Kin 110 lecture 11 Ch 11 Eating Disorders

Kin 110 lecture 11 Ch. 11 Eating Disorders (p. 385 -403) Ch. 12 Pregnancy and Breatsfeeding (p. 414 -417; 419 -424; 434 -437) 1

Eating Disorders • Eating serves psychological, social and cultural purposes • Media bombards us with ‘ideal’ body types • may develop unhealthy relationship with eating, obsessive weight loss and strange rituals around food • Food often linked with personal and emotional experiences 2

Eating Disorders – Psychological disorders; erode medical, social and psychological well being • Anorexia Nervosa – psychological loss or denial of appetite and self starvation, related in part to distorted body image and various social pressures associated with puberty – extreme weight loss, irrational fear of obesity and weight gain – Tables 11 -1 3

Anorexia Nervosa • Profile - competitive, obsessive, parents set extremely high standards • hypergymnasia - excessive exercise • early warning signs - rituals with food • cook large melas for others, not self • Physical signs and symptoms fig 11 -4 • Treatment - intervention by family and friends • team of physicians, dieticians, psychologists – nutritional therapy – psychological therapy 4

Bulimia Nervosa • college age young adults • large quantities of food are eaten at one time (binge) and then purged from the body by vomiting, laxatives or other means • Tables 11 -1 • difficult to recognize, outer appearance is normal, self reported • obsessive cycle of bulimia (fig 11 -6) • health problems fig 11 -4 • Treatment - team of physicians – reduce binges, address misconceptions about food 5

Other Eating Disorders • Baryophobia - disorder of young children - stunted growth – parents underfeed to prevent obesity • Female Athlete Triad • high percentage of female athletes exhibit disordered eating patterns • coupled with irregular menstruation – ammenorhea • loss of bone mass - osteoporosis • treatment – – decrease preoccupation with food increase meals rebuild body establish regular menstruation 6

Binge Disorder • Compulsive overeating – binge episodes without purging at least twice per week • may not deal with emotional problems effectively • never learned appropriate ways to deal with feelings • Should learn to eat in response to hunger • avoid sliming diets initially • generally require professional help. 7

Preventing eating Disorders • Some concern about diet, health and weight is normal • some fluctuation in weight and appetite is normal – *large changes consult physician • Discourage restrictive diets, meal skipping and fasting • provide information about the normal changes with puberty • correct misconceptions about – nutrition, body weight, weight loss 8

Preventing Disorders • Carefully phrase weight related comments/recommendations • encourage normal expression of disruptive emotions • encourage children to eat when they are hungry • provide adolescents with some choices and self-accountability 9

Pregnancy Overview • Special considerations for time of life • illustrates larger importance of nutrition on body functioning • Important to plan pregnancy – modification of lifestyle – adequate nutrition – prevent fetal and infant problems • + 300 kcal per day – milk, meats and alt. – Iron, calcium, and folate (400 ug/day) • breastfeeding 10

Prenatal Growth • Ovum to fetus first 8 weeks • fetus to infant 32 weeks • nourished until birth by placenta – organ formed in mothers uterus – oxygen and nutrient exchange – fetal waste removal – release of hormones of pregnancy 11

Early Growth • Hyperplasia – increase in cell number • Hypertrophy – increase in cell size • 3 weeks – specialized organs and body parts begin to form – * many women still do not know they are pregnant* • 13 weeks – heart is functional, most organs formed, fetus can move 12

First Trimester • 9 months broken into three sections, trimesters • first trimester is critical time – spontaneous abortion, ~1/3 – genetic defects or fatal error in fetal development • very important to avoid harmful substances and maintain adequate nutrition – nutritional deficiencies transferred through placenta 13

Second Trimester • Fetus weighs ~ one ounce • limbs fully formed, has ears and begins to form tooth sockets • fetal heart beat can be detected with stethoscope • begins to look like infant, formed bones, can kick, suck its thumb • mothers breast weight inc. 30% • under nutrition can impair ability to breast feed 14

Third Trimester • Weighs 2 -3 lbs. • Fetus will deplete iron stores and blood glucose • infants born after 26 weeks have a good chance of survival in nursery – difficulties suckling and swallowing • 9 months – 7 -9 lbs. (3 -4 kg) 50 cm long – soft spot where skull bones will fuse (12 -18 months) 15

Nutrient Needs • emphasis is on increased nutritional requirements – individual requirements • Energy Needs • + 300 kcal / day – in 2 nd and 3 rd trimesters ( 2 cups low fat milk and piece of bread) • nutrient dense foods, increased nutrient requirements vs kcal • vitamin and mineral needs increase 20 -100%; kcal 15 % 16

Weight Gain • If active, add extra kcal for exercise to total intake – Walking, cycling, swimming recommended activities – specific precautions p 419 • Weight gain one of best predictors of pregnancy outcome – – 2 - 4 lbs. in first trimester. 75 - 1 LB per week, 2 nd and 3 rd total gain 25 -35 lbs. (BMI ~20 -26) fig 12 -5 p 421 • Requires regular monitoring • weekly record, allows for adjustments 17

Specific Nutrients • RDA for protein • Increase 10 - 15 g – many already over this – important to check, – role of protein? • Carbohydrates – 100 g / day to prevent ketosis(avg 200) • • vitamins most increase slightly Folate (RDA 600 ug) synthesis of DNA, rbc formation • folate rich fruits and veg, fortified cereals 18

Mineral Needs • IRON • 2 times the RDA in last two trimesters (30 mg/day) • hemoglobin synthesis – *fortified breakfast cereals* • attention to nausea and absorption (caffeine) • severe iron deficiency, LBW, and risk of fetal death 19

Mineral Needs • Calcium – adequate mineralization of fetal skeleton and teeth in 3 rd tri – increase intake with conception – 1200 - 1500 mg (milk group) • Zinc – growth and development – Increase 25 % above RDA 20

Vegetarian Mothers • Lacto ova or lacto should have no special concerns, with earlier recommendations in mind • iron • Vegans • focus on protein, vitamins D, B -6, B-12, iron and calcium • increase grains, beans nuts and seeds • Avoid Ketosis - difficult for fetal brain to utilize 21

Nutrition of Milk • Asses adequate intake by monitoring wetness and stool production • supplements with formula may be needed and are OK • should not start before breastfeeding is well established • important differences from cows milk (wait 1 year) – casien - protein difficult to digest – different minerals and carbos 22

Nutrition of Milk • Colostrum – first product of breast • antibodies – compensate for immature immune system – promotes intestinal health of infant • Mature Milk – after a few days, very different from cows milk 23

Mature Milk • Main proteins from a soft light curd in GI • binds iron and reduces bacterial growth • high in essential fatty acids and fats needed for brain development • DHA, visual acuity and nervous system development 24

Mature Milk • Composition changes • increased fat content with feeding, should last 20 min. to get good growth and infant satisfaction • can supplement up to 4 ounces of water / day 25

Food Plan and Breastfeeding • Only slightly different from pregnancy • no longer require iron, folate • increased need for energy, vit. A and C, niacin and zinc • * increase milk group intake* • should maintain balanced diet, moderate fat content, maintain fluid intake • avoid crash diets 26

Milk Production • Requires ~ 800 kcal /day • recommend increase only 500 kcal per day • facilitates return to prepregnancy weight • *breast feeding enhances reduction of uterus • * may prevent breast cancer if maintained for several months • Table 12 -2 27