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Prevention of eating addictions

Prevention of eating addictions






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  • Suzanne: 1, 3, 7Abby, 2, 4
  • Maria
  • Suzanne – connect to Jessica – chocolate comment
  • Suzanne – case conceptualization – factors to look for - highlight comorbidity and its important during screening and assessment process
  • Abby
  • Maria
  • MariaSuzanne – recent research - behavioral symptoms body checking and body avoidance, ritualistic weighing and trying on special clothing to check for fit
  • Maria
  • Abby
  • Suzanne – elaborate on research funding ten million = $12 million; Alzheimer’s 4.5 million = $647,000,000; Schizophrenia 2.2 = $350,000,000
  • Abby – left slide – share first then SuzanneSuzanne - Highlight gender differences
  • Maria’s slide
  • Abby
  • Suzanne – statistics are our country’s reality – prevention is what we can do to make a difference in the numbers
  • Suzanne – use Jessica’s story as an anchor for prevention interventions and counseling techniques
  • Suzanne – note important role of school counselors
  • Suzanne – connection to c.c work and systematic change – institutionalized racismSymptoms may worse if focus on signs, symptoms, and dangers
  • Abby
  • Suzanne – earlier the better
  • Suzanne – ask volunteer to create children’s story behind a statistic
  • Suzanne – school counselors – primary prevention – whole class lesson ideaWhich book would have Jessica related to as a young girl?
  • Suzanne – adolescence - grades 4-6 – Develop Healthy Body Image Curriculum – challenge society values?Image is valued over substance: “How I look” is more important that “who I am.” An essential criterion for the “right” look is a thin/lean body. – connect to ShapeablesDenial of Biological Diversity: Anyone can be slim if he or she works at it. Fatter people eat too much or are inactive. Fat is bad/wrong.Denial of the Effects of Externally Presrcribed Hunger Regulation: Dieting is an effective weight-loss strategy.Discounting the Value of Health: complacency about choices do no result in the desired look: Eat, drink, be merry. .. Healthy choices for health’s sake are too much work!
  • Maria
  • Maria’s slide
  • Abby—study conducted in which they told those treated for bulimia to contact counselor if feeling like they would relapse….NOBODY contacted them and many relapsed
  • Maria
  • Maria
  • Maria
  • Maria
  • Suzanne - Targeted, early interventions – what would Jessica’s answers be to these questions?
  • Suzanne – ask audience – why you think self-reports may be more reliable than client interviewing?
  • Suzanne:A study stated that a bit more than 40% of individuals will lifetime diagnosis do not seek treatment.
  • Suzanne: connect to Motivational Interviewing – amplify variables
  • Suzanne – I have created a metaphor to help me sort these components outTreatment is like a journey/adventure/trip goal – name of adventure – what client hopes/plans to gain from journey/ think finish line objectives – markers/pit stops along the way to help accomplish goalinterventions – what client and counselor are going to do to met the objective - actions
  • Maria’s Slide
  • Abby
  • Abby—just a few support groups-many out there online and in person
  • Suzanne – 1, 3, 7Abby – 2, 4,

Prevention of eating addictions Prevention of eating addictions Presentation Transcript

  • Prevention of Eating Addictions
    Maria Afordakos, Suzanne Ashley, & Abby Moncrief
    Summer 2010
  • Pre-presentation QuizTrue or False?
    Research has linked eating to the human’s brain reward system.
    Anorexia and Bulimia are the two most common eating disorders.
    Females are more likely to present eating disorders symptoms than males.
    Most teachers and school counselors do not feel equipped enough to properly discuss eating addictions.
    All who suffer from an eating addiction are overweight or obese.
    It is harder to treat someone with an eating addiction than someone who is addicted to alcohol or other substances.
    Prevention programs should focus on warning the public about signs, symptoms, and dangers of eating addictions.
  • CNN Health File
    How can eating act as an addiction?
    Remember Jessica’s story throughout our presentation.
