a serious, often chronic, eating disorder. People with anorexia nervosa view themselves as overweight, even though they are often dangerously thin. For someone with this condition, eating becomes an obsession. Often, unusual or particular eating habits, and other weight control habits develop. These can include: o avoiding food o avoiding meals o picking out a few foods and eating only these foods in small quantities o carefully weighing and portioning food o repeatedly checking body weight o intense and compulsive exercise o purging by means of vomiting o abuse of laxatives, enemas, and diuretics Anorexia is far more common in girls, and an estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime.


Symptoms Symptoms of anorexia nervosa include:

• Resistance to staying at a body weight that is at or above the minimum healthy weight for age and height • Intense fear of gaining weight or becoming fat, even though underweight • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or

shape on self-evaluation, or denial of the seriousness of the current low body weight • Delayed onset of first menstrual period • Infrequent or absent menstrual periods (in females who have reached puberty)

The course and outcome of anorexia nervosa depend on the person. Some fully recover after a single episode. Other people suffer up and downs in weight gain and relapses into anorexia. Finally, a third group has the most severe form of the condition, with chronically deteriorating health over time.

Anorexia is dangerous and sometimes fatal. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females 15-24 in general. The most common causes of death are complications of anorexia such as cardiac arrest or electrolyte imbalance, and suicide.

What is the prognosis (outcome) of anorexia?

Anorexia is among the psychiatric conditions with the highest mortality rate, with an estimated 6% of anorexia victims dying from complications of the disease. The most common causes of death in people with anorexia are medical complications of the condition including cardiac arrest and electrolyte imbalances. Suicide is also a cause of death in people with anorexia.

Early diagnosis and treatment can improve the overall prognosis in an individual with anorexia. With appropriate treatment, about half of those affected will make a full recovery. Some people experience a fluctuating pattern of weight gain followed by a relapse, while others experience a progressively deteriorating course of the illness over many years and still others never fully recover. It is estimated that about 20% of people with anorexia remain chronically ill from the condition.

As with many other addictions, it takes a day-to-day effort to control the urge to relapse. Many individuals will require ongoing treatment for anorexia over several years, and some may require treatment over their entire lifetime.

The treatment of anorexia must focus on more than just weight gain. The prognosis of anorexia is variable, with some people making a full recovery. Others experience a fluctuating pattern of weight gain followed by a relapse, or a progressively deteriorating course over many years. As with many other addictions, it takes a day-to-day effort to control the urge to relapse, and treatment may be needed on a long-term basis.

Bulimia Bulimia nervosa is a serious eating disorder, in which people binge eat, and later purge - either by vomiting, laxatives, excessive exercise, or other behavior designed to offset the impact of the food. People with bulimia usually weigh within the normal range for their age and height. However, like anorexics, bulimics are usually afraid of gaining weight, want to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia usually perform the behaviors (both binge eating, and purging) secretly. Bulimics typically describe feeling disgusted and ashamed when they binge, yet relieved once they purge. An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime. Symptoms of Bulimia Nervosa Symptoms of bulimia nervosa include:

• Recurrent episodes of binge eating, characterized by eating an excessive amount of food in a short amount of time, and a feeling of lack of control over eating during the binging episode

• Repeated behavior to compensate for the binging and prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications (purging), fasting, or excessive exercise

• Binging and purging, on average, at least 2 times a week for 3 months or more • Self-image is unduly dependent on body shape and weight


Binge Eating As many as 2 to 5 percent of Americans have a binge-eating disorder. Binge-eating disorder typically involves recurrent episodes of out-of-control eating, with the same binge-eating symptoms as those with bulimia. The main difference when compared to bulimia is that binge-eaters do not purge their bodies of excess calories. Therefore, many with the disorder tend to be overweight. Binge-eating disorder is associated with feelings of self-disgust and shame, and these feelings often trigger additional binge-eating, creating a cycle of binge eating. Symptoms of Binge-Eating Disorder Binge-eating episodes are associated with the following symptoms:

• excessive eating in a fixed timeframe • eating much more rapidly than normal • eating until feeling uncomfortably full • eating large amounts of food when not feeling physically hungry • eating alone because of being embarrassed by how much one is eating • feeling disgusted with oneself, depressed, or very guilty after overeating • marked distress about the binge-eating behavior

What causes binge eating disorder?

