With the term ‘obesity’, we characterize an abnormal or excessive accumulation of body fat, which constitutes a great threat to health. Obesity, and more specifically the central type of obesity, which is characterized by excess fatty tissue around the abdominal region, is associated with an increased risk of developing diabetes and cardiovascular disease, and perhaps even ‘the metabolic syndrome’

1. Obesity
and
eating
disorders

2. Obesity
With the term ‘obesity’, we characterize an abnormal or
excessive accumulation of body fat, which constitutes a
great threat to health.
Obesity, and more specifically the central type of
obesity, which is characterized by excess fatty tissue
around the abdominal region, is associated with an
increased risk of developing diabetes and cardiovascular
disease, and perhaps even ‘the metabolic syndrome’

3. What is the difference between an overweight and an
obese patient?
• Body mass index (BMI) : An adult who has a
BMI of 25–29.9 kg/m2 is said to be overweight,
while an adult with a BMI in excess of 30 kg/m2
is said to be obese.

4. Role of dietary fat intake in the
development of obesity
 The increase in fat intake of the modern diet and
reduced physical activity are the two main causes
of the development of obesity in industrialized
countries. Fat is the most energy-dense nutrient in
our diet, producing nine calories per gram, which is
more than twice the calories derived from other
macronutrients such as carbohydrates and proteins

5.  Fat can contribute to the development of obesity
by regulation of leptin levels.
 Increased dietary fat intake results in central leptin
resistance,
whereas the restriction of dietary fat can lead to a
partial improvement in leptin signaling, resulting in
a spontaneous reduction in appetite and body
weight.

6. Role of sugar and carbohydrate intake
in the development of obesity?
Carbohydrates represent the most essential
energy fuel for the organism and play a very
important role in our diet.

7. Causes of Eating Disorders
• Personality Traits
• Genetics
• Environmental Influences
• Biochemistry

8. 1- Personality Traits
• Low self-esteem
• Feelings of inadequacy or lack of control in life
• Fear of becoming fat
• Depressed, anxious, angry, and lonely feelings

9. 2- Genetic Factors May Predispose
People to Eating Disorders
 Increased risk of anorexia nervosa among first-degree
relatives of individuals with the disorder
 increased risk of mood disorders among first-degree relatives
of people with anorexia, particularly the binge-
eating/purging type.

10. 3- Environmental Factors
Troubled family and personal relationships
Difficulty expressing emotions and feelings
History of trauma, sexual, physical and/or mental abuse
• 60-75% of all bulimia nervosa patients have a history of
physical and/or sexual abuse

11. 4- Biochemical Factors
• Chemical imbalances in the neuroendocrine system
– These imbalances control hunger, appetite, digestion, sexual function,
sleep, heart and kidney function, memory, emotions, and thinking
• Serotonin and norepinephrine are decreased in acutely ill
anorexia and bulimia patients
• Excessive levels of cortisol in both anorexia and depression

12. I- Anorexia Nervosa
• Description
– Characterized by excessive weight loss
– Self-starvation
– Preoccupation with foods, progressing restrictions
against whole categories of food
– Anxiety about gaining weight or being “fat”

13. Anorexia Nervosa
• Symptoms
– Resistance to maintaining body weight at or above a
minimally normal weight for age and height
– Intense fear of weight gain or being “fat” even though
underweight

14. Anorexia Nervosa
• mean age at onset is 17 years
• affects about 1% of all females in late adolescence
and early adulthood
onset and course

15. Health Consequences of Anorexia Nervosa
• Abnormally slow heart rate and low blood pressure,
Reduction of bone density (osteoporosis), which
results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney
failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin, hair loss is common.

16. Anorexia Treatment
• Three main phases:
– Restoring weight lost
– Treating psychological issues, such as:
• Distortion of body image, low self-esteem, and
interpersonal conflicts.
– Achieving long-term remission and rehabilitation.
• Early diagnosis and treatment increases the
treatment success rate.