  • Overeating, Binge Eating, & Eating Disorders as Addictions
    Current evidence links pathological obesity and drug addiction through common brain characteristics.
    reward pathway in brain
    increased dopamine during ingestion of food has been reported
    result in similar behaviors and feeling states, such as loss of control, compulsive usage, chronic relapsing
    (Gold, Frost-Pineda, & Jacobs, 2003)
  • Overeating, Binge Eating, & Eating Disorders as Addictions
    Common associations shared between eating disorders & drug addictions:
    compulsive use/behavior despite adverse consequences
    denial of problem
    use of substance to relieve negative affect with guilt of use
     genetic links
     common neurobiological pathways
    (Gold et al., 2003)
  • Recent, Relevant News on Eating
    June 1, 2010 on CNN
    Binge eating is recommended as a psychiatric diagnosis in the DSM
    Tends to run in families
    More common in males and older age
    Currently--Eating Disorder Not Otherwise Specified--EDNOS
    Bad because EDNOS patients have more severe medical needs but don't qualify for the level of care from insurance companies
  • Definition of Food Addiction
    A food addiction is any disorder characterized by a preoccupation with food.
    Among the disorders associated with food addiction are anorexia, bulimia, and compulsive eating.
    Food addicts gain pleasure from the anticipation, availability, and ingestion of food.
  • Symptoms of Food Addiction
    Obsessed with thoughts about food.
    Eats to relieve worry or stress.
    Eats until they feel sick.
    Feels anxious while eating.
    Worries or feels anxious while eating which results in more eating.
    Overeats because the food is there.
    Eats too fast so they can eat more.
    Eats everything on the plate even when they feel full.
    Feels guilty when they overeat.
    Hides food so they can eat in secret away from other people.
    Goes on a food binge after dieting or after trying to cut back.
    Does not like the feeling of being hungry.
    Sees food as something to be avoided or as harmful.
  • Food Addiction Cycle
    (Minirth, Sneed, Hemfelt, Meier, 1990)
  • Types of Eating Disorders Linked Eating Addictions
    Anorexia:  starving self and weight loss
    Bulimia:  binging and purging to control  weight
    Eating Disorder Not Otherwise Specified—EDNOS
    Binge Eating Disorder:  compulsively overeat and rapidly consume thousands of calories in a short period of time
    Most common food addiction in U.S.
    Overeating: consuming excessive amounts of food over a long period of time
  • Statistics
    Approximately 10 million females & one million males have eating disorders.
    Anorexia has the highest morality rate of any mental illness.
    Eating disorders are more expensive to treat than schizophrenia.
    Eating disorders are more common than Alzheimer's disease.
    (NEDA, 2010)  
  • Statistics
    Anorexia:  less than 1%
    Bulimia:  2%-3%
    EDNOS: 2%-5%
    (Lock & Fitzpatrick, 2009)
    Gender Differences
    Girls or women are either as likely as, or LESS likely than, boys or men to report:
    Binge eating
    Use of excessive exercise for weight control
    Girls or women are more likely than boys or men to report:
    Weight dissatisfaction
    Dieting for weight control
    Use of purging
    (Striegal-Moore , Rosselli, Perrin, DeBar, Wilson, May, & Kraemer, 2009)
  • Common Reasons to Overeat
    • Overeaters may respond compulsively to cultural pressures
    • Overeaters may subconsciously desire added pounds to protect themselves from love and intimacy
    • Overeaters may use food to satisfy their need for immediate gratification
    • Overeaters may eat to punish themselves or others
    • Overeaters may have a faulty perception of their body image
    • Overeaters eat to satisfy other “hungers”
    • Overeaters may have emotional feelings about food which were developed at their parents’ dinner table.
    • Overeaters may eat to control their circumstances
    • Overeaters may use food as a tranquilizer.
    (Minirth, Sneed, Hemfelt, Meier, 1990)
  • Warning Signs of an Eating Addiction
    Preoccupation with body or weight
    Obsession with calories, food, or nutrition
    Rapid weight loss or weight gain
    Compulsive exercising
    Eating alone or in secret
    Hoarding high-calorie food
    Constant dieting, even if thin
    Taking laxatives or diet pills
    Making excuses to get out of eating
    Avoiding social situations that involve food
    Going to bathroom right after meals
  • Prevention
  • Case Study
    Jessica from CNN Health File reported:
    One year ago, she lost 50 pounds.