No one knows for sure what causes binge eating disorder. As many as half of all people with binge eating disorder are depressed or have been depressed in the past. Whether depression causes binge eating disorder or whether binge eating disorder causes depression is not known. It is also unclear if dieting and binge eating are related. Some people binge eat after dieting. Dieting here means skipping meals, not eating enough food each day, or avoiding certain kinds of food. These are unhealthy ways to try to change your body shape and weight.

Studies suggest that people with binge eating may have trouble handling some of their emotions. Many people who are binge eaters say that being angry, sad, bored, worried, or stressed can cause them to binge eat. Certain behaviors and emotional problems are more common in people with binge eating disorder. These include abusing alcohol, acting quickly without thinking (impulsive behavior), not feeling in charge of themselves, not feeling a part of their communities, and not noticing and talking about their feelings.

Researchers are looking into how brain chemicals and metabolism (the way the body uses calories) affect binge eating disorder. Other research suggests that genes may be involved in binge eating, since the disorder often occurs in several members of the same family. This research is still in the early stages.

What are the complications of binge eating disorder?

People with binge eating disorder are usually very upset by their binge eating and may become depressed. Research has shown that people with binge eating disorder report more health problems, stress, trouble sleeping, and suicidal thoughts than people without an eating disorder do. People with binge eating disorder often feel bad about themselves and may miss work, school, or social activities to binge eat. People with binge eating disorder may gain weight. Weight gain can lead to obesity, and obesity puts people at risk for many health problems, including o type 2 diabetes o high blood pressure o high blood cholesterol levels o gallbladder disease o heart disease o certain types of cancer

Most people who binge eat, whether they are obese or not, feel ashamed and try to hide their problem. Often they become so good at hiding it that even close friends and family members do not know they binge eat.

Treatment Strategies for Eating Disorders Eating disorders can be treated and sufferers can return to a healthy weight. The sooner these disorders are diagnosed and treated, the better the outcome will likely be. Eating disorders are complex, and treating them involves development of a comprehensive plan that involves medical care and monitoring, psychological support and interventions, nutritional counseling, and, when necessary, medication.

9.NPA.3.2&3.3, Appendix 9d

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members and trusted friends individuals can be helpful in ensuring that the person with an eating disorder receives needed treatment and rehabilitation. For some people, treatment may be long term. Anorexia Treatment Treatment of anorexia requires a specific program that involves three main phases:

1. restoring weight that has been lost to severe dieting and purging 2. treating any psychological disturbances, such as distortion of body image, low self-esteem, and interpersonal

or emotional conflicts; and 3. achieving long-term remission and rehabilitation, or full recovery.

Early diagnosis and treatment definitely increases the treatment success rate. Use of medications in people with anorexia is usually considered only after the patient has started to regain weight. Certain antidepressants known as selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for dealing with mood and anxiety symptoms experienced by anorexia patients. For patients who have had severe weight loss, initial treatment is often in an inpatient hospital setting, where feeding plans can help deal with the patient's medical and nutritional needs. In some cases, intravenous feeding (IV) is recommended. Once the malnutrition has been addressed, and weight gain begins, psychotherapy (often cognitive-behavioral or one-on-one and group psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Families are sometimes included in the therapy. Bulimia and Binge-Eating Disorders Treatment The primary goal when treating bulimia is to cut down on or even eliminate the binge eating and purging. Treatment, therefore, involves nutritional counseling, psychological support, and medication management.

Patients establish a pattern of eating regular, non-binge meals, and therapy focuses on improvement attitudes related to the eating disorder, encouragement of healthy but not excessive exercise, and resolution of other conditions such as mood or anxiety disorders. Individual psychotherapy (especially cognitive-behavioral or interpersonal psychotherapy), group psychotherapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective.

Antidepressants such as the selective serotonin reuptake inhibitors (SSRIs) have been found helpful for people with bulimia, especially those who have depression or anxiety, or who don't respond to therapy alone. These medications also may help prevent relapse.

The treatment goals and strategies for binge-eating disorder are similar to those for bulimia, and studies are currently evaluating the effectiveness of various interventions.

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