17. Anorexia Treatment
• Hospitalization (Inpatient)
– Extreme cases are admitted for severe weight loss
– Feeding plans are used for nutritional needs
• Weight Gain
– Immediate goal in treatment
– Physician strictly sets the rate
• In the beginning 1,500 calories are given per day
• Calorie intake may eventually go up to 3,500 calories per day
• Nutritional Therapy
– Dietitian is often used to develop strategies for planning
meals and to educate the patient and parents

18. Prognosis for Improvement
• Anorexia
– 50% have good outcomes
– 30% have intermediate outcomes
– 20% have poor outcomes
• Anorexia
– Poorer prognosis with:
• Initial lower weight
• Presence of vomiting
• Failure to respond to previous treatment
• Bad family relationships before illness

19. II-Bulimia Nervosa

20. Description
• Recurrent episodes of binge eating. An episode of
binge eating is characterized by both of the following:
-eating, in a discrete period of time (e.g., within any
2-hour period), an amount of food that is definitely
larger than most people would eat during a similar
period of time and under similar circumstances
-a sense of lack of control over eating during the
episode (e.g., a feeling that one cannot stop eating
or control what or how much one is eating)

21. Symptoms
• Eating large amounts of food uncontrollably (binging)
• Vomiting, using laxatives, or using other methods to
eliminate food (purging)
• Excessive concern about body weight
• Depression or changes in mood

22. onset and course
• The average onset of Bulimia begins in late
adolescence or early adult life
– Usually between the ages of 16 and 21
• usually begins in late adolescence or early adult life
and affects 1-2% of young women
• 90% of individuals are female
• frequently begins during or after an episode of
dieting

23. Health Consequences of Bulimia Nervosa:
• Causes electrolyte imbalances that can lead to irregular
heartbeats and possibly heart failure and death. Electrolyte
imbalance is caused by dehydration and loss of potassium and
sodium from the body as a result of purging behaviors.
• Inflammation and possible rupture of the esophagus from
frequent vomiting.
• Chronic irregular bowel movements and constipation as a result
of laxative abuse.

24. Bulimia Treatment
• Treatment Involves:
– Psychological support
– Nutritional Counseling
• Teaches the nutritional value of food
• Dietician is used to help in meal planning strategies
– Medication management
• Antidepressants (SSRI’s) are effective to treat patients who also
have depression, anxiety, or who do not respond to therapy alone
• May help prevent relapse

25. Prognosis for Improvement
• Bulimia
– 45% have good outcomes
– 18% have intermediate outcomes
– 21% have poor outcomes
• Bulimia
– Poorer prognosis with:
• High number hospitalizations because of severity
• Extreme disordered eating symptoms at start of
treatment
• Low motivation to change habits

26. 1-Dietary weight-reducing program
It is a program that includes daily servings of:
• fruits and vegetables (raw or cooked),
• fat-free or low-fat milk and milk products
• servings from starchy foods (e.g. bread, rice, pasta,
cereals) and potatoes,
• adequate protein sources such as lean meat, poultry,
fish, beans, eggs and nuts,
• certain amount of fat, mainly in the form of
monounsaturated olive oil
Management of obesity

27. 2- Very low calorie diets
• VLCDs are very strict dietary programs that
provide a very low-energy intake of 400–800
kcal and a total protein intake of 45–100 g per
day,

28. 3- High-protein diets
• High-protein diets are the most popular type
of exclusion diets used in the weight-control
industry.
• The higher intake of protein and the severe
restriction of carbohydrates in the diet,
through the exclusion of fruits, starchy foods,
had been considered the best solution for
obesity.

29. What is the role of exercise in the
treatment of obesity?
• Exercise is considered a cornerstone of weight
loss and weight maintenance.
• weight loss can only be achieved by
decreasing energy intake and/or increasing
physical activity.