    She has a new job and a new wedding.
    She has gained the weight back.
    “I feel bad so I eat. I feel bad so I eat.
    When I’ve had a bad day, I really crave
    something, say chocolate.”
    Jessica shared on the clip.
  • Basic Principles of Prevention
    Systematic approach to create change
    –Primary Prevention = designed to prevent the occurrence of eating addiction before they begin; promote healthy lifestyle
    –Secondary Prevention = designed to promote early identification; often called “targeted prevention”
    The earlier an eating disorder is discovered and addressed, the better the chance for recovery.
    (Levine & Maine, 2005)
  • Effective Principles of Prevention
    Should address:
    –Cultural obsession with slenderness
    –Roles of men and women in society
    –Development of people’s self-esteem & self-respect
    Should NOT solely focus on warning the public about signs, symptoms, and dangers of eating addictions
    School programs & community organizations should coordinated with eating disorder professionals.
    (Levine & Maine, 2005)
  • Primary Prevention
    Teachers, health educators, school nurses, school counselors, school psychologists, and sports coaches are NOT prepared to talk about eating addictions with students
    40% of school counselors did not feel competent in helping students with eating addictions
    49% reported they only felt moderately competent
    (Price, 1990 as cited in Yagar, 2005)
  • “A culture is formed by the stories its children are told.” (Kater, 2005)
  • Society's Statistics
    80% of American women are dissatisfied with their appearance (Smolak, 1996).
    42% of 1st-3rd grade girls want to be thinner (Collins, 1991).
    81% of 10 year olds are afraid of being fat (Mellin et al., 1991).
    46% of 9 to 11 year olds are "sometimes" or "very often" on diets (Gustafson-Larson & Terry, 1992).
    Americans spend over $40 billion on dieting and diet-related products each year (Smolak, 1996).
  • Bibliotherapy as Part of Prevention
    By: Andy Mills & Becky Osborn
    Ages 3-8
    “It’s not the size of your shape or the shape of your size, but what’s in your heart that deserves first prize.”
    Full Mouse Empty Mouse
    A Tale of Food and Feelings
    By: Dina Zeckhausen
    Ages 7-12
    Highlights the importance of talking about feelings and finding comfort in healthy ways.
  • Toxic Cultural Myths Underling Body Image, Eating, Fitness, Nutrition, and Weight Problems(Kater, 2005)
  • Prevention for Adolescents
    Do not hesitate to approach child with your concerns about their eating attitudes and behaviors.
    Be attentive to all the changes in children’s lives as they grow and develop.
    Observe and monitor child’s home and school life.
    Have open communication with child.
    Did you know…
    -Research suggests that daughters of mothers who have a history of eating disorders may be at higher risk for developing an eating disorder.
    -In addition, children and adolescents may be more at risk for developing an eating disorder if their parents have psychiatric disorders or substance abuse disorders.
    (Katzman, Pinhas, 2005)
  • Prevention of Cultural Food Addiction
    American culture breeds overeaters with Fast Food Industry -> Supersize portions
    In the last 50 years, Americans went from eating once or less per month to at least once per day per family.
    Fast food has also allowed people to become “secret eaters” by allowing them to eat in the cars before driving to work or driving home.
    The American people are also consumed with “fad diets,” diet pills, laxatives, special weight-loss machines or clothing.
    (Minirth, Sneed, Hemfelt, Meier, 1990)
  • Relapse Prevention
    Have regularly scheduled follow-up visits with individuals who are treated successfully for bulimia
    None of the 30 subjects who relapsed during the follow-up period came back for treatment as instructed
    (Mitchell, Agras, Wilson, Halmi, Kraemer, & Crow, 2004)
  • Relapse Prevention
    Dr. Stephen F. Grinstead is  a Relapse Prevention Expert on Eating Addiction and Coexisting Disorders. He has created a workbook for those in recovery of eating addictions to allow them to plan and map out their recovery -- A Healthy Living Plan. The following are chapters from Dr. Stephen Grinstead's  The Eating Addiction Relapse Prevention Workbook:
    Exercise 1: Looking at the principles of a Healthy Living Plan from a Biopsychosocialspiritual perspective, then listing your personal triggers in each of those categories and creating your own Healthy Living Plan.
    Exercise 2: Learning how to develop your personalized definition of abstinence as an important component of your recovery and Healthy Living Plan.
    Exercise 3: Completing the Eating Addiction Problem Checklist to help determine your level of problem (past and/or present) with compulsive use of eating.
    Exercise 4: Looking at the pros and cons concerning the way you have used eating in the past and making a decision to stop using eating as a coping tool.
    Exercise 5: Creating a craving management plan and an early relapse intervention plan
  • Relapse Prevention
    The last five chapters of the workbook are in place to identify High Risk Factors and triggers of your eating addiction. 
    Exercise 7: Defining high risk situations and picking your own personal high risk situation that you would like to learn to manage.
    Exercise 8: Mapping (exploring) past ineffectively managed and effectively managed high risk situations, then using that information to project and explore a future high risk situation.
    Exercise 9: Learning to identify and manage personal reactions to high risk situations by exploring your automatic thinking, feelings, urges, actions, and social reactions that drive the relapse process and are triggered when you encounter a high risk situation.
    Exercise 10: Developing a personalized recovery plan by selecting and scheduling recovery activities that will help you identify and manage future high risk situations.
    Exercise 11: Completing a final evaluation process that asks you to complete a check list to determine how well you believe you did completing this workbook.
  • Counseling Techniques & Support
  • Are you a Food Addict?
    1. Have you ever wanted to stop eating and found you just couldn't? 
    Do you think about food or your weight constantly? 
    Do you find yourself attempting one diet or food plan after another, with no lasting success? 
    Do you binge and then "get rid of the binge" through vomiting, exercise, laxatives, or other forms of purging? 
    Do you eat differently in private than you do in front of other people? 
    Has a doctor or family member ever approached you with concern about your eating habits or weight?
    Do you eat large quantities of food at one time (binge)? 
    Is your weight problem due to your "nibbling" all day long? 
    Do you eat to escape from your feelings? 
    Do you eat when you're not hungry?
    Have you ever discarded food, only to retrieve and eat it later? 
    Do you eat in secret? 
    Do you fast or severely restrict your food intake? 
    Have you ever stolen other people's food? 
    Have you ever hidden food to make sure you have "enough?"
    Do you feel driven to exercise excessively to control your weight? 
    Do you obsessively calculate the calories you've burned against the calories you've eaten? 
    Do you frequently feel guilty or ashamed about what you've eaten? 
    Are you waiting for your life to begin "when you lose the weight?"
    Do you feel hopeless about your relationship with food?
  • Screening
    CAGE questionnaire
    used in screening alcohol dependence
    modified for binge eating
    Have you ever felt the need to cut down on eating?
    Have you ever had guilty feelings about your eating?
    Have you ever gotten up in the middle of the night or early in the morning to eat?
    Several positive responses may indicate a problem.
    (Gold et al., 2003)
  • Assessment
    Self-reports may be more reliable than data gathered in client interviews.
    Eating Disorder Examination (EDE) is one diagnostic tool.
    Counselor should assess health-related quality of life factors, general psychological distress, and coping strategies.
    (Mond, Hay,, Darby, Paxton, Quirk, Buttner, ... Rodgers, 2009)
  • Diagnosis
    Evidence suggests that the majority of individuals with a lifetime eating disorder diagnosis DO NOT receive treatment.
    High Comorbidity
    (Mondet. al, 2009)
  • Seeking Treatment
    Motivational Variables
    Clients with greater perceived inability to suppress emotional difficulties.
    Clients with greater perceived impairment in role functioning, such as unable to complete work or household responsibilities due to health problem
    (Mond et. al, 2009)
  • Potential Treatment Plan
    Long-Term Goal:
    Develop healthy cognitive patterns and beliefs about self that lead to alleviation and help prevent relapse.
    Short-Term Objective:
            1. Identify and develop a hierarchy of high-risk situations for unhealthy eating or weight loss practices
    Therapeutic Interventions:
    Assess the nature of any external cues and internal cues that precipitate the client’s uncontrolled eating and/or compensatory weight management behaviors
    Direct and assist client in construction of hierarchy of high-risk internal and external triggers for uncontrolled eating.
    (Jongsma, Peterson, Bruce, 2006)
  • Three Types of Therapy
    • Cognitive-behavioral therapy focuses on the dysfunctional thoughts and behaviors involved in binge eating. Allows patient to become self-aware and recognize their triggers and how to avoid them. Allows therapist to guide client and educate them on nutrition, exercise, etc.
    • Interpersonal psychotherapy – will focus on relationship issues that may contribute to compulsive eating. Patient will begin to learn how to communicate more effectively and develop healthier relationships. This will allow the client to have the support that they need, satisfying relationships that will inevitably lead to less urges to binge and make them easier to resist.
    • Dialectical behavior therapy – This would teach the client to accept themselves, how to better manage stressful situations/issues in their life, and how to monitor and handle their emotions. This will allow the client and therapist to investigate and change any unhealthy thoughts about body image, food, eating, etc.
  • Family Counseling Benefits
    Allows counselor to uncover potential patterns that have been passed through the generations
    Counselor can see how these patterns may contribute to the development and continuation of the eating disorder in the family
    Provides a safe place where family members are able to explore and express their feelings
    If counselor offers educational information about societal influences to all family members and parents, parents will blame themselves less 
    (Costin, 1999)
  • Support Groups
    Overeaters Anonymous
    Food Addicts in Recovery Anonymous
    Anorexics Anonymous
    Bulimics Anonymous
    Eating Disorders Anonymous
    Eating Addictions Anonymous
  • References
    Collins, M. E. (1991). Body figure perceptions and preferences among pre-adolescent children. International Journal of Eating Disorders, 199-208.
    Costin, C. (1999).  The eating disorder sourcebook:  A comprehensive guide to the causes,
        treatments, and prevention of eating disorders (2nd ed.).  Los Angeles:  Lowell House.
    Food Addicts In Recovery Anonymous. (2000) Are you a Food Addict?. Retrieved from www.foodaddicts.org.
    Gold, M. S., Frost-Pineda, K., & Jacobs, W. S. (2003). Overeating, binge eating, and eating disorders, as addictions. Psychiatric Annals, 33(2), 117-122. Retrieved June 2, 2010, from PsychINFO.
    Grinstead, Stephen F. Dr. (April 2009). Eating Addiction Relapse Prevention – Flourishing in Recovery. Retrieved from www.recoverytoday.net.
    Gustafson-Lawson, A. M., & Terry, R. D. (1992). Weight-related behaviors and concerns of fourth-grade children. Journal of American Dietetic Association, 818-822.
    Jongsma, A. E., Peterson, L. M., & Bruce, T. J. (2006). The complete adult psychotherapy treatment planner. Hoboken, N.J.: Wiley.
    Kater, K. J. (2005). Healthy body image: teaching kids to eat and love their bodies too! : promoting healthy body image, eating, fitness, nutrition and weight : a comprehensive resource manual and lesson guide with scripted-lessons and activities for grades four, five or six (2nd ed.). Seattle, WA: Eating Disorders Awareness and Prevention.
    Katzman, Debra, and LeoraPinhas. Help for Eating Disorders: a Parents' Guide to Symptoms, Causes & Treatments. Toronto: R. Rose, 2005. Print.
    Levine, M., & Maine, M. (2005). Eating disorders can be prevented! National Eating Disorders Association. Retrieved June 13, 2010, from http://www.nationaleatingdisorders.org
    Lock, J. & Fitzpatrick, K.K. (2009). Advances in Psychotherapy for children and adolescents with eating disorders. American Journal of Psychotherapy, 63(4), 287-303.
    Mellin, L., McNutt, S., Hu, Y., Schreiber, G. B., Crawford, P., & Obarzanek, E. (1991). A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollment: The NHLBI growth and health study. Journal of Adolescent Health, 27-37.
    Mills, A., & Osborn, B. (2003). Shapesville. Carlsbad, CA: Gurze Books.
    Minirth, Dr. Frank, Dr. Paul Meier, Dr. Robert Hemfelt, and Dr. Sharon Sneed. Love Hunger: Recovery from Food Addiction. Thomas Nelson, 1990. Print.
  • References
    Mitchell, J.E., Agras, W.S., Wilson, G.T., Halmi, K., Kraemer, H., & Crow, S. (2004).  A trial of a relapse prevention strategy in women with bulimia nervosa who respond to cognitive- behavior therapy.  doi:  10.1002/eat.10265
    Mond, J. M., Hay, P. J., Darby, A., Paxton, S. J., Quirk, F., Buttner, P., ... Rodgers, B. (2009). Women with bulimic eating disorders: When do they receive treatment for an eating problem? Journal of Consulting and Clincial Psychology, 77(5), 835-844. doi: 10.1037/a0015336
    National Eating Disorders Association. (n.d.). Retrieved June 13, 2010, from http://www.nationaleatingdisorders.org/
    Park, M. (2010, June 1).  Binge eating recommended as psychiatric diagnosis; obesity is not.  CNN.com.  Retrieved from www.cnn.com
     Smith, M. & Barston, S. (2008, February).  Helping someone with an eating disorder:  Advice 
        for parents, family members, and friends.  Retrieved from www.helpguide.org
    Smith, M. & Barston, S., Segal R. (2008, March). Binge Eating Disorder: Symptoms, Causes, Treatment, and Help. Retrieved from www.helpguide.org
    Striegel, R. H., Rosselli, F., Perrin, N., DeBar, L., Wilson, G. T., May, A., & Kraemer, H. C. (2009). Gender differences in the prevalence of eating disorder symptoms. International Journal of Eating Disorders, 42(5), 471-474. doi: 10.1002/eat.20625
    Yager, Z. & O'Dea, J.A. (2005).  The role of teachers and other educators in the prevention of 
        eating disorders and child obesity:  What are the issues?  Eating Disorders, 13, 261-278. doi: 10.1080/10640260590932878
    Zeckhausen, D., & Boyd, B. (2008). Full mouse, empty mouse: a tale of food and feelings. Washington, DC: Magination Press.
  • Additional Readings
    From the First Bite: A Complete Guide to Recovery from Food Addiction, By: Kay Sheppard
    Food Addiction: The Body Knows: Revised & Expanded Edition, By: Kay Sheppard
    Anatomy of a Food Addiction: The Brain Chemistry of Overeating: An Effective Program to Overcome Compulsive Eating, By: Anne Katherine
    Why Can't I Stop Eating?: Recognizing, Understanding, and Overcoming Food Addiction (Paperback), By: Debbie Danowski
    Conquer Your Food Addiction : The Ehrlich 8-Step Program for Permanent Weight Loss, By: CarylEhrlich
    Food for Thought: Daily Meditations For Overeaters, By: Elisabeth L.
    Breaking the Bonds of Food Addiction (a Psychology Today publication) By: Susan McQuillan
    The Eating Disorder Sourcebook:  A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders.  2nd Edition, By:  C. Costin
  • Pre-presentation QuizTrue or False?
    Research has linked eating to the human’s brain reward system. = TRUE
    Anorexia and Bulimia are the two most common eating disorders. = FALSE
    Females are more likely to present eating disorders symptoms than males. = FALSE
    Most teachers and school counselors do not feel equipped enough to properly discuss eating addictions. = TRUE
    All who suffer from an eating addiction are overweight or obese. = FALSE
    It is harder to treat someone with an eating addiction than someone who is addicted to alcohol or other substances. = TRUE
    Prevention programs should focus on warning the public about signs, symptoms, and dangers of eating addictions. = FALSE